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The Fellowship of ...the Island of Ireland

Author: Dr Sarah Russell
27 February 2018

Dr Sarah Russell, Head of Research and Clinical Innovation at Hospice UK, reflects upon the first part of her Florence Nightingale Foundation Travel Scholarship.

Last year I was delighted to be awarded a travel scholarship from the Florence Nightingale Foundation to observe, explore and reflect upon different approaches to advance care planning practice, dementia care, outcomes, hospice research and knowledge mobilisation in New Zealand and Ireland.

Recently I completed the first part of my scholarship with a week in Ireland. In our day to day jobs, we rarely get the opportunity to discuss and reflect in depth upon the challenges and solutions in other services and settings. My challenge was to decide “what to do with the time that is given us” (The Fellowship of the Ring by JR Tolkien).

An overview of my itinerary included conversations and visits to the All Ireland Institute for Hospice and Palliative Care (AIIHPC) (Dublin), Our Lady’s Hospice and Care Services (Dublin), Irish Hospice Foundation team (Dublin),  the National Dementia Office, researchers from  University College Cork, the Centre for Health Policy and Management (Trinity College Dublin), School of Psychology (University College Dublin) and Programme Manager for National Clinical Programmes for Palliative Care (Royal College of Physicians of Ireland). I also visited the Public Health Agency (Northern Ireland), researchers from Queens University Belfast and Ulster University and the Hospice UK Project Echo Belfast Office.

My overarching impression of the island of Ireland was one of fellowship. From the generosity of my host organisation the  AIIHPC , to the bus driver’s patience as I got to grips with different transport systems, to the individuals who gave up their time to share their experiences, ideas and work. I also learnt to pay attention to TripAdvisor’s hotel reviews…

Among many reflections, I had one that I keep returning to; the role of knowledge brokering to support rhetoric into practice.

The need to bridge the gap between evidence and practice is a much-cited goal in research studies. When research (or in fact any education, policy or clinical intervention) is designed there is quite rightly a focus on objectives, questions, conduct and results of the project. A further consideration is the importance of the studies’ designs to include realistic and robust sharing and implementation of knowledge to practice. There are multiple terms used to describe the concept of moving knowledge into practice, with evidence of the importance of two-way dialogue, organisational structures, and systems design, as well as co-creating knowledge.

In addition there is a growing discourse about the role of individuals, teams and organisations as knowledge brokers i.e. who support collaborations and partnerships within and across clinical, research, and policy worlds to improve the generation and use of research knowledge see (Glegg and Hoens 2016). A recent systematic review highlighted the multiple functions of knowledge brokers such as engaging stakeholders, gathering information, facilitating collaboration and generating tailored products.  You can see more information about this here .

Across all my visits and conversations, there was a thread of knowledge brokering which enabled productive relationships and activity. Examples included the Royal College of Physicians, Draft Model of Care for Palliative Care in Ireland as well as the Public Health Agency and Health and Social Care Board in Northern Ireland. Others included the development of tailored advance care planning products and education programmes from the Irish Hospice Foundation and the Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK),  shared by the AIIHPC and Dr Suzanne Guerin

Professor Joanne Reid from Queens University Belfast provided examples of simulation in end of life education, and Dr Suzanne Timmons and Dr Siobhan Fox discussed their work in palliative care and Parkinson’s disease . The AIIHPC commented on their palliative care research network, palliative hub for resources as well as the Voices4Care community.

So, what is my main reflection from the first part of the Florence Nightingale Travel scholarship?  It is concerned with paying more attention to how knowledge can be moved into policy, practice and education, to improve or sustain care. To shorten the gap between the generation of knowledge and its implementation by incorporating it more efficiently into research or intervention design; knowledge mobilisation, implementation methods and objectives.

There are frameworks and models that can support the use of knowledge into practice and as I reflect upon the many research applications I have read about this year, I am aware that perhaps as a community we need to be more disciplined about this. Considering knowledge mobilisation (with the accompanying implementation design) is a key part of research design and perhaps of our individual roles. In the same way that we advocate a holistic approach to patients and their families considering all aspects of their care and experiences – so we should do with research questions, design, conduct and dissemination e.g. consider knowledge mobilisation and implementation planning as part of the ‘total’ package.

In the ‘Fellowship of the Ring’ by JR Tolkien (part of the Lord of the Rings Trilogy), the previous ring bearer Bilbo Baggins says to his cousin and nephew Frodo “Don't adventures ever have an end? I suppose not. Someone else always has to carry on the story.” The story to carry onto the next part of the scholarship in New Zealand is the role and functions of knowledge brokering and implementation as an individual, a role, organisations and a community.

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