knowledge utilization studies program …knowledge in practice research utilization & the...

KNOWLEDGE UTILIZATION STUDIES PROGRAM

…Knowledge in Practice

Research Utilization & the Individual

What do we know?

Carole A. Estabrooks, RN, PhDUniversity of AlbertaEdmonton, Canada

2nd Annual Knowledge Utilization ColloquiumOxford, July 2002



AHFMR, Alberta Heritage Foundation for Medical Research

CIHR, Canadian Institutes of Health Research

Acknowledgements



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:



STAFFHuey ChongKatie HeskethKylie HugoJarmila SazavskyConnie WintherJames KropfreiterSelena Wong

Summer UG studentsKristin Brigidear* Sara Katz Kathy O’Leary*

GraduateMargaret MilnerShannon Scott-Findlay*Kim FraserGreta Cummings*Anastasia Mallidou

POST-DOCJoanne Profetto-McGrath



Outline

1. Some background

2. Individual vs. organizational

3. Conclusions

History of Evidence Based Practice?

1903G.Tardé

2002

1992EBM

1970sCURN Project

1955 Menzel & Katz

1943Ryan & Gross

1993Cochrane

Collaboration

1997NFH

Canada

1985 Conceptual Papers in Nursing

1920 - 1960

Agricultural extension model




Evidence-based medicine

Evidence-based nursing

Evidence-based practice

Evidence-based policy

Evidence-based decision-making

Professionalization and …

RU Research Publications (Nursing)

0

2

4

6

8

10

12

14

161

97

21

97

41

97

61

97

81

98

01

98

21

98

41

98

61

98

81

99

01

99

21

99

41

99

61

99

82

00

0

Canada

U.K.

U.S.A

Other

Individual v/s Organizational (Nursing)

0

2

4

6

8

10

12

14

1619

7219

7419

7619

7819

8019

8219

8419

8619

8819

9019

9219

9419

9619

9820

00

IndividualDeterminantsOrganizationalDeterminantsBoth



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

• 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

Systematic review

KUSP RU studies (Estabrooks, PI)



Research utilisation and the individual nurse: A systematic

review

Carole A. Estabrooks, RN, PhDJudith A. Floyd, RN, PhD

Shannon Scott-Findlay, RN, MNKatherine A. O’Leary, BA

Matthew Gushta, BA



Online database yield1063

Articles requested and screened for

inclusion/exclusion 104

Studies meeting inclusion criteria 20 (representing 22

articles)

Studies excluded

82

Search and retrieval process



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

Six categories of predictors were identified: Beliefs & attitudes Information seeking Education Involvement in research activities Professional characteristics Other socio-economic factors



INDIVIDUAL DETERMINANTS THAT CORRELATE SIGNIFICANTLY WITH THE USE OF RESEARCH

0 10 20 30 40 50 60

BELIEFS AND ATTITUDES

INFORMATION SEEKING

EDUCATION

INVOLVEMENT IN RESEARCH ACTIVITIES

PROFESSIONAL CHARACTERISTICS

OTHER SOCIO-ECONOMIC FACTORS

PERCENTAGE



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

Methodological problems Only 2 studies considered ‘strong’

Unit of analysis issues Little to suggest that individual

determinants influence RU



Implications

Design/analysis Theoretical framing Predictors Dependant variable Solo work



The Determinants of Research Utilization Studies

Pain Management in Adults&

Pain Management in Infants & Children

Funded by: CIHR and AHFMR



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



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



A. Prefer socially driven sourcesa. Co-workersb. Patients

B. Experiential Learning

C. Traditional dissemination methods rank poorly

e.g., Medical/Nursing journals

RU StudiesSources of Practice Knowledge

Unit 1 (adult)

Unit 2 (adult)

Unit 3 (peds)

Unit 4 (peds)

Unit 5 (peds)

Unit 6 (peds)

Unit 7 (peds)

Overall

INDIVIDUAL CLIENT/PATIENT

2.5 2 1 2 2 1 2 2

INTUITIONS 7 7 4

4.5 8 8 5 7

PERSONAL EXPERIENCE 2.5 1 2

1 1 2 1 1

NURSING SCHOOL 1 4 3

3 5.5 10 9 4.5

PHYSICIAN DISCUSSIONS 9 6 9

6 4 3 8 3

PHYSICIAN'S ORDER'S 8 8 6.5

7.5 9 7 12.5 9

MEDICAL JOURNALS 16 15 16

15 15 14 15 15

NURSING JOURNALS 13 12 13

11 12.5 9 10 12

NURSING RESEARCH JOURNALS

14 14 14.5

16 15 13 12.5 14

TEXTBOOKS 11 9 11

12.5

11 11 14 11

WHAT HAS WORKED FOR YEARS

5 11 6.5

7.5 3 12 4 10

WAYS NURSE HAS ALWAYS DONE IT

12 13 12 10 12.5 15 11 13

FELLOW NURSES 6 5 9

4.5 5.5 6 7 6

INSERVICES IN WORKPLACE

4 3 5 12.5 7 5 3 4.5

POLICY AND PROCEDURE MANUALS

10 10 9 9 10 4 6 8

THE MEDIA 15 16 14.5

14 15 16 16 16

Sources of Practice Knowledge



KUSP RU Studies7 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

Variable

Ideal Score

Predicted Score

Predicted Score

Predicted Score

Predicted Score

Predicted Score

Predicted Score

Predicted Score

Education 100 42.80 51.60 41.40 40.00 48.40 54.00 53.60

Authority 100 63.00 71.50 77.75 63.25 74.00 64.75 74.00

Intent to use RU 100 89.00 88.00 76.50 72.00 76.00 83.50 85.00

Admin. Support 100 71.50 87.25 78.00 58.25 81.00 80.50 71.75

Research Resources 100 44.80 66.20 54.40 13.40 39.20 72.80 70.00

Co-worker Support 100 78.07 83.80 77.80 82.67 90.20 71.73 75.40

Predicted converted RU score 600 389.17 448.35 405.85 329.57 408.80 427.28 429.75

Residual Score 210.83 151.65 194.15 270.43 191.20 172.72 170.25

Predicted RU Score 7 4.54 5.23 4.73 3.84 4.77 4.98 5.01

Predicted Rank 6 1 5 7 4 3 2

Overall RU Rank 6 3 5 7 4 1 2

Unit 4 (Peds)

Unit 5 (Peds)

Unit 6 (Peds)

Unit 7 (Peds)

Ideal Unit

Unit 1 (Adult)

Unit 2 (Adult)

Unit 3 (Peds)

KUSP RU StudiesSocial Interaction Archetype

Environment

Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7

Co-Worker SupportRange: 5-15

Questioning BehaviourRange: 5-15

Valuing Continuing EducationRange: 5-25

Work ValuesRange: 5-20

11.28 12.17 11.92 11.5

18.18 20.04 18.67 18.22

13.07 10.34 11.12

11.52 12.22 12.67 12.5 12.8 11.96 11.5

19.93 19.75 18.29

16.68 17.39 15.25 15.9 16.87 16.46 15.17



Conclusions

Impact of organizational context

Future directions



Organizational Determinants

Kitson, Harvey & McCormack, 1998

McCormack, Kitson, Harvey, Rycroft-Malone, Titchen & Seers, 2002



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

Stages and phases





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





• Organizational approachesPractice environment, context, climate & culture addressed

• Linkages, interactions, social & relational capitol

• KU as an independent variable

• Sustainable, interdisciplinary programs of research

We need . . .



E-Mail us at: [email protected]

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

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