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Department: Professional Enrichment

International dissemination of evidence

Conley, Patricia PhD, RN, PCCN

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doi: 10.1097/01.CCN.0000612860.71342.d3
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Achieving international dissemination of research findings involving critical care issues in nursing is essential to optimizing patient outcomes. Research evidence can impact the lives of individuals all over the world, but knowledge gaps exist due in part to lack of publication or presentation of research findings. Moher and colleagues reported that more than 50% of completed research findings are not published.1 This article discusses the need for global dissemination of research and outlines the steps researchers can take to publish their study results.

Global dissemination of research: A stepwise approach

Brownson and colleagues state that the gap between research evidence and application in practice settings and policy development is partially because of ineffective dissemination.2 The process of effective dissemination begins when a researcher designs a study that examines a healthcare topic as identified by the World Health Organization (WHO) as a global leading cause of death.3 (See Trajectory for international research evidence dissemination.) Next, selection of an appropriate journal in which to publish findings can be determined by the most suitable audience of healthcare professionals and key stakeholders to implement and finance the change in practice.5 Using the example of chronic obstructive pulmonary disease (COPD), a debilitating and costly pulmonary disorder that ranks as the fourth-leading cause of death in the world and third in the US, journals to consider for publication of COPD research findings might include those with a focus on critical care, respiratory care, or international research.3,6

Careful reflection is then made of the best-suited conferences with audiences who will promote the uptake of evidence-based positive research results and put them into practice.4,7,8 There are general to specific interest groups for nursing researchers to focus dissemination of their research evidence, including the American Association of Critical Care Nurses, Sigma Theta Tau International Honor Society of Nursing (today known as Sigma), and American Nurses Credentialing Center Pathway to Excellence® Conference.

Social media

Social media provides various platforms for dissemination of research findings, such as blogs, Facebook, LinkedIn, and Twitter, that can reach a multitude of healthcare professionals, the public, and policy makers at minimal to no cost. Despite the benefits of social media, research scientists must be cognizant that social media does not provide the same quality assurance found in peer-reviewed journals or conferences that use criteria to accept abstracts for speaker presentations.9,10 Though social media can spread information more quickly than peer-reviewed publications, the reality is social media lacks standards for dissemination of research evidence. Open access is an option for dissemination of scholarly research evidence with advantages and disadvantages. Advantages include but are not limited to free access to research results, minimizing wasted funding from unnecessary duplication of research, and expedited uptake of knowledge and translation of evidence into practice. Some disadvantages involve cost to researchers or lack of peer review, and new journals do not have an established impact factor (index of average number of citations to recent articles published in that journal).11

Barriers to dissemination

Several obstacles exist to prevent international dissemination of research evidence, which includes lack of training for infrastructure of researchers and institutions, funding for travel, and difficulty obtaining passports or visas.

Literature review

Reporting both positive and negative research outcomes is essential. In Fan and colleagues' research study, 209 intervention group participants were given discharge education, as well as antibiotics and prednisone to self-initiate for an exacerbation of COPD, compared with 217 participants who were instructed per standard of care group.12 The study was terminated when mortality in the intervention group reached 28 patients compared with 10 in the standard of care group. Researchers concluded that intervention group participants had likely been overconfident in self-treatment and waited too long to seek medical care.12 Although Fan and colleagues saw negative results, sharing their findings can prevent other clinicians from repeating their mistake.

In contrast, but equally important, are Ko and colleagues' efficacious findings published on a randomized control trial that assessed the outcomes of participants in a comprehensive intervention group compared with those in the standard of care group that had usual discharge instructions.13 Researchers discovered that a post hospital educational and physical rehabilitation program for intervention group participants who had been admitted for an acute exacerbation of COPD had a decrease in hospital readmissions (P = .047) and length of stay (P ≤ .001).13 Sharing positive study results can help others replicate positive patient outcomes.

One published exemplar study illustrates the value of disseminating evidence based on a retrospective demographic analysis to determine the leading causes of death using global data. Cao and colleagues' findings indicated rates of cancer rising or expected to increase in low- and middle-income countries, surpassing cardiovascular disease.14 These findings enable researchers and healthcare professionals to focus on interventions, education, and resources to deter the detrimental impact on quality of life and life expectancy related to risks of cancer and its treatment.

Effective dissemination of research evidence can promote unbiased reporting to decision-makers, funders, and regulatory bodies to prevent wasted research funding in the US.1,15 An estimated quarter of a trillion US dollars annually are spent on research with a large sum reportedly wasted due to multiple factors, including lack of proper dissemination of biomedical research findings.1

Sample research dissemination

The author's original COPD feasibility study conducted on a progressive care unit is used here as an example of recognized research evidence that was presented at an international conference. The clinical study used the American Lung Association My COPD Action/Management Plan for discharge instructions and the WHO Quality of Life-BREF (WHOQOL-BREF) questionnaire to evaluate levels of satisfaction with participants' quality of life at time of discharge and reevaluated by phone call 30 days after hospital discharge.16

The study results were disseminated first at a hospital board meeting in an oral presentation, then at a Sigma research conference in Indianapolis, Ind., as a podium presentation, and in a poster presentation at the Magnetizing Kansas City conference held in Legends, Kan. Following publication of the research results in an international nursing journal, multiple invitations to international conferences were extended to the principal investigator for speaking presentations in Spain, Japan, Italy, United Arab Emirates, and France to share the findings of the study. The author's podium presentation took place at the “International Conference on Nursing 2019” in Rome, Italy, in October 2019. This study was unique in that it examined the outcomes of an action plan and QOL measures on a high-acuity participant population. Even though a small sample of participants completed the study (n = 13), they reported good to moderate satisfaction with discharge instructions and perceived increased knowledge of self-management related to COPD symptoms and appropriate action to take. There were no statistically significant results of QOL measured in a small cohort of participants. In addition, participants had no reported unscheduled visits to healthcare providers, ED visits, or calls to 911. One hospital readmission within 30 days was reported following discharge for COPD with the length of stay being 2 days.

Although this example focused on COPD research, there are many other diseases ranked as leading causes of death worldwide that should continue to be studied and reported on internationally. Similar topics of disease that healthcare professionals manage worldwide involve some of the following: cardiovascular disease, diabetes, and stroke. Research evidence for these serious pervasive health issues needs evidence-based best practices obtained from effective unbiased translation of research evidence from local medical centers to national and international symposiums.17,18

Conclusion

Translating research evidence into nursing care for safe, best, and cost-efficient practices is paramount to optimizing patient outcomes. Dissemination of research findings either by podium or poster presentation to a global audience is an equally important task to dissemination at the local and national levels for researchers. Nurse scientists have a responsibility to share evidence from studies that could impact the health of patients beyond their medical center. This responsibility goes beyond the doors of our patient population locally to a global patient population. Louis Pasteur, a chemist and microbiologist said it best: “Science knows no country, because knowledge belongs to humanity, and is the torch that illuminates the world.”19

Trajectory for international research evidence dissemination2,4

This figure illustrates the strategic stages for international dissemination of research findings from researchers studying the WHO's identified global health conditions.

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Figure

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