My term as Associate Editor, Evidence Based Nursing (EBN) comes to an end this week. As I reflect over the last three years on the activities that we participate in as an Associate Editor – rating scientific abstracts for their rigor and relevance to nursing (those with the highest ratings are selected for a commentary written on the study), reviewing submitted commentaries, and participating in podcasts, blogging, tweeting, and an online journal club, I realize how quickly our approaches to evaluating research evidence and sharing best practices have changed over a few years. For someone my age, this has been a steep learning curve as using the latest technologies to communicate is not intuitive to me. However, I have persisted with the support of my younger colleagues affiliated with the EBN journal as I do believe that accessing and assessing the best available evidence is essential for nurses to be able to provide safe, quality care.
I have spent my nursing career working with and studying how best to support persons with dementia and their family caregivers to enjoy a quality of life and to remain in their own homes for as long as possible. My research has examined the process of knowledge exchange between rural persons with dementia, their family caregivers, and community-based health care providers (HCPs). Family caregivers, not surprisingly, approach their most trusted sources first such as relatives and friends. Information from local organizations and dementia care internet sites was also accessed by caregivers and HCPs. However, all participants tended to rely on others to assess the reliability and validity of the primary source of evidence. While this may be an acceptable approach to assessing critical information, it indicates there is opportunity to promote more dynamic knowledge exchange processes. A troubling finding was that persons with dementia who were assessed as “stable” and who had a caregiver who appeared to be managing with their dementia care, were expected by HCPs to find information on their own and to seek help when needed. However, several caregivers reported that they did not have the energy or wish to use the few hours they had to themselves to seek out information on dementia care, representing a disconnect between how they were perceived by HCPs and the reality of their care giving experience. Rationing the amount of supportive services provided and information exchanged can contribute to increased use of more costly services such as visits to the emergency rooms to sustain care giving.
Thus, support is needed as family caregivers often do not have the time, energy, skills, or knowledge to seek out dementia care information independently. In addition, persons with dementia typically do not recognize the need for this knowledge, leaving family caregivers potentially isolated in this journey. Increased resources are needed to ensure that rural HCPs are proactively connecting with persons with dementia and their caregivers on a regular basis to provide the best available information to make informed decisions at each stage of their dementia care journey and to build trusting relationships (Forbes et al., in press; Forbes et al., 2012).
I feel very fortunate to have been able to contribute to the EBN journal as I truly believe that the journal is a great format to share nursing research that will improve the care we give to our patients, clients, and family caregivers. Using a variety of approaches to exchange the latest evidence, that is useful to practicing nurses, only enhances the spread of the evidence.
References:
Forbes, D., Blake, C., Thiessen, E., Finkelstein, S., Gibson, M., Morgan, D…Culum, I. (in press). “I couldn’t be in a better place”: Dementia care knowledge sharing within a First Nation community. Canadian Journal on Aging, 32(4).
Forbes, D., Finkelstein, S., Blake, C., Gibson, M., Morgan, D.G., Markle-Reid, M.,…Thiessen, E.J. (2012). Knowledge exchange throughout the dementia care journey by rural community-based health care practitioners, persons with dementia, and their care partners: A qualitative interpretive descriptive study. Journal of Rural and Remote Health, 12, 2201. Retrieved from http://www.rrh.org.au