NURSE CHAMPIONS: A KEY ROLE IN BRIDGING

THE GAP BETWEEN RESEARCH AND PRACTICE

Author: Carole L. White, PhD, RN, San Antonio, TXSection Editor: Nancy McGowan, PhD, RN

Evidence-based practices (EBPs) exist for manyhealth conditions, yet these practices are not routi-nely implemented in clinical care delivery.1 To

improve patient care and outcomes, we must narrow thegap between what we know from research and what weuse in practice. The challenge lies in the timely integra-tion of discovery into our daily clinical practice. Alreadyover-extended practitioners or managers do not have thetime or skills to keep current with the large volume ofresearch publications in their area of practice. In this eraof information overload, the need for accountability inproviding evidence-based quality clinical care underscoresthe critical role of synthesis studies, such as systematicreviews and meta-analyses, along with clinical practiceor best practice guidelines.2

Despite the availability of these summary tools, suc-cessfully integrating them into clinical practice is challen-ging. A number of strategies such as system supports,education, local opinion leaders, and audit and feedbackhave been tested for their effectiveness in promoting thetranslation of research findings into practice. A lack of evi-dence persists, however, about which strategies are mosteffective for which situations and through which mechan-isms.3 Particularly, we lack evidence about effective strate-gies to enhance best practice in nursing.

Thompson et al.4 undertook a systematic review ofinterventions aimed at increasing research use in nursingand concluded that the current state of the science provideslittle guidance regarding effective interventions for increas-ing research use in clinical practice, although they didreport some support for local opinion leaders. The role ofnurse champion, similar to local opinion leader, has been

suggested as a potentially important role for helping toinfluence and sustain best practice in the workplace.Although the champion role has been studied extensivelyin the management and medical literature, it is relativelynew as a specific strategy for implementing best practicein nursing.5 In a multicenter study examining the imple-mentation of best practice guidelines, participants acrossthe multiple sites consistently reported that support fromnurse champions, along with education sessions and theinvolvement of multiple stakeholders, were important facil-itators in implementing best practice guidelines.2

Who is the nurse champion? The nurse champion isan excellent practitioner who comes from within the orga-nization and is passionate about improving quality of care.The nurse may self-identify as a champion or may beselected by peers or leadership to take on this role, whichmay be informal but also can be formalized. Personal own-ership of the innovation or project is a central feature of thechampion role. Champions embrace the project as theirown and enthusiastically promote it throughout the stagesof its dissemination. They orient their peers to the innova-tion and encourage its adoption.5-7

How does a nurse champion influence the adoption ofbest practices in the workplace? A key to successful diffusionand implementation of an innovation, according to Roger’sDiffusion of Innovations theory, is modeling by peers andimitation of the innovative behavior by potential adopters.8

Research about nurses’ preferred sources for informationsuggests that nurses prefer interpersonal contact and com-munication with colleagues rather than Internet or tradi-tional sources of practice knowledge.9,10 In a U.S.-widestudy of nurses’ readiness to adopt evidence-based practices,Pravikoff et al.10 asked nurses about how they found theinformation they needed for clinical questions; 67% saidthey always or frequently sought information from col-leagues rather than from a reference text or journal arti-cle. Clinicians typically deal with uncertain situations byseeking knowledge and opinions from peers and notnecessarily by reviewing the scientific merits of the inno-vation, which supports the importance of nurse cham-pions working with their peers at the nursing unit orclinic level. The interpersonal contact that is central tothe champion role may be the key to its success inimplementing EBP.

Carole L. White is Associate Professor, School of Nursing, University of TexasHealth Science Center at San Antonio, San Antonio, TX.

For correspondence, write: Carole White, PhD, RN, School of Nursing,University of Texas Health Science Center at San Antonio, 7703 FloydCurl Drive, San Antonio, TX 78229-3901; E-mail: whitec2@uthscsa.edu.

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Despite the promotion of the role of nurse championsin EBP, little research has been conducted about thedimensions of their role and what they see as relevant activ-ities and why.11 To address this gap in knowledge, Ploeget al.6 conducted a mixed methods study with nurses whohad attended champions’ workshops and administratorsworking in the same institutions as the champions. Fromtheir results, the researchers reported that champions arechange agents who function in a variety of roles includingeducator, facilitator, mentor, leader, policy developer, andevaluator, to diffuse best practice guidelines. In qualitativeinterviews, champions described their roles in exploring,auditing, and monitoring of best practices and providingfeedback about the outcomes from implementation. Ploegand her colleagues identified 3 specific diffusion strategiesof champions.

