October 9, 2012 part 1

Abstracts
New KUSP article Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach.
Cranley LA, Norton PG, Cummings GG, Barnard D, Batra-Garga N, Estabrooks CA.
BMC geriatrics 2012 Sep 25;12(1):59

In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants) are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE) project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides) to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. METHODS: The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. RESULTS: Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. CONCLUSIONS: Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

New KUSP article Insights into the impact and use of research results in a residential long-term care facility: a case study.
Cranley LA, Birdsell JM, Norton PG, Morgan DG, Estabrooks CA.
Implementation science : IS 2012 Sep 13;7(1):90

BACKGROUND: Engaging end users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. METHODS: We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. RESULTS: We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides)–what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. CONCLUSIONS: Four themes emerged regarding staff engagement with the research process: sharing feedback reports from the TREC study; the meaning of TREC to staff; understanding organizational context; and using the study feedback for improvement at Restwood. This study has lessons for researchers on how to share research results with study participants, including management.

New KUSP article Feedback reporting of survey data to healthcare aides.
Hutchinson AM, Batra-Garga N, Cranley L, Bostrom AM, Cummings G, Norton P, et al.
Implementation science : IS 2012 Sep 13;7(1):89

BACKGROUND: This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed. METHODS: A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews. RESULTS: One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating. CONCLUSIONS: This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.

New KUSP article Nursing home administrators’ perspectives on a study feedback report: a cross sectional survey.
Bostrom AM, Cranley LA, Hutchinson AM, Cummings GG, Norton PG, Estabrooks CA.
Implementation science : IS 2012 Sep 13;7(1):88

BACKGROUND: This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. METHODS: A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. RESULTS: Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twentytwo indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information. CONCLUSIONS: Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.

New KUSP article Should we feed back research results in the midst of a study?
Estabrooks CA, Teare G, Norton PG.
Implementation science : IS 2012 Sep 13;7(1):87

BACKGROUND: This report is an introduction to a series of three research papers that describe the evolution of the approaches taken by the Translating Research in Elder Care (TREC) research team during its first four years to feed back the research findings to study participants. TREC is an observational multi-method health services research project underway in 36 nursing homes in the prairie provinces of Canada. TREC has actively involved decision makers from the sector in all stages from initial planning, through data collection to dissemination activities. However, it was not planned as a fully integrated knowledge translation project. These three papers describe our progress towards fully integrated knowledge translation–with respect to timely and requested feedback processes. The first paper reports on the process and outcomes of creating and evaluating the feedback of research findings to healthcare aides (unregulated health professionals). These aides provide over 80% of the direct care in our sample and actively requested the feedback as a condition of their continued cooperation in the data acquisition process. The second paper describes feedback from nursing home administrators on preliminary research findings (a facility annual report) and evaluation of the reports’ utility. The third paper discusses an approach to providing a more in-depth form of feedback (expanded feedback report) at one of the TREC nursing homes. FINDINGS: Survey and interview feedback from healthcare aides is presented in the first paper. Overall, healthcare aides’ opinions about presentation of the feedback report and the understand ability, usability, and usefulness of the content were positive. The second paper describes the use of telephone interviews with facility administrators and indicates that the majority of contextual areas (e.g., staff job satisfaction) addressed in facility annual report to be useful, meaningful, and understandable. More than one-half of the administrators would have liked to have received information on additional areas. The third paper explores how a case study that examined how involvement with the TREC study influenced management and staff at one of the TREC nursing homes. The importance of understanding organizational routines and the impact of corporate restructuring were key themes emerging from the case study. In addition, the Director of Care suggested changes to the structure and format of the feedback report that would have improved its usefulness. CONCLUSIONS: We believe that these findings will inform others undertaking integrated knowledge translation activities and will encourage others to become more engaged in feedback processes.

