EDITORIAL
Vol. 14 No. 3 November 1999
Clinical professorial appointments in nursing and midwifery which are joint appointments between universities and clinical settings, are a relatively new phenomenon in New Zealand. What does the role encompass? Does it differ from a wholly university based professorial appointment? These are some of the questions I am often asked. Let me try to answer them in a roundabout way.
One of the great passions in my professional life is the constant pursuit of evidence based practice. It is an elusive beast but I enjoy the chase and the tantalising glimpses of it as I get closer and closer. I do it because there is an inherent logic in the belief that “...the implementation of good quality research is likely to have improved outcomes for patients and is therefore important for quality patient care...”(Kitson, Harvey & McCormack, 1998, p. 150). It ought therefore to be a simple matter to achieve but I, like many others, have gradually come to realise, it is not. While there is much energy spent and attention and funding given to the conduct of rigorous research and the generation of new knowledge, which is published and accessible, there is much less attention paid to how to implement findings into everyday clinical practice. Why is it so problematic? Why is it that “...health professions collectively are still searching for better ways of understanding how we can
achieve this” (Kitson et al., 1998, p. 150 ).
In a nutshell, it appears to be a direct consequence of the complexity of the practice world of nurses and midwives. Linear models which propose a straightforward process from informing practitioners of research findings, developing guidelines to change practice and monitoring the consequences, are too simplistic. We are fortunate to have recently been visited by Alison Kitson, the Professor and Director of the Royal College of Nursing Institute in Oxford where this issue is beginning to be explored. Kitson and her colleagues have proposed an important multidimensional theoretical framework which takes into account the complexity of practice and gives equal weight to the generation and implementation of evidence. They propose that successful implementation (SI) of research is “…a function [f] of the relationship between the nature of the evidence [E], the context [C] in which the proposed change is to be implemented and the mechanisms by which the change is facilitated [F]” (Kitson et al., 1998, p. 150).
I want to use this conceptual framework as a way of exploring what the role of the clinical professor encompasses. It is my opinion that a major component of the role is to enable the successful implementation of evidence based practice by operating simultaneously on all aspects of the equation SI = f(E,C,F) as a change agent and leader.
Let’s explore ‘E’. The clinical professor is in a position to collaborate with colleagues to explore the nature, strength and ‘implementation potential’ of evidence in relation to clinical practice issues by using the skills of scholarly inquiry established within the university, together with expertise as a clinician. Where evidence is weak or absent, the role requires designing and conducting research to address knowledge gaps. It also requires the development of curricula to assist colleagues to develop skills in critical appraisal, to problem solve, reflect and make decisions in relation to clinical practice, evidence production and implementation. In this way the role promotes higher education and lifelong learning for clinicians as a way of integrating research and practice. The siting of the university academic within the clinical setting also provides opportunities for the academic to legitimate claims to understand practice, to demonstrate clinical expertise and to identify a research agenda directly from practice.
And now to ‘C’. Working from within the service organisation, the clinical professor will be able to determine the contextual support required for implementation and will be able to influence improvements in the environment for evidence based practice to be operationalised. This requires an understanding of the prevailing culture in the clinical setting which includes, working collaboratively to set standards for clinical practice; determining the ability of existing systems for measuring and monitoring and providing feedback on performance; understanding the nature of human relationships; the quality of leadership; the clarity of roles and responsibilities. This also requires paying attention to the internal and external political environment and contributing to policy development in both arenas. As a leader charged with practice development and as an academic in an international community, the clinical professor has a role within the organisational management structure and is well placed to develop a sophisticated understanding of the international, national and local issues which impact on practice.
The third component ‘F’ suggests that the clinical professor is able to provide support tailored to help people change their ways of thinking and working to embrace change either by assuming the role of facilitator, or by mentoring local facilitators. This calls for a well developed understanding of change management derived from either an experiential or theoretical stance. It may also lead to further curriculum development and research. The framework proposes that where evidence for changing practice is strong and contextual support is high, little facilitation is required and vice versa.
The model certainly has face validity for me and has provided a way of articulating what it means to be a clinical professor. However it must be said that the role of clinical professor is conceptualised differently depending on the particular area of interest of the incumbent. I have described mine. I enjoy the fact that the location of a clinical professor visibly crosses institutional boundaries and makes explicit what may be implicit in other academic roles.
‘Enabling the implementation of evidence based practice’ is the title of the paper describing the conceptual framework developed by Kitson and her colleagues. ‘Enabling’ is a deceptively simple word which gives little hint of the complex nature of the act.
Maralyn Rowley RGON, RM, BA, Grad Dip Clin Epidem, PhD
Professor of Midwifery and Women’s Health
Victoria University of Wellington
Leader Midwifery and Nursing
Women’s Health Service
Capital Coast Health, Wellington
Reference
Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the
implementation of evidence based practice: a conceptual framework.
Quality in Health Care, 7, 149-158
