|CONCEPTS AND ISSUES
|Year : 2019 | Volume
| Issue : 1 | Page : 7-10
Jemimah Jayakumar1, Rogina JS Savarimuthu2
1 ICON Clinical Research India Private Limited, Chennai, Tamil Nadu, India
2 Chettinad College of Nursing, Chennai, Tamil Nadu, India
|Date of Web Publication||09-Oct-2019|
Mrs. Jemimah Jayakumar
ICON Clinical Research India Private Limited, Chennai ONE IT Park, North Block - Floor 4, Pallavaram-Thoraipakkam 200 Feet Road, Thoraipakkam, Chennai - 600 097, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Translational research (TR) aids in transforming research findings into practical actions. TR starts from observations and experiences of patterns and relationships in a researchers' world, which creates research questions. The research question is answered in stages of research starting from the laboratory to testing in clinical trials and then moving onto checking efficacy in patients and communities. Nurses utilising TR can improve quality of nursing care. The phases and stages of TR are discussed in this paper.
Keywords: Translational research, T phases, nursing
|How to cite this article:|
Jayakumar J, Savarimuthu RJ. Translational research. Indian J Cont Nsg Edn 2019;20:7-10
| Introduction|| |
Research in health care has increased over the decades with an aim to improve patient care quality and bring about positive changes in human behaviour related to health. Such changes in quality of care and individual behaviour are not possible without bringing research findings into practice. The movement of translational research (TR) has evolved from what was known as 'translating research' into practice. According to Woolf, for professionals who focus on promotion of health as the primary outcome, 'TR refers to translating research into practice, i.e., ensuring that new treatments and research knowledge actually reach the patients or populations for whom they are intended and are implemented correctly.'
TR is the process involving the transfer of knowledge and discovery gained from the basic sciences to its application in clinical and community settings, i.e., from 'bench-to-bedside' and 'bedside-to-community.' The aim of TR is to identify effective strategies through which dissemination and uptake of research findings in different target audiences can be achieved. TR is the process in which conditions, costs and resources which are required to progress theory into evidence-based practice are determined. Moreover, TR transforms scientific findings and discoveries from basic laboratory, clinical and/or population studies into new clinical tools, processes or applications with consequent improvement in the patient care and promotion of public health.,,
The major objectives of TR are to
- accelerate the process of moving the findings from bench research to bedside as interventions
- enhance collaboration between researchers working in different settings at different phases of translation
- utilise potential knowledge and expertise of personnel from different disciplines to focus on common goal
- promote optimal outcomes for all patients rather than acceptable solutions.
| Model Of Translational Research|| |
The model of TR as shown in [Figure 1] includes the 'T' phases, the theoretical framework and phases of TR as applied to nursing.
Phases of translational research
The phases of translation called as 'T' phases explain the continuum of translation research as follows:,
- T0 – Comprises of basic biomedical research including preclinical and animal studies, not including interventions with human subjects. It is characterised by the identification of opportunities and approaches to health problems
- T1 – Involves the translation of research to humans that includes Phase 1 clinical trials and focus on new methods of diagnosis, treatment and prevention in highly controlled settings. It strives to move basic discovery into health application
- T2 – Deals with the translation of research to patients, including Phase 2 and 3 clinical trials and controlled studies leading to clinical application and evidence-based guidelines. It assesses the value of application for health practice leading to the development of evidence-based guidelines
- T3 – Incorporates the translation of research to practice, including comparative effectiveness research, post-marketing studies, clinical outcomes' research, health services and dissemination and implementation research. It attempts to move evidence-based guidelines into health practice, through delivery, dissemination and diffusion research
- T4 – Consolidates the translation of research to communities, including population-level outcomes' research, monitoring of mobility, mortality, benefits, risks, impacts of policy and change. It seeks to evaluate the 'real world' health outcomes of population health practice.
Stages of translational research
Translation involves the process of converting observational, pragmatic and clinical evidence into interventions that improve the health of the individual and community. This translation process involves different types of research at different stages which correlate with 'T' stages of the TR.
Stage I: Basic research
Basic research involves basic-level exploration of cell structures, genetics and physiological response of cells and tissues to various intrinsic and extrinsic triggers that may lead to defects, illness and disease. Basic research is generally carried out in the laboratory. This denotes the frequently mentioned bench research.
Stage II: Preclinical research
In preclinical research, the research question applies to how the findings from the laboratory can be tested in samples of animal or human tissues or animated models. This stage in research determines the possibility of testing the new innovations in the human being.
Stage III: Clinical research
The findings from the basic and preclinical research will be used to expand on research methods that test the efficacy and safety of new interventions, products in controlled trials among selected individuals or volunteers. Clinical research may also extend to testing technologies and interventions that influence the healthcare outcomes at individual and organisational levels. The process and outcomes in this phase are vital for getting necessary approval from regulatory bodies.
