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The Role of Intermediaries: Getting Evidence Into Practice

Linda Ferguson, RN, doctoral candidate at the Faculty of Nursing, University of Alberta, Canada. Margaret Milner, MN, RN, Faculty of Nursing, University of Alberta, Canada. Erna Snelgrove-Clarke, RN, doctoral candidate at the McGill University School of Nursing. Corresponding author: Margaret Milner, MN, RN, Faculty of Nursing, 3-107, Clinical Sciences Building, University of Alberta, Edmonton, AB T6G 2G3 (e-mail: fmilner@ualberta.ca). Ehrenberg and Estabrooks’ assertion that using research does matter began this series of articles on research utilization (RU) in practice. RU with due consideration of patient preferences, clinical judgment, and available resources can contribute to positive patient outcomes. For many reasons, however, the use of research in nursing practice is limited. We now know that passive diffusion of research has had a limited effect on the use of research to improve patient outcomes. We need better understanding of factors in the practice setting that support research use. Nurses have consistently reported lack of time, lack of access to research, and lack of skill in critiquing research as their main barriers to greater RU. The identification of RU as a social process, coupled with research that demonstrates nurses prefer social mediums over other knowledge sources, suggests that intermediaries may be a necessary link to greater research use. The authors discuss the role of intermediaries and their ability to influence the use of research in clinical practice. They highlight some important points to consider from the literature and suggest strategies that enhance RU within the context of the intermediary role. Intermediaries are individuals within the practice environment who can influence nurses toward specific goals. They have clinical credibility and research knowledge that enables them to facilitate the use of research within the practice setting. Intermediaries are known by several different titles, such as champions, facilitators, opinion leaders, change agents, and linking agents, and are situated both formally and informally within nursing, medicine, and other health disciplines. Nurses with specialized knowledge, such as enterostomal therapists, advanced practice nurses (APN) (including nurse practitioners [NPs] and clinical nurse specialists [CNSs]), and nurses in educator roles, are well positioned to act as intermediaries. These nurses often have both clinical judgment skills and knowledge of research that bridge the gap between theory and practice in the clinical settings. Nurse managers and highly skilled senior nurses may also be viewed as important intermediaries as they influence other nurses in supporting research-based practice changes.