實證知識轉譯－落實科學證據於護理臨床實務

Evidence-Based Knowledge Translation: From Scientific Evidence to Clinical Nursing Practice

10.6224/JN.63.6.5

陳可欣(Kee-Hsin Chen)；高靖秋(Ching-Chiu Kao)；陳杰峰(Chieh-Feng Chen)

護理 ； 實證健康照護 ； 實證 ； 知識轉譯 ； nursing ； evidence-based healthcare ； evidence ； knowledge translation

護理雜誌

63卷6期（2016 / 12 / 01）

5 - 11

繁體中文

Guyatt教授於1992年提出「實證醫學」這個概念後，引起全世界廣泛的注意。2007年美國醫學研究院呼籲，在2020年之前，美國90%的臨床照護決策，需有精確、及時及最新的研究證據，作為醫療照護的依據。然而，知道（knowing）跟實際做（doing）之間存在著鴻溝。加拿大健康研究學院（Canadian Institute of Health Research）於2000年即提出知識轉譯（knowledge translation）這個名詞，用以陳述並縮小研究知識與臨床實踐間的鴻溝。本文將簡述實證知識轉譯的概念架構、障礙及促進策略，並分享防堵知識轉譯管道中7處滲漏（leakage），包括：注意到、接受、可行、有能力做、開始做、認同及養成習慣之可行方法及經驗。期望藉由本文能協助臨床健康照護者，提供有效的健康照護服務及產能，以增進民眾福祉，進而強化整個健康照護體系。

In 1992, Gordon Guyatt coined the term ＂evidence-based medicine＂, which has since attracted worldwide attention. In 2007, the Institute of Medicine’s Roundtable on Evidence-Based Medicine set the goal that 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information and would reflect the best available evidence by 2020. However, the chasm between knowing and doing remains palpable. In 2000, the Canadian Institute of Health Research applied the term ＂knowledge translation＂ to describe the bridge that is necessary to cross the gap between research knowledge and clinical practice. The present paper outlines the conceptual framework, barriers, and promotion strategies for evidence-based knowledge translation and shares clinical experience related to overcoming the seven layers of leakage (aware, accepted, applicable, able, acted on, agreed, and adhered to). We hope that this paper can enhance the public well-being and strengthen the future health care system.

