Advancing knowledge translation: Is there a role for doctoral students?

Despite the growth of health science research, there remains a persistent concern over the lack of appraisal of research results and the failure of research uptake into practice and policy (Grimshaw, Eccles, Lavis, Hill, & Squires, 2012). Journal publications and conference presentations are essential for research dissemination within the research community, but are insufficient for improving care standards (Straus, Tetroe, & Graham, 2013). For years continuous medical and nursing education and other professional development initiatives have been employed to increase research utilization and uptake in practice (Davis et al., 2003). Despite what seemed like effective approaches, healthcare decisions continue to be made at individual (patient and care provider), systemic, and policy levels without robust research support (Straus, Tetroe, & Graham, 2009). Nurses seldom use research to guide practice and mostly rely on experiential knowledge, trial and error, and peer opinions for decision-making (Stokke, Olsen, Espehaug, & Nortvedt, 2014). A knowledge-practice gap exists because knowledge transfer approaches have been primarily focused on the presentation, synthesis, and dissemination of research. Such approaches have proven ineffectual and less accessible among care providers (Grol & Grimshaw, 2003) and play an insignificant role in research translation (Davis et al., 2003). Knowledge translation (KT) emphasizes a shift in researchers’ practice; that is, rather than merely publishing in journals, presenting at conferences, and shelving research reports in university repositories, researchers should strive for the research uptake and its actual application for the improvement of healthcare and patient outcomes. The Canadian Institute of Health Research (2016) defines KT as “a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve the health of Canadians (individuals), provide more effective health services and products and strengthen the healthcare system” (para. 2). KT focuses on bridging the evidence-practice gap to improve care standards, strengthen the healthcare system, and enhance care providers’ capacities (Simpson, 2015). KT could serve as the mechanism for effective decision-making by addressing research utilization barriers with theory-based strategies that can be adapted to accommodate any given healthcare context (Nowell, 2015). In light of KT's growing popularity is there, or should there be a role for doctoral students in terms of advancing the science of KT? If one considers doctoral students the stewards of the nursing discipline, responsible for synthesis, and dissemination of nursing knowledge (Trautman, Idzik, Hammersla, & Rosseter, 2018), they should be mentored as the future scientists responsible for transforming practice, education, and research. Presently, there are no indications that doctoral-level research is promoting change or transformation. Perhaps, some students are conducting the highest quality research, but a KT plan is more of an afterthought as opposed to something that they consider from the outset and devote considerable attention and effort throughout the research process. The purpose of this editorial is to provide recommendations as how to maximize the potential of doctoral students to advance KT. Before proceeding, clarification of KT terms is in order. There are two types of KT. First, end-of-grant KT refers to the dissemination of research in journal publications and conference proceedings or transforming results to accommodate changing needs of knowledge users (Straus et al., 2013). It also involves using intensive dissemination activities such as writing research summaries and conducting educational sessions for targeted audiences, and engaging knowledge users in planned dissemination activities (CIHR, 2010). The second type is an integrated KT which a collaborative and participatory approach and refers to the involvement and engagement of knowledge users in research from the start, including development of research questions, selection of methodologies, development of tools, and outcome measures; and then their participation in data collection, interpretation, dissemination, and implementation of research. It is often referred to as “engaged scholarship, participatory research, co-production of knowledge” (Gagliardi, Kothari, & Graham, 2017, p.105). While keeping in mind these two types of KT, consider the recommendations presented below as possible options to advance the role of students. Doctoral students can focus their research on the most contemporary patient and nurse oriented research problems, which are more relevant to their research settings and to the needs of their hospital communities (Sylvia, 2009) and to the nursing discipline as a whole. Moreover, if students shift their research methodology from pure quantitative or qualitative to a mixed-methods or to a participatory action approach they would be adopting the underlying theoretical principles that are consistent with the science of KT. For example, participatory action approach is founded on principles consistent with a KT model referred to as the knowledge-to-action cycle (Graham et al., 2006). Similar to a participatory action approach, this