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

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.