KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Research Utilization & the Individual What do we know? Carole A. Estabrooks, RN, PhD University of Alberta Edmonton, Canada 2 nd Annual Knowledge Utilization Colloquium Oxford, July 2002

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice AHFMR, Alberta Heritage Foundation for Medical Research CIHR, Canadian Institutes of Health Research Acknowledgements

…Knowledge in Practice KNOWLEDGE UTILIZATION STUDIES PROGRAM Putting Knowledge to Work/ Mettre le savoir en pratique CENTRE FOR KNOWLEDGE TRANSFER | CENTRE SUR LE TRANSFERT DES CONNAISSANCES Centre for Knowledge Transfer Graduate training Research Collaboration with policy makers To increase research-based decision-making in KT through:

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice STAFF Huey Chong Katie Hesketh Kylie Hugo Jarmila Sazavsky Connie Winther James Kropfreiter Selena Wong Summer UG students Kristin Brigidear* Sara Katz Kathy O’Leary* Graduate Margaret Milner Shannon Scott-Findlay* Kim Fraser Greta Cummings* Anastasia Mallidou POST-DOC Joanne Profetto-McGrath

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Outline 1.Some background 2.Individual vs. organizational 3.Conclusions

History of Evidence Based Practice? 1903 G.Tardé EBM 1970s CURN Project 1955 Menzel & Katz 1943 Ryan & Gross 1993 Cochrane Collaboration 1997 NFH Canada 1985 Conceptual Papers in Nursing Agricultural extension model

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice KNOWLEDGE UTILIZATION STUDIES PROGRAM Evidence-based medicine Evidence-based nursing Evidence-based practice Evidence-based policy Evidence-based decision-making Professionalization and …

RU Research Publications (Nursing)

Individual v/s Organizational (Nursing)

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice RU Models in Nursing WICHEN (Krueger, et al.) CURN (Horsley, et al.) NCAST (Barnard, King & Hoehn) RNABC Goode Horn (Goode, et al.) Iowa (Titler, et al.) Stetler CRU (Dufault) Ottawa (Logan, et al.) Kitson, et al. Change to EBP (Rosswurm & Larrabee)

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Common Features Generally premised on individual, rational actor assumptions  Good decision-makers use research  Research makes it better Tend to be prescriptive Frequently use Rogers’ theory Generally have not been developed as interdisciplinary

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Individual v/s Organizational  Systematic review  KUSP RU studies (Estabrooks, PI)

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Research utilisation and the individual nurse: A systematic review Carole A. Estabrooks, RN, PhD Judith A. Floyd, RN, PhD Shannon Scott-Findlay, RN, MN Katherine A. O’Leary, BA Matthew Gushta, BA

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Online database yield 1063 Articles requested and screened for inclusion/exclusion 104 Studies meeting inclusion criteria 20 (representing 22 articles) Studies excluded 82 Search and retrieval process

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Systematic Review Included Studies (N=22) Barta (1995)Logsdon et al. (1998) Bostrum & Suter (1993)Kirchoff (1982) Brett (1989)Lacey (1994) Butler (1995)Parahoo (1998; 1999) Champion & Leach (1989)Michel & Sneed (1995) Coyle & Sokop (1990)Rodgers (2000) Davies (1999)Rutledge et al. (1996) Estabrooks (1999a; 1999b)Tsai (2000) Hatcher & Tramner (1997)Varcoe & Hilton (1995) Lia-Hoagberg et al. (1999)Winter (1990)

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Individual Determinants Six categories of predictors were identified:  Beliefs & attitudes  Information seeking  Education  Involvement in research activities  Professional characteristics  Other socio-economic factors

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Beliefs & Attitudes Most frequently assessed determinant (N=10) was attitude toward research  significant in 5 out of 6 studies  most frequently replicated result in all categories  only predictor with a consistent pattern of positive effect

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Results Methodological problems  Only 2 studies considered ‘strong’ Unit of analysis issues Little to suggest that individual determinants influence RU

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Implications Design/analysis Theoretical framing Predictors Dependant variable Solo work

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice The Determinants of Research Utilization Studies Pain Management in Adults & Pain Management in Infants & Children Funded by: CIHR and AHFMR

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Study Team University of Alberta Carole Estabrooks, RN, PhD (PI) Janice Lander, RN, PhD Judy Norris, RN, PhD Charles K. Humphrey, MA Karen Golden-Biddle, PhD Francis Lau, PhD University of Calgary Geertje Boschma, RN, PhD University of Toronto Bonnie Stevens, RN, PhD Judy Watt-Watson, RN, PhD Linda O’Brien-Pallas, RN, PhD Gail Donner, RN, PhD J. I. (Jack) Williams, PhD

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice RU Studies Ethnographic case studies (n=7)* Multi-site (6 mo./unit) Qualitative data (interviews, focus groups, observation) Quantitative data (2 weeks in each unit) Documentary data (~ 600 total) * two adult and five pediatric units

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice A.Prefer socially driven sources a.Co-workers b.Patients B.Experiential Learning C.Traditional dissemination methods rank poorly e.g., Medical/Nursing journals RU Studies Sources of Practice Knowledge

Sources of Practice Knowledge

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice KUSP RU Studies 7 Unit Archetype Conceptualized factors from the RU literature which also existed in our datasets Comparison analysis across units which reduced variables to only those of significance Social & organizational environmental characteristics became paramount

KUSP RU Studies Social Interaction Archetype

Environment

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Conclusions  Impact of organizational context  Future directions

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Organizational Determinants Kitson, Harvey & McCormack, 1998 McCormack, Kitson, Harvey, Rycroft-Malone, Titchen & Seers, 2002

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice 1950s Science push 1970s Demand pull 1980s Dissemination 1990s Linkages & interactions 2000s Situated knowledge use? Stages and phases

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice We know... Insufficient theorizing Measurement problems Lack of causal analyses Over reliance on rational actor models Lack of models that include organizational interests, interaction and linkage Over examination KU as product Fragmentation

KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice Organizational approaches Practice environment, context, climate & culture addressed Linkages, interactions, social & relational capitol KU as an independent variable Sustainable, interdisciplinary programs of research We need...

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KNOWLEDGE UTILIZATION STUDIES PROGRAM …Knowledge in Practice