KT model entails steps to generate new knowledge that rely on the collaboration of knowledge users. Specifically, the steps are: (a) identification of knowledge-to-action gaps; (b) adaptation of knowledge to local context; (c) assessment of barriers to and facilitators of knowledge use; (d) selecting, tailoring, and implementing interventions; (e) monitoring knowledge use and evaluating outcomes; and (f) sustaining knowledge use (Straus et al., 2013). The knowledge-to-action cycle would enable doctoral students to constantly consider not only the input from knowledge users but the context (i.e., the unique healthcare setting) within which research findings are to be implemented. When employing the model students would develop an integrated KT plan and ensure the synthesis of knowledge from multiple perspectives and the involvement of patients and families, practicing nurses, knowledge users, and other stakeholders throughout the research process (Straus et al., 2013). Arguably many doctoral students may complete their doctoral research to earn their doctorate, gain access to academia, or to achieve the highest educational credentials. Their goals may never include advancement of disciplinary nursing knowledge. Therefore, they should focus on establishing a program of research. A program of research is a systematic and sustained process of conducting multiple studies using various methodologies, with each study building upon the preceding, to generate a body of knowledge regarding a specific aspect of nursing practice, education, or research (Beck, 2016). Developing a program of research, refining the disciplinary knowledge, and tailoring it to meet the needs of the patients, communities, and other knowledge users can help in a gradual transfer of knowledge into actual practice. Knowledge brokering “links researchers and decision-makers, facilitating their interaction so that they are better able to understand each other's goals and professional culture, influence each other's work, forge new partnerships and use research-based evidence. Brokering is ultimately about supporting evidence-informed decision-making in the organization, management, and delivery of health services” (Canadian Foundation for Healthcare Improvement, 2018). Doctoral students usually have more exposure to practice settings and are enthusiastic to carry out novel projects, hence can serve as knowledge brokers through forming partnerships, collaborating with organizations and associations, and sustaining their partnerships to continue the application of research knowledge into practice, education, and policy-making (Thompson & Schwartz Barcott, 2018). Therefore, students should reach out, build connections, and collaborate with health-care associations and organizations responsible for developing policies and implementing research and evidence based policies to bring about practice change. Most doctoral dissertations include a wealth of information about the existing literature, problem statement, methodology, methods, and research findings and future implications. Missing, however, is a tentative dissemination plan informing the actual application and uptake of findings in practice. Doctoral students can develop a tentative dissemination plan, and refine and revisit the plan upon research completion to avoid putting the cart before the horse (Gill & Dolan, 2015). Refinement of a dissemination plan can be accomplished through collaboration with the organization or setting wherein the research is being conducted. At the completion of their doctoral research, students can use both peer-reviewed (i.e., conference presentations and journal publications) and non-peer reviewed dissemination strategies (i.e., blogs, podcasts, Facebook, Instagram, WhatsApp, and twitter, and YouTube videos) to share their research findings in simple summaries. Students can also develop tailored dissemination and implementation strategies for the implementation settings. Moreover, students may want to lobby organizations, institutions, and associations for policy and practice change. For example, one of the emerging innovative approaches used across several universities is the 3-Minute Thesis (3MT). 3MT enables students to practice developing simple and short summaries of their research findings and sharing with knowledge users. Doctoral students can share 3MT on their blogs and social media platforms to attract attention of actual and potential knowledge users. In conclusion, doctoral students are responsible for generating knowledge and promoting evidence-informed practice to improve patient care, therefore KT planning must be an integral component of doctoral research from conceptualization through to dissemination. Mentors should be encouraged to urge their students to use creative approaches, as recommended in this editorial. Being more intentional about the relevance of the research focus, developing a program of research, building connections through knowledge brokering, early dissemination planning and multifaceted dissemination strategies, all have the potential to optimize research utilization and ultimately, we may witness doctoral students impacting healthcare outcomes. The author declares no conflict of interest.

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