Research Utilization:

1. Research Utilization: The Nursing Knowledge System

2. Table of Contents • State of the Art • Where are we now? • Nursing Research • Examples of different types of studies • Knowledge Management • As the foundation of future Research Utilization • Knowledge System • As the conceptual guide for future Research Utilization

3. State of the Art:The Wide and Savage Sea in the Knowledge Society

4. State of the Art • Terminology • Knowledge Management, Transfer, Translation, Utilization, Research Transfer, Implementation Research • Subject Realms • Health, Business, Governance, Social Sciences • Roles • Knowledge Brokering, Funding agencies, Implementation Units • Approaches • Social Engineering, Mode 2, Triple Helix

5. State of the Art • Research Utilization is a form of Knowledge Utilization. That is, Knowledge Utilization or transfer, or translation in its broadest terms allows for all kinds of knowledge to be used as input, that is, personal testimony, citizen input, media, policy, and research. RU is more a specific species of the genus.

6. State of the Art • Basic Distinctions or Levels of Analysis • Policy and Politics • As represented by the managers, policy makers, • Practice and Application • As represented by the clinicians and associated staff • Theory/Research • As represented by the Academics who develop different ideas.

7. State of the Art

8. State of the Art

9. State of the Art • Some Considerations of Research • Do you….engage in quality research on a specific methodology, special to, and specifically measuring research utilization? • Model, tool, questionnaire, or concept • Do you….take an empirical method and apply it to a problem and discuss research utilization as a process of application?

10. Information Utilization Scale Stage of Concern Scale Levels of Use Scale An Evaluation Scale Research Utilization Index Overall Policy Impact Scale Diffusion of Innovations AHRQ Knowledge Transfer Framework State of the Art

11. PARIHS Conduct and Utilization of Research in Nursing Iowa Model of Research in Practice Ottawa Research Model Collaborative research utilization model Stetler/Marram Model for application of research findings in practice Framework for dissemination and utilization of research for healthcare policy and practice Multidimensional Framework BARRIERS to Research Utilization Scale Research Factor Questionnaire State of the Art

12. State of the Art Asselin (2001) Knowledge Utilization Among Experienced Staff Nurses • Identification of RU (Horsley et al. 1978) • Six Phases of Research Utilization • Identify practice problems and assess valid research • Evaluate research as it relates to problem and organizational climate • Develop practice protocols based on research • Implement pilot and evaluate the protocol • Decide to adopt, alter, or reject the protocol • Develop a plan to disseminate the protocol and maintain the practice over time.

13. State of the Art Amara et al (2004) New Evidence on Instrumental, Conceptual, and Symbolic Utilization of University Research in Government Agencies • Purpose • What is the extent of instrumental, conceptual, and symbolic use of university research in government agencies? • Method • Uses the traditional divisions in KU: Instrumental, Conceptual, Symbolic • Explanatory models: Engineering, Organizational Interests, Two Communities metaphor, Interaction Explanations (and Linkage Mechanisms) • Survey administered to government departments; 833 usable surveys • Results • Departments like Health, Education, and Social Services utilize all three models more than others. • The three models are complementary to their work.

14. Nursing Research:Clinical Realm Funk et al (1991) BARRIERS: The Barriers to Research Utilization Scale • Purpose • Identifying Roger’s Diffusion of Innovation as an important model for health and nursing context • Develop an instrument for the assessment of clincians’, administrators, and academics perceptions of barriers to the utilization of research findings in practice • Method • Items for the instrument were developed from the literature on research utilization, from the Conduct and Utilization of Research in Nursing (CURN) Project Research Utilization Questionnaire and from informal data gathered from nurses. • Instrument was pilot tested; Stratified random sample of 5000 individuals was drawn from the 1987 American Nursing Association membership roster; selected from 22 states; only RNs full time were included in sample • Results • Factors identified within the BARRIERS tool closely parallel 4 concepts in Rogers’ Model of Innovation Diffusion: Adopter; organization; Innovation; communication.

15. Nursing Research:Bibliometrics Estabrooks et al. (2004) Mapping the Field: A Bibliometric Analysis of the Research Utilization Literature in Nursing • Methodology • Searching bibliographic databases resulting in 630 articles on research utilization between 1972 and 2001 • Used available bibliographic software (freeware from Internet) to organize results • Results • Models important to Nursing (Iowa Model of Research in Practice, Multidimensional framework, Ottawa Model of Research Use) • Top Journals (Journal of Advanced Nursing, Nursing Standard) • Important Authors (Cheryl Stetler, Jo-Anne Horsley, Carole Estabrooks)

16. Nursing Research: Bibliometrics More Results from Estabrooks et al. (2004) • Limited research transfer: only 2% of the references in the clinical research utilization literature were references to research articles. • More than 60% of references in articles are to research by nurses (Nurses citing Nurse Scholarship) • 40% of references citing external sources. The scholarship is not completely insular.

