The theory-practice gap: ECMO research example

The time taken for research findings to enter clinical practice can be very lengthy. A contributing factor is the time lag between the research literature identifying the issue, and medical and nursing texts discussing it. The example of ECMO (Extracorporeal Membrane Oxygenation) is used to examine this issue, specifically the extent to which relevant nursing journals and textbooks discuss the effects of ECMO on medication.

A systematic review of papers identifying the problem (pharmacokinetics in ECMO patients) and the dissemination of this to clinicians was undertaken. Publications used by those exploring the problem were most likely to be found in Medline, and those disseminating to nurses in CINAHL. Textbooks on neonatal nursing and paediatric intensive care with sections on ECMO were also explored.

There are several studies that show drug delivery is altered in patients receiving ECMO, dating back to 1989. Only three papers likely to be accessed by clinicians were found to address the effect of ECMO on drug delivery. Two of the textbooks addressed these issues but it took eight years from the issue being first raised to any medical or nursing text discussing it.

Nurses will most likely not be aware of the latest research in their area if they rely on textbooks. Advanced education that gives critical appraisal and literature-searching skills, such as found in master's courses, should help the clinical nurse employ evidence based practice.