New article by Janet Squires, Ali Hutchinson, and Carole Estabrooks Designing Strategies to Implement Research-Based Policies and Procedures: A Set of Recommendations for Nurse Leaders Based on the PARiHS Framework.
Squires JE, Reay T, Moralejo D, Lefort SM, Hutchinson AM, Estabrooks CA.
J Nurs Adm. 2012 May;42(5):293-7.

Organizational policies and procedures are one vehicle for translating research into nursing practice and improving quality and patient and organizational outcomes. However, their existence alone is not sufficient to ensure use. In this article, we describe the Promoting Action on Research Implementation in Health Services framework and how nurse leaders can use the framework to support the implementation of research-based policies and procedures.

New article by Peter NortonAdvancing knowledge translation in primary care
Menear M, Grindrod K, Clouston K, Norton P, Legare F.
Canadian family physician Medecin de famille canadien 2012 Jun;58(6):623-7, e302-7.

Canada’s premier health research agency, the Canadian Institutes of Health Research (CIHR), has recently committed to helping Canada become an international leader in the generation and translation of high-quality primary health care (PHC) research by 2020.4 In line with this commitment, CIHR hosted a Summer Institute on Primary Health Care Research for Canadian research trainees in June 2010. The Summer Institute’s theme was chosen by CIHR, which then nominated a leader to help organize the meeting. This leader, Dr Peter Norton, created a Steering Committee consisting of 4 other senior PHC researchers (Drs Earl Dunn, Moira Stewart, Rick Glazier, and Fred Tudiver) who together established the meeting’s objectives and design. The result was a 4-day capacity-building initiative that brought together 30 trainees and 13 faculty leaders to focus on the next frontiers in PHC research. Trainees were graduate students, postdoctoral fellows, and clinician scientists (eg, family physicians, nurses, pharmacists), representing a range of disciplines and institutions. Faculty were distinguished researchers in the PHC field and led plenary sessions, directed animated group activities and discussions, and mentored trainees throughout the meeting. Plenary sessions were interactive and allowed trainees and faculty to address many conceptual, methodologic, ethical, and practical issues relevant to PHC research.

New article by Sandy Cobban Using interviews to construct and disseminate knowledge of oral health policy.
Clovis JB, Brillant MG, Matthews DC, Cobban SJ, Romanow PR, Filiaggi MJ, McNally ME.
Int J Dent Hyg. 2012 May;10(2):91-7.

Using interviews to construct and disseminate knowledge of oral health policy. Abstract: Objectives: Policymakers worldwide are challenged by the problem of oral health inequities. The goal of an interprovincial partnership in Canada was to guide policy aimed at improving the oral health of vulnerable populations. Insights regarding barriers and enablers to developing such policy in one province (Newfoundland & Labrador, Canada) were required to enhance collaboration between decision makers and researchers and to contribute to the evidence informing policy development. Methods: Snowball technique identified fourteen key informants. Semistructured audio-recorded interviews were conducted in person or by telephone. Two researchers independently conducted the analyses of the transcribed interviews, one using NVivo software and the second, manual coding. Triangulation of the analyses confirmed the findings. Results: Agreement between the two approaches showed that most key informants believed that oral health is an important policy issue; however, most felt it was not a high priority among the general public and most were unable to articulate the policy process. Barriers to oral health becoming a governmental priority were related to resource allocation and to poor communication among some groups including dentists and dental hygienists. Current government programmes and initiatives were praised but considered weak in health promotion strategies. Recommendations for enhancing oral health priority varied. Conclusions: Attention to the methodological considerations of qualitative research enhanced the credibility of the method and confidence in the findings. Leveraging of existing programmes and improving communication were recommended to contribute to raising the priority of oral health within the government, thereby increasing their commitment to address oral health care, particularly for vulnerable populations.© 2011 John Wiley & Sons A/S.