17. Nursing Research:Bibliometrics Meijers et al. (2006). Assessing the relationships between contextual factors and research utilization in Nursing • Investigating Factors • The aim of this study was to systematically review the literature on studies reporting a relationship between contextual factors and research utilization by nurses in clinical practice • Contextual Factors included: Time, Access to research, leadership, authority, culture, structure, support, incentives, skills, education, size of hospital, professionalism, communication, innovation champion • Results • No single study was assessed to be of high methodological quality • Identified 10 study findings that had a statistically significant relationship with research utilization: • Role, Access, organizational climate, multifaceted support, time, Education

18. Nursing Research:Bibliometrics Other Interesting Results fromMeijers et al. (2006) • Measures of Research Utilization, whose validity is clearly demonstrated, are needed. One approach to enhancing interpretation is to provide nurses with a clear definition of research utilization before they complete a survey • More theory and research are needed to conceptualize and measure nursing context. • Observational and intervention studies with less reliance on self-report would strengthen the evidence obtained from research in this field. • The impact of research utilization on patient outcomes has to be assessed, as well as the sustainability of practice changes when implementing research findings.

19. Nursing Research:Organizational Measures Cummings et al (2007) Influence of Organizational Characteristics and Context on Research Utilization • Method • Secondary data from the 1998 Alberta Registered Nurse (ARN) Study • ARN survey focused on work environment, structure, staffing, burnout, job satisfaction, quality of care, workplace violence among others • Three variables measured PARIHS dimensions of context (culture, leadership, and evaluation) • Structural Equation modeling used • Results • Three hospital characteristics—responsiveness, administration, relational capital, and hospital size—positively, but indirectly, influenced nurses’ research utilization by acting through staff development, opportunities for nurse-to-nurse collaboration, and staffing and support services.

20. Nursing Research:Organizational Measures Fink, Thompson, Bonnes (2005) Overcoming Barriers and Promoting the Use of Research in Practice • Method • Descriptive, cross-sectional, pre-survey, post-survey design to identify inpatient nurses’ personal and professional characteristics, perceptions of organizational culture and the effectiveness of organizational strategies. • Although the focus is organizational, there is an emphasis on personal characteristics such as “positive attitudes” • Results • Research activities most participated: Shared research findings with peers (70%), attended conference (67%) Evidence based council meetings (55%); participant in data collection (n = 123), attending Journal club (n = 105) • Barriers to Research included: Nurse had no authority to change practice, aware of research, administration not allowing implementation, nurse is isolated from colleagues, access to research, no time on the job to read research.

21. Nursing Research: Individual-Organizational Interrelationship Leiter et al (2007) Personal and organizational knowledge transfer • Purpose • Measure individual and organizational knowledge transfer in the health-care setting. (They also consider the issue of job burnout in relation to KT) • Method • Nurses recruited for provincial nursing leadership conference. • Devised measures for both Personal & Organizational KT (Likert Scale) • Factor Analysis conducted//structural equation model • Results • Personal KT – healthcare report use, membership on regional nursing councils • Organizational to Personal KT - dynamics that encourage individuals to align their perspective with the values of their organizational environment and for the organization to create values that reflect the perspective of employees. • However, Nurses DO NOT avoid KT because of fatigue

22. Nursing Research:Individual Determinants Estabrooks (1999) Modeling the Individual Determinants of Research Utilization • Purpose • This study’s objectives were to develop and test a series of structural equation models that included individual factors believed to influence research utilization • Method • Using Instrumental, Conceptual & Persuasive research utilization • Model fit was assessed by examining chi-square, the adjusted goodness of fit index • Results • Some individual factors: Activism, Affiliation, attitude, Autonomy, Awareness of policy, Belief suspension, Cosmopoliteness, Dogmatism, Educational level, Problem solving ability, Theoretical orientation, Time spent reading professional journals, Trust

23. Nursing Research:Nursing Culture Watson et al. (2005) Exploratory Factor Analysis of the research and development culture index among qualified Nurses • Purpose • Factor analysis of a rating instrument for assessing the strength of organizational Research and Development (R&D) Culture • R&D Culture Index developed as means of appraising R&D culture • Methods • Qualitative research is the basis for creating the formal index to administer to nurses. • Results • Both Individual and Organizational Factors are important and distinctive. • Three components must be developed: Skill base of practitioners, infrastructure of organizations, and reflective development nature of the immediate work environment

