Secondary outcomes in clinical studies require re-evidence to advance change in clinical practice. As evidence-based practice is central to clinical practice, the nature of evidence determines the validity and practicability of decisions aimed at evolving change in the workplace. Costantino, Montano, and Casazza (2015) advise healthcare providers to differentiate between primary and secondary outcomes of clinical studies before considering their applications in the improvement of clinical practice. Primary results offer ‘hard’ findings that directly relate to patients, whereas secondary outcomes provide ‘soft’ findings that indirectly relate to patients.
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Usually, a clinical study has a primary outcome, which is the center of the study, and several secondary outcomes, which are auxiliary and dependent on the primary outcome. Despite the significance of secondary outcomes, they are not valid and reliable in advancing change because the design of the research does not focus on their production. Costantino et al. (2015) consider secondary outcomes as not clinically meaningful but explorative findings that await further studies to confirm their validity and reliability in clinical practice. In this view, re-evidence is necessary to adjust the research design and focus on secondary outcomes with the objective of confirming the validity of findings.
Application of Emphatic Approach in Nursing Care
The emphatic approach to care applies to the practice of nursing for it provides a way of translating phenomenological knowledge as evidence-based findings for nursing care. The embodied relational understanding, the aesthetic phenomenology, and the translational process are the three consecutive steps that nurses have to follow in applying the approach of emphatic knowledge in nursing care (Galvin & Todres, 2011).
The embodied relational understanding regards knowledge as a complex, which requires a three-prong method, namely, ‘head’, ‘hand’, and ‘heart’, to have a holistic comprehension of the three domains of phenomenological knowledge. In nursing practice, nurses can apply the embodied relational understanding by considering facts about patients objectively, confirming the feasibility of interventions, and complying with ethical care. The aesthetic phenomenology uses poetry in describing situations and states for patients to create interpersonal and personal connections. Nurses can apply the artistic quality of poetry in enabling patients to identify their conditions and relate to circumstances they experience.
The translational process entails the application of the embodied understanding and the aesthetic phenomenology among patients with certain illnesses. In the case of stroke, patients feel betrayed, invisible, and unheard due to their conditions. Thus, to enable patients to understand their conditions, nurses must employ a poetic language characterized by imagery, rhythm, and repetitions.
Dissemination of Guidelines in Nursing Practice
The creation of a plan, the provision of a lay version, and the use of a combined method are the three key strategies that nurses can use in disseminating guidelines to patients in nursing practice. According to Schipper, Bakker, De Wit, Ket, and Abma (2016), a plan is critical because it defines the target audience, the scope of guidelines, the appropriate wording, and the dissemination strategy. From this perspective, nurses should ensure that they have an elaborate plan for disseminating guidelines aimed at improving nursing care and patient outcomes.
Since researchers write medical recommendations in a professional language, nurses should create a lay version for patients to understand their conditions, goals of treatment interventions, and available treatment options with their respective benefits and risks. Regarding the use of a combined method, nurses should use books, brochures, posters, and conferences in disseminating information to the general population. Philos, Bergman, Maayan, Soares-Weiser, and Bjorndal (2015) recommend the translation of guidelines, incorporation of inputs from the overall audience, and creation of reading materials and websites to enhance dissemination. Therefore, nurses should enrich the dissemination of guidelines to empower patients and allow them to participate in their care, make informed decisions, augment adherence to medications, and advance patient outcomes.
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Costantino, G., Montano, N., & Casazza, G. (2015). When should we change our clinical practice based on the results of a clinical study? Study endpoints. Internal Emerging Medicine, 10(1), 875-877.
Galvin, K. T., & Todres, L. (2011). Research based empathic knowledge for nursing: A translational strategy for disseminating phenomenological research findings to provide evidence for caring practice. International Journal of Nursing Studies, 48(4), 522-530.
Philos, H., Bergman, H., Maayan, N., Soares-Weiser, K., & Bjorndal, A. (2015). Systematic reviews on child welfare services: Identifying and disseminating the evidence. Journal of Evaluation in Clinical Practice, 21(5), 855-60.
Schipper, K., Bakker, M., De Wit, M., Ket, J. C. F., & Abma, T. A. (2016). Strategies for disseminating recommendations or guidelines to patients: A systematic review. Implementation Science, 11(82), 1-17.