The first strategy of a champion was raising awarenessabout best practice guidelines through formal and informaleducation strategies and acting as a resource to support andmentor nurses. Second, champions functioned as persua-sive practice leaders, working with staff, peers, and otherprofessionals on a variety of committees and interdisciplin-ary groups to persuasively advocate for EBP through theutilization of best practice guidelines. Finally, championswere most effective when they were able to tailor guidelineimplementation strategies to the organizational context.

Several recent publications highlight the nurse cham-pion role in implementing and sustaining EBPs.12-14

Gutierrez and Smith14 provided a detailed exemplar ofthe pivotal role of nurse champions in their program toprevent falls. Concerned about their fall rate, they under-took a project to implement an evidence-based fall preven-tion protocol. Nurses were recruited to be fall championsand underwent a specific training session to prepare themfor the role. They examined barriers to implementing theevidence-based fall prevention policy and contextualizedstrategies for implementation. As champions for integratingbest evidence for prevention of falls, they collected dataregarding falls, provided education to their peers aboutthe best evidence for fall prevention, and conducted bed-side rounds to examine patient behaviors. These fall cham-pions were not experts in the area of fall prevention at theinitiation of the project, but through the process of under-taking the champion role, they gained expertise in this areaand served as an ongoing resource to their peers. Thechampions changed not only the practice related to fallsbut also made an impact on the unit culture. This aspectis particularly critical for sustainability of a practice change.

As research continues to provide evidence to furtherour understanding about what strategies are most effective

in what settings to promote the transfer of knowledge,recent research suggests that nurse champions may be wellpositioned to promote the adoption of EBPs among theirpeers.6 The effect of these “change agents” seems to gobeyond changing the practice of the unit to influencingthe unit’s values and beliefs around the importance of evi-dence in the practice setting. Future research is needed tofurther our understanding of the most effective strategiesnurse champions use and to examine both patient andcost outcomes.

REFERENCES1. Institute ofMedicine. Crossing the quality chasm: a new health system for

the 21st century. Washington, DC: The National Academy Press; 2001.

2. Davies B, Edwards N, Ploeg J, Virani T. Insights about the process andimpact of implementing nursing guidelines on delivery of care in hospi-tals and community settings. BMC Health Serv Res. 2008;8:29.

3. Titler MG. Translation science and context. Res Theory Nursing Pract.2010;24:35-55.

4. Thompson D, Estabrooks C, Scott-Findlay S, Moore K, Wallin L.Interventions aimed at increasing research use in nursing: a systematicreview. Implement Sci. 2007;2:15.

5. Thompson GN, Estabrooks CA, Degner LF. Clarifying the concepts inknowledge transfer: a literature review. J Adv Nurs. 2006;53:691-701.

6. Ploeg J, Skelly J, Rowan M, et al. The role of nursing best practicechampions in diffusing practice guidelines: a mixed methods study.Worldviews Evid Based Nurs. 2010;7:238-51.

7. Titler MG, ed. Developing an Evidence-Based Practice. 7th ed. St. Louis,MO: Mosby; 2009.

8. Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: Free Press;2003.

9. Estabrooks CA, Chong H, Brigidear K, Profetto-McGrath J. ProfilingCanadian nurses’ preferred knowledge sources for clinical practice. Can JNurs Res. 2005;37:118-40.

10. Pravikoff DS, Tanner AB, Pierce ST. Readiness of U.S. nurses forevidence-based practice. Am J Nurs. 2005;105:40-51.

11. Soo S, Berta W, Baker GR. Role of champions in the implementationof patient safety practice change. Healthc Q. 2009;12:123-8. Spec NoPatient.

12. Campbell J. The effect of nurse champions on compliance withKeystone intensive care unit sepsis-screening protocol. Crit CareNurs Q. 2008;31:251-69.

13. Friedman L, Engelking C, Wickham R, Harvey C, Read M, WhitlockKB. The EDUCATE study: a continuing education exemplar for clinicalpractice guideline implementation. Clin J Oncol Nurs. 2009;13:219-30.

14. Gutierrez F, Smith K. Reducing falls in a definitive observation unit: anevidence-based practice institute consortium project. Crit Care Nurs Q.2008;31:127-39.

Submissions to this column are encouraged and may be sent toNancy McGowan, PhD, RNMcgowann@uthscsa.edu

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