Stage IV: Clinical implementation
This stage includes testing/exploring strategies that will assist in adoption of interventions and innovations that have been found useful from the previous stages of research. The application of findings from the research extends to the care of individuals in the clinical setting. The findings from the exploration are beneficial to evaluate the usefulness in different context and identify new issues or gaps which can be formulated into a research question.
Stage V: Public health
The research in this study involves examining the health outcomes at the population level. The feasibility and applicability of interventions/findings in different population groups will give a better understanding of the scope and use of study findings in the overall population, both nationally and globally.
According to Ray, TR is based on three pillars: the laboratory, the hospital and the community. The process of translation is reciprocal and not unilateral with multiple 'complex feedback loops' (p 164) in that the findings from bench inform the clinical interventions and technologies, and the observations and findings from clinical area propose new questions for research.
Framework for improving knowledge translation
Basic scientific discovery is the basic knowledge contributing to the evolution of theoretical knowledge. Pilot studies and clinical trials contribute to the potential application of the basic scientific knowledge. The evidence-based guidelines which emerge from the clinical application of knowledge determine the efficacy of the knowledge. Application of knowledge in clinical care as intervention reflects the effectiveness of the knowledge. Utilisation of novel effective knowledge in meeting the health need of public health aids in dissemination of knowledge. Theoretical framework is the benchmark with which the actual performance is compared with. The difference between the two gives raise to gap analysis which impacts the theoretical framework. This results in revision in practice. The gap beacons for changes in political environment, social network and available resources.
| Translational Research And Nursing|| |
The objectives of individual, collaborative or multicentric nursing research are to improve the quality of nursing care given, offering greater security to patients and influencing more effective healthcare policies. Clinical research, systematic literature reviews, convergent-care research, phenomenological studies and social representations aim to respond to professional practice questions. Despite these efforts, there exists a gap among studies and the use of the results from research carried out in public/community or hospital healthcare services. Nurse scientists study how individuals respond to illness or adapt to changes. Nurse scientists can utilise data and observations derived from clinical setting to design and develop basic and applied research and deplete the gap., Theoretical framework of TR focuses on evidence-based practice and knowledge transformation processes, acquisition of novel knowledge, knowledge reciprocity, evidence synthesis for application and inquiry and the interpretation of disseminated research.
For Nursing TR simply means bringing research into practice so the quality of patient care improves leading to better patient outcomes. In nursing, TR can be used in translating descriptive theories into patient assessment tools, explanatory theories into comprehensive assessment tools and predictive theories into intervention protocols. TR decreases the time required for theories to be translated into tools and protocols that improve quality of life [Figure 1]. Further, it attempts to close the theory-research-practice gap by fostering scientific collaboration, enhancing a climate of inquiry and innovations, promoting sharing of ideas and expertise and enabling collective approach to bring changes in policies that are related to patient care in the hospital and community.
Phases of translational research in nursing
The phases of TR in nursing can be explained as a process of converting theoretical knowledge into research question, the applicability of research findings as interventions, refining the social utility and compatibility of guidelines and protocols and dissemination of the vital findings for practice change. The phases include the PICOT, the FAME, the pragmatic adequacy and the evaluation process.
Phase I (PICOT Phase)
P: Patient population – Refers to the probable samples who will be recruited for the study.
I: Intervention area of interest – Allude to the treatment that will be provided to individuals enrolled in the study.
C: Group comparison – Denotes the plan on using a reference group to compare with the treatment intervention.
O: Desired Outcome – Deals with the plan on measuring the effectiveness of the intervention.
T: Time – Describes the duration of data collection.
Phase II (FAME Phase)
F: Feasibility – It is the clinical feasibility about whether or not an intervention is physically, culturally or financially practical or possible within a given context.
A: Appropriateness – It is the extent to which an intervention is apt to the context in which care is given.
M: Meaningfulness – It is the extent to which an intervention is positively experienced by the patent which is related to personal experience, opinions, values, thoughts, beliefs and interpretations of patients or clients.
E: Effectiveness and economic – It is the extent to which an intervention, when used appropriately, achieves the intended effect and is cost-effective.
Phase III (Pragmatic adequacy)
Pragmatic adequacy is the utility of theory for nursing practice in relation to social meaningfulness, compatibility and consistency.
Phase IV (Evaluation)
Evaluation comprises summing up, dissemination and publication of the research findings contributing to evidence-based practice.
| Advantages Of Translational Research|| |
TR results in delivery of concrete scientific evidence-based knowledge and skills that are benefited by the individual and community at large. TR utilises recent discoveries in basic science, test compounds influencing the mechanisms in the clinical trials to gauge their effectiveness which is implemented into large-scale trials resulting in scientific evidence. This results in the emergence of new protocols and procedures contributing to the welfare of the individual client and the community at large in terms of health and illness. The comprehensive advantages of TR are given in [Table 1].
| Conclusion|| |
TR is the process of applying ideas, insights and discoveries generated through basic scientific inquiry to the treatment or prevention of human disease. Nurses utilising TR can contribute to enhancement of nursing theory and practice through different levels of research, thus reducing the research practice gap.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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