New article by Janet Squires Knowledge translation of research findings
Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE
Implementation Science 2012, 7:50

One of the most consistent findings from clinical and health services research is the failure to translate research into practice and policy. As a result of these evidence-practice and policy gaps, patients fail to benefit optimally from advances in healthcare and are exposed to unnecessary risks of iatrogenic harms, and healthcare systems are exposed to unnecessary expenditure resulting in significant opportunity costs. Over the last decade, there has been increasing international policy and research attention on how to reduce the evidence-practice and policy gap. In this paper, we summarise the current concepts and evidence to guide knowledge translation activities, defined as T2 research (the translation of new clinical knowledge into improved health). We structure the article around five key questions: what should be transferred; to whom should research knowledge be transferred; by whom should research knowledge be transferred; how should research knowledge be transferred; and, with what effect should research knowledge be transferred?

New article by Susan Slaughter Functional outcomes of nursing home residents in relation to features of the environment: validity of the Professional Environmental Assessment Protocol.
Slaughter SE, Morgan DG.
J Am Med Dir Assoc. 2012 Jun;13(5):487.e1-7.

The aim of this article was to examine associations between specific dimensions of nursing home environments and the functional ability (walking and eating) of residents with dementia, and to contribute to the ongoing psychometric development of the Professional Environmental Assessment Protocol (PEAP). DESIGN: One-year prospective cohort study. SETTING: Fifteen nursing homes in a western Canadian province. PARTICIPANTS: Convenience sample of 120 nursing home residents with middle-stage dementia. MEASUREMENTS: Every 2 weeks we observed residents’ abilities to walk to the dining room and to feed themselves. At the end of a year of observation and immediately following a brief interview with the unit managers, we used the PEAP to measure the extent to which 9 specific dimensions of nursing home environments support the ability of residents with dementia to walk and to eat. Cox proportional hazards models were used to evaluate the effect of specific environmental features on residents’ walking and eating disability. RESULTS: “Support of functional ability” was associated with a reduced hazard of both walking and eating disability. The environmental dimensions of “maximizing awareness and orientation” and better “quality of stimulation” were associated specifically with reduced hazard of walking disability, whereas the dimensions of the nursing home environment specifically associated with a reduced hazard of eating disability included improved “safety and security,” “opportunities for personal control,” and “regulation of stimulation.” The Cox proportional hazards models using the 13-point PEAP scale were not significantly different from nested models using the 5-point PEAP scale, indicating that the 2 scales did not differ in their ability to discriminate between more and less supportive environments for residents with dementia. CONCLUSIONS: Specific dimensions of the nursing home environment reduced the hazard of walking disability, whereas others reduced the hazard of eating disability. Modifying specific features of nursing home environments may reduce disability in nursing home residents with dementia. The 5-point PEAP scale is able to discriminate between nursing home environments as well as the 13-point scale. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

New article by Ali Hutchinson and Lars Wallin Realist synthesis: illustrating the method for implementation research.
Rycroft-Malone J, McCormack B, Hutchinson AM, Decorby K, Bucknall TK, Kent B, Schultz A, Snelgrove-Clarke E, Stetler CB, Titler M, Wallin L, Wilson V.
Implement Sci. 2012 Apr 19;7(1):33.

BACKGROUND: Realist synthesis is an increasingly popular approach to the review and synthesis of evidence, which focuses on understanding the mechanisms by which an intervention works (or not). There are few published examples of realist synthesis. This paper therefore fills a gap by describing, in detail, the process used for a realist review and synthesis to answer the question ‘what interventions and strategies are effective in enabling evidence-informed healthcare?’ The strengths and challenges of conducting realist review are also considered. METHODS: The realist approach involves identifying underlying causal mechanisms and exploring how they work under what conditions. The stages of this review included: defining the scope of the review (concept mining and framework formulation); searching for and scrutinising the evidence; extracting and synthesising the evidence; and developing the narrative, including hypotheses. RESULTS: Based on key terms and concepts related to various interventions to promote evidenceinformed healthcare, we developed an outcome-focused theoretical framework. Questions were tailored for each of four theory/intervention areas within the theoretical framework and were used to guide development of a review and data extraction process. The search for literature within our first theory area, change agency, was executed and the screening procedure resulted in inclusion of 52 papers. Using the questions relevant to this theory area, data were extracted by one reviewer and validated by a second reviewer. Synthesis involved organisation of extracted data into evidence tables, theming and formulation of chains of inference, linking between the chains of inference, and hypothesis formulation. The narrative was developed around the hypotheses generated within the change agency theory area. CONCLUSIONS: Realist synthesis lends itself to the review of complex interventions because it accounts for context as well as outcomes in the process of systematically and transparently synthesising relevant literature. While realist synthesis demands flexible thinking and the ability to deal with complexity, the rewards include the potential for more pragmatic conclusions than alternative approaches to systematic reviewing. A separate publication will report the findings of the review.