1. 林宜柏、吳昇容、許仲偉、許華書、蘇秉淵(2011)。高血壓病人服藥遵從性及其相關因素之探討。亞東學報，31，81-86。
   連結：
2. 張萃雯、顧姍庭、林宛蒨(2015)。提升血液透析病人降血壓藥物服用遵從性。臺灣腎臟護理學會雜誌，14(1)，51-65。
   連結：
3. Abrahamson, K. A.,Fox, R. L.,Doebbeling, B. N.(2012).Facilitators and barriers to clinical practice guideline use among nurses.American Journal of Nursing,112(7),26-35.
4. Bastian, H.,Glasziou, P.,Chalmers, I.(2010).Seventyfive trials and eleven systematic reviews a day: How will we ever keep up?.PLoS Medicine,7(9),e1000326.
5. Ciric, I.,Ragin, A.,Baumgartner, C.,Pierce, D.(1997).Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience.Neurosurgery,40(2),225-237.
6. Coulter, A.,Collins, A.(2011).Making shared decision making a reality: No decision about me, without me.London, England:The King's Fund.
7. Evidence-Based Medicine Working Group(1992).A new approach to teaching the practice of medicine.JAMA: Journal of the American Medical Association,268(17),2420-2425.
8. Gagnon, M. L.(2011).Moving knowledge to action through dissemination and exchange.Journal of Clinical Epidemiology,64(1),25-31.
9. Glasziou, P. P.,Chalmers, I.,Green, S.,Michie, S.(2014).Intervention synthesis: A missing link between a systematic review and practical treatment(s).PLoS Medicine,11(8),e1001690.
10. Glasziou, P.,Haynes, B.(2005).The paths from research to improved health outcomes.Evidence-Based Nursing,8(2),36-38.
11. Graham, I. D.,Logan, J.,Harrison, M. B.,Straus, S. E.,Tetroe, J.,Caswell, W.,Robinson, N.(2006).Lost in knowledge translation: Time for a map?.The Journal of Continuing Education in the Health Professions,26(1),13-24.
12. Harvey, L. A.,Brosseau, L.,Herbert, R. D.(2014).Continuous passive motion following total knee arthroplasty in people with arthritis.Cochrane Database of Systematic Reviews,2,CD004260.
13. Heyer, N. J.,Derzon, J. H.,Winges, L.,Shaw, C.,Mass, D.,Snyder, S. R.,Liebow, E. B.(2012).Effectiveness of practices to reduce blood sample hemolysis in EDs: A laboratory medicine best practices systematic review and meta-analysis.Clinical Biochemistry,45(13-14),1012-1032.
14. Hoffmann, T. C.,Erueti, C.,Glasziou, P. P.(2013).Poor description of non-pharmacological interventions: Analysis of consecutive sample of randomised trials.BMJ: British Medical Journal,347,f3755.
15. Huang, T. W.,Chen, S. L.,Bai, C. H.,Wu, C. H.,Tam, K. W.(2013).The optimal duration of compression therapy following varicose vein surgery: A meta-analysis of randomized controlled trials.European Journal of Vascular and Endovascular Surgery,45,397-402.
16. Institute of Medicine(2007).The learning healthcare system: Workshop summary (IOM Roundtable on Evidence-Based Medicine).Washington, DC:The National Academies Press.
17. Koh, S. S.,Manias, E.,Hutchinson, A. M.,Donath, S.,Johnston, L.(2008).Nurses' perceived barriers to the implementation of a fall prevention clinical practice guideline in Singapore hospitals.BMC Health Services Research,8,105.
18. O'Sullivan, G.,Liu, B.,Hart, D.,Seed, P.,Shennan, A.(2009).Effect of food intake during labour on obstetric outcome: Randomised controlled trial.BMJ: British Medical Journal,338,b784.
19. Pentland, D.,Forsyth, K.,Maciver, D.,Walsh, M.,Murray, R.,Irvine, L.,Sikora, S.(2011).Key characteristics of knowledge transfer and exchange in healthcare: Integrative literature review.Journal of Advanced Nursing,67(7),1408-1425.
20. Sackett, D. L.,Straus, S. E.,Richardson, W. S.,Rosenberg, W.,Haynes, R. B.(1997).Evidence-based medicine: How to practice and teach EBM.New York, NY:Churchill Livingstone.
21. Straus, S. E.,Tetroe, J. M.,Graham, I. D.(2011).Knowledge translation is the use of knowledge in health care decision making.Journal of Clinical Epidemiology,64(1),6-10.
22. Straus, S. E.,Tetroe, J.,Graham, I.(2009).Defining knowledge translation.CMAJ: Canadian Medical Association Journal,181(3-4),165-168.
23. Straus, S. E.,Tetroe, J.,Graham, I. D.(2013).Knowledge translation in health care: Moving from evidence to practice.London, England:BMJ.
24. Tam, K. W.,Tsai, L. W.,Wu, C. C.,Wei, P. L.,Wei, C. F.,Chen, S. C.(2011).Using vote cards to encourage active participation and to improve critical appraisal skills in evidence-based medicine journal clubs.Journal of Evaluation in Clinical Practice,17(4),827-831.
25. Taylor, R. S.,Sagar, V. A.,Davies, E. J.,Briscoe, S.,Coats, A. J. S.,Dalal, H.,Singh, S.(2014).Exercise-based rehabilitation for heart failure.Cochrane Database of Systematic Reviews,4,CD003331.
26. Timsit, J. F.,Mimoz, O.,Mourvillier, B.,Souweine, B.,Garrouste-Orgeas, M.,Alfandari, S.,Lucet, J. C.(2012).Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults.American Journal of Respiratory and Critical Care Medicine,186(12),1272-1278.
27. Vickers, A. J.,Savage, C. J.,Hruza, M.,Tuerk, I.,Koenig, P.,Martínez-Piñeiro, L.,Guillonneau, B.(2009).The surgical learning curve for laparoscopic radical prostatectomy: A retrospective cohort study.The Lancet Oncology,10(5),475-480.
28. 周碧玲、林佳靜(2012)。醫病關係對癌症病人服藥遵從性與症狀控制的影響。護理雜誌，59(1)，11-15。
29. 羅淑芬、鄭麗娟、張慈惠、彭台珠(2002)。燒傷病患對彈性衣穿著之知識、健康信念、遵從行為及其相關因素之探討。慈濟醫學雜誌，14(3)，163-172。

1. 廖翎聿(Lin-Yu LIAO);張祐泟(You-Cheng CHANG);陳芬如(Fenju CHEN);楊淑珍(Shunt-Chen YANG)(2024)。以護理實證應用的戒菸護理措施提升住院病人戒菸。護理雜誌。71(2)。70-80。