Practice Experience Interviews Interview with "Jennifer," RN, MPH, director of quality assurance at a Veterans Affairs medical center.

In a telephonic interview with this nursing professional, questions were posed concerning how research is found, accessed and applied for quality assurances purposes. According to Jennifer, Veterans Affairs medical centers (VAMCs) typically feature up-to-date medical libraries that can be used by any staff member. The library resources at this VAMC included numerous peer-reviewed journals and Internet access for additional relevant journal articles. In addition, Jennifer reported that her office had Internet access as well as access to the hospital's intranet (the decentralized hospital computer program or DHCP) that links this VAMC with other VAMCs as well as regional offices and the VA's Central Office in Washington, DC.

When queried concerning how research was applied in her practice, Jennifer noted that her office was responsible for coordinating peer reviews of questionable medical practices identified in the VA's patient incident reporting program and timely research is required in order to evaluate reported practices. Likewise, Jennifer reported that her office was also responsible for risk management at the VAMC and research concerning best evidence-based practice for reducing medication errors and patient falls was conducted the findings implemented at this VAMC. An example of this type of applied research was the distribution of a series of posters for nursing stations that highlighted methods for reducing medication errors (the first featured the so-called seven Rs" for medication administration: right patient, right medication, right dosage, right route, right time, right reason and right documentation). Jennifer reports that medication errors were reduced by 50% following the distribution of this poster.

2) Interview with "Jack W," information technology manager at a Veterans Affairs medical center.

In a telephonic interview with Jack, questions were posed concerning how research is found, accessed and applied in the VAMC's information resource management division. In response, Jack reported that their division was constantly bombarded by requests for nonstandard IT equipment and coding support that was difficult to provide. As a result, this division relies on trade journals to identify new IT equipment that might satisfy the medical center's needs. In addition, this division uses the DHCP to consult with other IT practitioners concerning issues of interest. Because the hospital's medical library does not subscribe to trade journals or other publications related to information technology, Jack also said that his division routinely "surfs the Web" in search of commercial IT solutions and vendors that offer them. An example of this type of research being applied in a real-world situation at this VAMC was the adoption of electronic patient health records to facilitate practitioner access to patient information and improve clinical outcomes.

Because the VAMC has transitioned into an electronic patient health records system, though, his division is also required to ensure that patient confidentiality is maintained and that practitioners do not review medical records for which they are not authorized access. For this purpose, the information resources division researches relevant controlling legislation and VA policies and procedures to ensure the hospital is in compliance. Finally, Jack noted that his division was always vigilant concerning IT trends and innovations by researching these issues on the Internet.

3) Interviews with a quality assurance nurse, "Ray," RN and a quality assurance program director, "Brad," MPH at a VAMC.

In two separate telephonic interviews, questions were posed to these individuals concerning how research is found, accessed and applied in the VAMC's quality assurance office. In response, Ray reported that she was responsible for benchmarking department-level QA data each month and then performing statistical analyses and publishing the results hospital-wide as part of the VA's quality assurance procedures to comply with Joint Commission requirements. For this purpose, Ray noted that she routinely consulted the Internet and conducted research in the hospital's medical library to identify relevant standards and to review how other medical centers have achieved successful results. As an example of this type of research, Ray reported that just prior to the previous Joint Commission inspection, she learned about a standard requiring a hospital policy for problem resolution. After searching the DHCP, Ray found a comparable policy in place at another VAMC and was able to publish this policy prior to the Joint Commission's inspection.

In response to the same questions, Brad reported that he is the hospital's congressional liaison and is responsible for the timely resolution of patient problems, usually on the same day. If a patient's problem is not immediately resolvable, the congressional office is notified telephonically and a written response...

The types of complaints that are received are categorized and tracked by service department (e.g., ambulatory care, pharmacy, nursing unit, etc.) and these benchmarks are included in the hospital-wide QA report each month. Brad noted that he occasionally performed research in the hospital's medical library and the Internet to determine comparable congressional inquiry levels at other VAMCs.
4) Interview with two key stakeholders, "John" and "Robyn," both RNs at a VAMC concerning suggestions they have related to relevant research topics and how these relate to implementation science.

When posed with the above-stated questions in a telephonic interview, John reported that he was interested in creating a professional community of practice for emergency room nurses. According to John, emergency room nurses have one of the highest if not the highest rate of burnout syndrome of any health care discipline, and he confided that the hospital had experienced significant unplanned turnover of registered nurses in its emergency room in recent years. In response to this problem, John suggests a professional community of practice using a social media network such as Facebook to share "horror stories" and how other nurses successfully coped with these inordinately stressful working environments. In addition, John suggested that this type of resource could also be used to summarize recent studies of best practices for helping registered nurses in general and emergency room nurses in particular cope with burnout syndrome.

In response to the above-stated questions in a face-to-face interview, Robyn suggested that the VA streamline its policies concerning the adoption of new evidence-based practices by forming a VA Central Office task force that could review recent studies concerning posttraumatic stress disorder and severe traumatic brain injuries to identify best evidence-based practices and make recommendations concerning their implementation VA-wide. Robyn added that she had participated in a VA Central Office task force in the past which developed a VA-wide quality assurance checklist that measured all 152 medical centers nationwide to help VAMC directors identify opportunities for improvement.

5) Interview with "Rachel," RN, MPH, chief nursing officer at a VAMC concerning how research is found, accessed and applied in this nursing practice setting.

In a telephonic interview with Rachel, she responded to the above-stated questions by confirming the use of the hospital's medical library, DHCP and Internet for research purposes, but added that her service subscribes to several nursing journals as well. In addition, Rachel as well as other members of her staff regularly attend workshops and seminars concerning recent trends and advances in nursing care, in some cases in other cities. When Rachel or other staff members attend such an event, they share their experience in a memorandum to other nursing service personnel as well as in the hospital-wide monthly QA reports when appropriate. Beyond the foregoing, Rachel also reported that she routinely consults with other nursing professionals in the VA system as well as within her own VAMC concerning problem areas and researches these issues to identify potential solutions.

This nursing professional also noted that when she was transferred to this VAMC and assumed the position of chief nursing officer, the position had been essentially vacant for nearly 6 months and nursing morale was at an all-time low. Because she was relatively new to leadership roles, Rachel reported that she researched transactional and transformational leadership styles to learn how to become a more effective chief nursing officer. Likewise, Rachel reported attending a nursing leadership seminar for this purpose. Since assuming this position in 2014, Rachel reports that nursing morale has improved but conceded that recruiting and retention were still problematic.

6) Interview with "Mary," nurse practitioner in a surgical ward at a VAMC concerning this advanced practice role and its contribution to advancing nursing knowledge and practice.

In a telephonic interview, Mary responded to the above-stated questions by emphasizing the expanded role of nursing professionals in recent years and the new positions of authority they now enjoy compared to just a few decades ago. Increasingly, Mary advised, nurse practitioners are vitally important partners in the health care team but there remains a need for continuous education of these professionals in order to ensure they remain cognizant concerning recent advances in their specialty areas and new evidence-based practices that can help improve the quality of patient care.

According to Mary, nurse practitioners are in a good position to take a leading role in this area by performing retrospective analyses of clinical data, conducting IRB-approved patient studies and sharing empirical observations with other nursing professionals or allied health care staff who may be conducting relevant research. In addition, Mary…