Research

As has now become our tradition, in this first issue of JAPNA in the New Year, abstracts of papers presented at the 27th APNA annual conference are featured. As I reviewed the collection of abstracts, I was struck with both the many advances that psychiatric mental health nursing has made in the last decade and the challenges that lie ahead.

One of the three main learning objectives of the 27th APNA conference focused on evidence-based models of care to promote mental health and minimize mental health problems. Given the momentous transitions in U.S. health care that are being launched in 2014, the focus on evidence-based models of care is timely and prudent. Evidence-based practice (EBP) is recognized in the Affordable Health Care Act as a key factor in achieving universal access to care that is clinically effective and financially manageable. Titler, a widely recognized nursing leader in EBP, recently stated,

Evidence-based practice (EBP), once viewed as a luxury, is now central in discussions about quality of care. We can longer afford to invest billions of dollars in research and leave it to chance alone, that empirical findings will find their way to the point of care delivery. (Titler, 2011, p. 291)

The Iowa Model is a framework developed by nurses to describe the process of translating research findings to practice (Titler, 2010). In this model, EBP is conceptualized as an ongoing team process that is “triggered at the bedside” through the identification of a clinical problem or the questioning of an existing care delivery practice. Central to this process is creation of an investigative team. The work of the team is to identify, critique, and synthesize relevant literature that will serve as the foundation for the practice change. In this model, as well as other EBP frameworks, the types of evidence that are used as the foundation for practice are hierarchically organized. At the top of the hierarchy are research reports. Findings of well-designed studies—that is, studies designed to establish a link between cause and effect, while controlling factors that might otherwise explain the relationship—are considered the strongest evidence on which to base clinical care. At the next level of the hierarchy are theoretical models, followed by scientific principles, expert opinion, and, finally, case reports. All evidence, regardless of level of hierarchy is critiqued to determine the validity of the findings and conclusions. When sufficient evidence is identified, a change in practice is piloted, implemented, and evaluated for impact on quality of care.

Advances in the use of EBP practice models in psychiatric and mental health nursing are readily apparent in the abstracts included in this issue. The abstracts cover a broad range of topics ranging from a refresher course on the basics of EBP to report of EBP project processes and outcomes. Most notably, several abstracts described successful implementation of group work to address key clinical topics. However, when considering the hierarchy of evidence, many of the abstracts would be classified as expert opinion—that is, knowledge stemming from clinical experience. Historically in nursing, expert opinion has been the primary source of practice knowledge. While clearly a legitimate and valid source of knowledge, expert opinion alone cannot continue to serve as the sole foundation for our practice. In this era of accountability and emphasis on measurable outcomes, empirical evidence must assume its rightful position at the primary foundation for clinical care.

Too few abstracts included in this issue are primary reports of well-designed studies that address topics central to quality psychiatric and mental health practice. The reasons for this deficit are unknown. Did psychiatric nurse researchers with well-developed programs of research fail to submit their abstracts to the conference? Were data-based abstracts considered too esoteric to be considered of interest to those attending the conference? Or was the relevance of the research to practice not adequately explained or simply not understood? Answers to these questions are currently unknown but are worthy of careful consideration to ensure APNA’s role in the continued development of our specialty.

Psychiatric mental health nurses are responsible for providing the highest quality evidence-based care. To do this, the full complement of psychiatric mental health nurses must work as a team. Nurses in practice are needed to report their most pressing problems and their ideas about workable solutions. Nurse scientists need to be active members of the team working to transform clinical questions into testable hypotheses and design and implement the most rigorous studies to test the hypotheses. DNPs are also central to the process as they are experts in critiquing and synthesizing research findings and translating them into feasible and effective interventions.

With this inaugural issue of 2014, we can celebrate the important accomplishments that psychiatric mental health nurses have achieved to date. In addition, together we can look forward to a productive year in which we tackle the hardest problems to ensure that all psychiatric and mental health nursing care is evidence-based.

Best wishes for health and happiness in the New Year.