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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. Acknowledgements. AHFMR, Alberta Heritage Foundation for Medical Research

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slide1

Research Utilization & the Individual

What do we know?

Carole A. Estabrooks, RN, PhD

University of Alberta

Edmonton, Canada

2nd Annual Knowledge Utilization Colloquium

Oxford, July 2002

acknowledgements
Acknowledgements
  • AHFMR, Alberta Heritage Foundation for Medical Research
  • CIHR, Canadian Institutes of Health Research
centre for knowledge transfer

Centre for Knowledge Transfer

Graduate training

Research

Collaboration with policy makers

To increase research-based

decision-making in KT through:

slide4

Summer UG students

Kristin Brigidear*

Sara Katz

Kathy O’Leary*

Graduate

Margaret Milner

Shannon Scott-Findlay*

Kim Fraser

Greta Cummings*

Anastasia Mallidou

STAFF

Huey Chong

Katie Hesketh

Kylie Hugo

Jarmila Sazavsky

Connie Winther

James Kropfreiter

Selena Wong

POST-DOC

Joanne Profetto-McGrath

slide5

Outline

  • Some background
  • Individual vs. organizational
  • Conclusions
history of evidence based practice
History of Evidence Based Practice?

1920 - 1960

2002

1903

G.Tardé

1992

EBM

1997

NFH

Canada

1955

Menzel & Katz

Agricultural

extension model

1993

Cochrane

Collaboration

1970s

CURN Project

1943

Ryan & Gross

1985 Conceptual

Papers in Nursing

slide7

KNOWLEDGE UTILIZATION STUDIES PROGRAM

Professionalization and …

Evidence-based medicine

Evidence-based nursing

Evidence-based practice

Evidence-based policy

Evidence-based decision-making

slide10

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)
common features
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
individual v s organizational
Individual v/s Organizational
  • Systematic review
  • KUSP RU studies(Estabrooks, PI)
slide13

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

slide14

Search and retrieval process

Online database yield

1063

Articles requested

and screened for inclusion/exclusion

104

Studies meeting inclusion criteria 20(representing 22 articles)

Studies excluded

82

systematic review included studies n 22
Systematic ReviewIncluded 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)

individual determinants
Individual Determinants

Six categories of predictors were identified:

  • Beliefs & attitudes
  • Information seeking
  • Education
  • Involvement in research activities
  • Professional characteristics
  • Other socio-economic factors
beliefs attitudes
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
results
Results
  • Methodological problems
    • Only 2 studies considered ‘strong’
  • Unit of analysis issues
  • Little to suggest that individual determinants influence RU
implications
Implications
  • Design/analysis
  • Theoretical framing
  • Predictors
  • Dependant variable
  • Solo work
slide21

The Determinants of Research Utilization Studies

Pain Management in Adults

&

Pain Management in Infants & Children

Funded by: CIHR and AHFMR

slide22

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 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

University of Calgary

Geertje Boschma, RN, PhD

slide23

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

slide24

RU StudiesSources of Practice Knowledge

  • Prefer socially driven sources
        • Co-workers
        • Patients
  • Experiential Learning
  • Traditional dissemination methods rank poorly

e.g., Medical/Nursing journals

kusp ru studies 7 unit archetype
KUSP RU Studies7 Unit Archetype

Conceptualized factors

from the RU literature which also existed in our datasets

Social & organizational environmental characteristics became paramount

Comparison analysis across units which reduced variables to only those of significance

slide27

KUSP RU Studies

Social Interaction Archetype

conclusions
Conclusions
  • Impact of organizational context
  • Future directions
organizational determinants
Organizational Determinants
  • Kitson, Harvey & McCormack, 1998
  • McCormack, Kitson, Harvey, Rycroft-Malone, Titchen & Seers, 2002
slide31

Stages and phases

  • 1950s Science push
  • 1970s Demand pull
  • 1980s Dissemination
  • 1990s Linkages & interactions
  • 2000s Situated knowledge use?
slide32

KNOWLEDGE UTILIZATION STUDIES PROGRAM

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 in Practice

slide33

KNOWLEDGE UTILIZATION STUDIES PROGRAM

We need . . .

  • Organizational approaches

Practice environment, context, climate & culture addressed

  • Linkages, interactions, social & relational capitol
  • KU as an independent variable
  • Sustainable, interdisciplinary programs of research

…Knowledge in Practice

slide34

E-Mail us at:

kusp@ualberta.ca

Visit our web site: http://www.ualberta.ca/~kusp/