CALL FOR ABSTRACTS: 2013 CADTH Symposium Evidence in Context
May 5-7, 2013 St. John’s, NL Deadline Monday October 29, 2012 3 pm MT

The 2013 CADTH Symposium Program Committee invites submissions of abstracts for panel sessions, and oral and poster presentations, related to the theme of Evidence in Context or that are of significant interest to producers and users of evidence-based information and advice on health technologies. The 2013 CADTH Symposium will present success stories and innovative approaches from across the country that are contributing to sustainability of the health system and improved health outcomes. As well, the Symposium will explore ways to maximize pan-Canadian investment in health care.

Grants & Awards
Commonwealth Fund & CHSRF: Harkness Fellowships
Deadline November 19, 2012

The Commonwealth Fund, in collaboration with the Canadian Health Services Research Foundation (CHSRF), invites applications for the Harkness/CHSRF Fellowships in Health Care Policy and Practice. Since 2001, a collaboration with the Canadian Health Services Research Foundation has brought a Canadian perspective to the program. Beginning with the class of 2012, the Commonwealth Fund and Canadian Health Services Research Foundation will co-fund one full time Canadian Harkness Fellowship each year, with the fellow to be tenured in the United States for 12 months. (Please note: this is a change from previous years and only a full-time fellowship will now be offered.) The Harkness Fellowships provide a unique opportunity for mid-career professionals-academic researchers, government policymakers, clinicians, hospital and insurance managers, and journalists-from Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom, to spend up to 12 months in the United States studying a critical issue on the health policy agenda, working with leading U.S. health policy experts, and gaining in-depth knowledge of not only the U.S. health care system, but also those of Fellows’ home countries. Each fellowship will provide up to U.S. $119,000 in support, which includes round trip airfare to the United States, a monthly stipend, travel to a program of Harkness seminars and policy briefings, project-related travel and other research expenses, health insurance, and U.S. taxes. In addition, a supplemental family allowance (e.g., approximately $55,000 for partner and two children up to age 18) is provided to Fellows to cover living expenses, airfare, and health insurance.

Publications

KT

KT
The effect of AIDS Clinical Trials Group Protocol 5164 on the time from Pneumocystis jirovecii pneumonia diagnosis to antiretroviral initiation in routine clinical practice: a case study of diffusion, dissemination, and implementation.
Geng EH, Kahn JS, Chang OC, Hare CB, Christopoulos KA, Jones D, Petersen ML,
Deeks SG, Havlir DV, Gandhi M.
Clin Infect Dis. 2011 Nov;53(10):1008-14. Epub 2011 Sep 29.