24. Nursing Research: Research Environment Ax, Susanne (2001). Nursing Students’ Perceptions of Research: Usefulness, Implementation and Training • Stresses the Research Component of Nursing in Britain • Purpose of Study • Investigate Nursing Research perceptions of usefulness, implementation, interest and personal involvement • Investigate Nursing Training in structure and design of classes, reading materials, personal study and stress • Methodology • One to one Interviews of 13 Nursing Students • Findings • Improving Practice by testing assumptions of current practice • Many students voiced difficulties voicing suggestions for change • Feeling of a lack of understanding, a disconnect to application

25. Nursing Research:Research Environment • Few students indicated that they employed their research knowledge or skills in practice. • Some students suggested that it was useful to know how to search the literature before going on a clinical placement • Few were actually involved in a research project at the time of the interview. • A separation of Scientific Research and Information Retrieval skills was not clear. • Many Nursing students had complained about the early introduction of research into the curriculum. Some reported increased anxiety.

26. Knowledge Management …as the foundation for Research Utilization • Technologically Driven • Digital Medical Records; Personal Digital Assistants; IPODs • Technological facilities, such as the revolution of Kiosks for Nurses to check email • Socially Driven • Absorptive Capacity; Communities of Practice; Epistemic Cultures • Concerned with context, culture and transferability of skills & knowledge • Identifying all of the people who are engaged in brokering activities • Who are the linkers? • Who are the people that synthesize nursing knowledge?

27. Knowledge Management ….as providing strategies to evaluate • Hansen et al (1999) Knowledge Strategy • Personalized or Tacit (People to People) & Codified or Explicit (Document to People) • First up, you decide whether or not your organization is focused on codified or personalized knowledge strategy • Once you decide, to excel, you invest an 80/20 split…one or the other, not both • Application • Hansen’s formula was applied to business and health organizations, evaluating them based on this idea of the 80/20 split. • It also has application for the academic world and Research Utilization

28. Knowledge Management • Dr. Liz Quinlan, Department of Sociology • With Hansen’s study in mind, a framework of codified and tacit knowledge is considered for reinterpretation of a Nursing Survey • She reviewed the Knowledge Transfer and Utilization literature: • She found that: • Codified knowledge strategies is seen as the most effective in improving health outcomes.

29. Knowledge Management Key Component Codified KM strategy (people to documents) Patient health outcomes Organizational support for Innovation h1 h2 h4 h3 Personalized KM strategy (people to people) Nurses’ job satisfaction and sense of well-being h4

30. Knowledge Management Exhaustion Personalized KM: Nurse-to-Nurse Nurse-to-Mgt Nurse-to-Drs Patient Outcomes Innovation Codified KM Key Element Job Satisfaction

31. Knowledge Management William Boateng, Sociology • This study examines the knowledge management strategies of health care decision- makers working in the context of selected RHAs in the SK province. • Study’s Conceptual Frameworks - Knowledge Management Strategies (Codification & Personalization), and Communities of Practice. • Members of Regional health authorities (RHAs) in the province of Saskatchewan constitute the unit of analysis for the study, which was guided by a qualitative research design. Interviews were used as the main data collection technique. For data analysis, “open and axial” coding methods based on the inductive and deductive approaches were adopted.

32. Knowledge Management William Boateng, Sociology • The study concludes that RHA members utilize more fully explicit rather than tacit forms of knowledge. • This indicates that RHA members pursue a codification strategy more strongly than a personalization strategy. • One of the main knowledge management practices adopted by the RHA members is the use of professional reports. • Moreover, it was found that the practices and strategies associated with managing knowledge were in place, despite the absence of a stated knowledge management policy. • Finally, RHAs cannot be regarded as communities of practice, even though they exhibit many of their features.

33. Knowledge System • Knowledge Systems Thinking Holzner and Marx, 1979 • Knowledge System represents the different, but sometimes overlapping, processes in society that involve knowledge production, organization, Transfer, Application and/or Implementation Von Bertalanffy, 1968 • Systems Theory involves an interconnectedness of processes, to do science is to have a knowledge system.

34. Knowledge System • AHRQ Knowledge Transfer Framework • The System • Knowledge Creation & Distillation • Diffusion & Dissemination • Adoption, Implementation, and Institutionalization • The Social • Process • Actors • Activities

35. For Your Consideration • Level of Analysis • Clinical, Policy, Academic • Roles of Nurses as Brokers • Individual or part of organization/unit • Knowledge Audit/Management • Tacit or codified; Access; skills at retrieving information; time on Internet • Considering the construction of a Model • Using Qualitative data to inform the construction of Quantitative approach (e.g., informal analysis such as environmental scans used by Nurses) • Tools • Logic models, Concept Mapping, Environmental Scanning, Social Network Analysis, Organizational Readiness Assessments • **Implementation Units** A British/Commonwealth supported idea to have special units whose specific purpose is to implement policy

36. Any Questions?