ADVERTISEMENT
Editor`s Opinion: Black and White
A conclusion is the place where you got tired of thinking. -Author unknown
Let's face it. Life is a lot less tiresome when you can stop thinking - when your mind is made up and the answers are at your fingertips. During times like these, when uncertainty appears to be the only global unifying factor, it is especially tempting to stop thinking, reach a conclusion, and "move on."
Similarly, clinical practice is much easier when treatment, diagnostic, and assessment options can be presented in simple black and white. Concluding that all is well because recommendations appear to make sense or because the research is finished and the guidelines have been published has a fulfilling appeal. Unfortunately, if the process of critical inquiry stops, so, too, will science, advances in clinical practice, and much needed innovations in policy. The good news is that we have colleagues who continue to ask the questions needed to obtain answers and formulate recommendations to help us improve care.
On one side of the spectrum, researchers continue to consider seemingly logical recommendations, such as the need to use visual and nonvisual indicators when assessing Stage I pressure ulcers in people with darkly pigmented skin.1 This recommendation, implemented by many and mandated by some agencies, seems valid and reliable. But is it? Fortunately, Sprigle and colleagues started asking these questions to help us eventually provide evidence-based assessments.
On the other side of the spectrum, colleagues wonder why every patient has not been able to benefit from the research and guidelines that are available in some areas of clinical practice. For example, the work of Caliri and colleagues2 and participants of the Urinary Incontinence conference report3 shows that just because guidelines were published a decade ago doesn't mean patients automatically receive optimal care. Dissemination of knowledge about these conditions has been hampered and can be grouped according to well-known barriers to research utilization - eg, characteristics of the adopter, the organization, the innovation itself, and communication.4 For better or worse, this is not a unique medical phenomenon. In their book, Putting Knowledge to Use, Glaser, Abelson, and Garrison5 calculated that it takes an average of 19.2 years for a novel idea to be utilized. Indeed, sometimes it seems as if bad ideas are better at selling themselves than good ones!
Not all of us are able to participate in the research process and must rely on those who keep asking the questions. However, all of us can help advance good ideas; or, in more scientific terms, remove some of the barriers of communication. At Ostomy/Wound Management, we have done so through efforts such as working with Dr. Diana Mason and the American Journal of Nursing to obtain the "The State of the Science on Urinary Incontinence" executive summary. You also can help break down these barriers by communicating what we know, incorporating existing knowledge in your practice or curriculum, or providing educational programs. Contact with the editorial staff of your facilities' newsletter or local newspaper is helpful in directing their attention to existing guidelines and research - all conveniently available on the Internet and in the journals you receive every month. We must continue our quest to arrive at conclusions - not because we are tired, but because it is our professional responsibility to improve care for all. Besides, wouldn't it be boring if life was black and white?
1. Sprigle S, Linden M, Riordan B. Analysis of localized erythema using clinical indicators and spectroscopy. Ostomy/Wound Management. 2003;49(3):42-52.
2. Caliri, MHL, Miyazak, MY, Pieper, B. Knowledge of pressure ulcers by undergraduate nursing students in Brazil. Ostomy/Wound Management. 2003;49(3):54-63.
3. The state of the science on urinary incontinence. Ostomy/Wound Management. 2003;49(3):64-67.
4. Funk SG, Champagne MT, Wiese RA, Tornquist EM. BARRIERS: The barriers research utilization scale. Appl Nurs Res. 1991;4(1):39-45.
5. Glaser EM, Abelson HH, Garrison KN. Putting Knowledge to Use. San Francisco, Calif.: Jossey-Bass, Inc.;1983.
