Research Utilization:

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Research Utilization

• The Nursing Knowledge System

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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

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State of the ArtThe Wide and Savage Sea in the
Knowledge Society

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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

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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.

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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.

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State of the Art
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State of the Art
1 Nursing includes knowledge transfer, implementation science, evidence based nursing, patient outcomes. 140
2 Public Health application of case studies, health promotion, theory and implementation gap 13
3 Social Sciences Welfare policy, public organizations, information use in clinical drug studies 11
4 Health Care Sciences International health research, decision making, Critical care 7
5 Rehabilitation professional development, occupational therapy, geriatrics, innovation 7
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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?

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State of the Art

• 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

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State of the Art

• 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

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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.

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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.

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Nursing ResearchClinical Realm

• Funk et al (1991) BARRIERS The Barriers to
  Research Utilization Scale
• Purpose
• Identifying Rogers 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.

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Nursing ResearchBibliometrics

• 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)

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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.

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Nursing ResearchBibliometrics

• 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

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Nursing ResearchBibliometrics

• Other Interesting Results from Meijers 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.

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Nursing ResearchOrganizational 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 characteristicsresponsiveness,
  administration, relational capital, and hospital
  sizepositively, but indirectly, influenced
  nurses research utilization by acting through
  staff development, opportunities for
  nurse-to-nurse collaboration, and staffing and
  support services.

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Nursing ResearchOrganizational 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.

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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

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Nursing ResearchIndividual Determinants

• Estabrooks (1999) Modeling the Individual
  Determinants of Research Utilization
• Purpose
• This studys 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

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Nursing ResearchNursing 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 (RD) Culture
• RD Culture Index developed as means of
  appraising RD 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

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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

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Nursing ResearchResearch 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.

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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?

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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
  splitone or the other, not both
• Application
• Hansens 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

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Knowledge Management

• Dr. Liz Quinlan, Department of Sociology
• With Hansens 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.

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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
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Knowledge Management
Exhaustion
Personalized KM Nurse-to-Nurse Nurse-to-Mgt Nur
se-to-Drs
Patient Outcomes
Innovation
Codified KM
Key Element
Job Satisfaction
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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.
• Studys 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.

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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.

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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.

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Knowledge System

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

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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

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Any Questions?