Diffusion, dissemination, and implementation of scientific evidence into routine clinical practice is not well understood. The Adult AIDS Clinical Trials Group (ACTG) Protocol 5164 showed that early antiretroviral therapy (ART; ie, within 14 days) after diagnosis of an opportunistic infection improved clinical outcomes, compared with later initiation. Subsequently, the San Francisco General Hospital (SFGH) HIV/AIDS Service performed the SFGH 5164 Initiative to disseminate and implement the findings of ACTG 5164. METHODS: We evaluated patients who received a diagnosis of Pneumocystis jirovecii pneumonia (PCP) from 1 January 2001 through 30 March 2011. Survival analyses were used to assess changes in the time to initiation of ART after PCP, and logistic regression was used to evaluate changes in the odds of early ART (ie, within 14 days) because of ACTG 5164 and SFGH 5164 Initiative. RESULTS: Among 162 patients, the adjusted hazard of ART initiation increased by 3.05 (95% confidence interval [CI], 1.86-5.02) after ACTG 5164 and by 4.89 (95% CI, 2.76-8.67) after the SFGH Initiative, compared with before ACTG 5164. When compared with before ACTG 5164, the proportion of patients who received ART within the 14 days after PCP diagnosis increased from 7.4% to 50.0% (P < .001) after ACTG 5164 and from 50.0% to 83.0% (P = .02) after the SFGH 5164 Initiative. CONCLUSIONS: Diffusion of findings from of a randomized trial changed practice at an academic medical center, but dissemination and implementation efforts were required to establish early ART at acceptable levels. Early ART initiation can be achieved in real-world patient populations.

Evidence-Based Practice and the Use of Information in State Agency Decision Making.
Jennings ET, Hall JL.
Journal of Public Administration Research & Theory 2012 04;22(2):245-266

An essay is presented on the use of information and the evidence-based practice (EBP) in state agency decision making regarding programmatic operations. The authors present a 2008 study which reveals that almost of the state agencies rely on their own walls for information in guiding their policy decisions and program. They also discuss the background of EBP and EB public policy, scientific studies on EBP, and validity and reliability of EB policy.

Mining the Management Literature for Insights into Implementing Evidence-Based Change in Healthcare
Karen Harlos, Jacqueline Tetroe, Ian D Graham, Madeleine Bird and,Nicole Robinson.
Healthcare Policy 2012 08/21;8(1):33-48

Objective: We synthesized the management and health literatures for insights into implementing evidence-based change in healthcare drawn from industry-specific data. Because change principles based on evidence often fail to be translated into organizational practice or policy, we sought studies at the nexus of organizational change and knowledge translation. Methods: We reviewed five top management journals to identify an initial pool of 3,091 studies, which yielded a final sample of 100 studies. Data were abstracted, verified by the original authors and revised before entry into a database. We employed a systematic narrative synthesis approach using words and text to distill data and explain relationships. We categorized studies by varying levels of relevance for knowledge translation as (1) primary, direct; (2) intermediate; and (3) secondary, indirect. We also identified recurring categories of change-related organizational factors. The current analysis examines these factors in studies of primary relevance to knowledge translation, which we also coded for intervention readiness to reflect how readily change can be implemented. Preliminary Results and Conclusions: Results centred on five change-related categories: Tailoring the Intervention Message; Institutional Links/Social Networks; Training; Quality of Work Relationships; and Fit to Organization. In particular, networks across institutional and individual levels appeared as prominent pathways for changing healthcare organizations. Power dynamics, positive social relations and team structures also played key roles in implementing change and translating it into practice. We analyzed journals in which first authors of these studies typically publish, and found evidence that management and health sciences remain divided. Bridging these disciplines through research syntheses promises a wealth of evidence and insights, well worth mining in the search for change that works in healthcare transformation.

Facilitators and barriers to clinical practice guideline use among nurses.
Abrahamson KA, Fox RL, Doebbeling BN.
The American Journal of Nursing 2012 Jul;112(7):26-35;

Clinical practice guidelines, which are designed to encourage consistent, efficient applications of scientific evidence in the daily practice of clinicians, are often underutilized. The majority of research concerning their implementation and use has focused on the work of physicians; more research concerning their use by nurses is needed.
OBJECTIVES: We sought to learn more about nurses’ perceptions of facilitators and barriers to the use of clinical practice guidelines. METHODS: This study examined free-text responses to two open-ended survey questions provided by 575 RNs working at 134 Veterans Affairs medical centers nationwide. We performed conventional content analysis on these data, which allowed thematic categories and subcategories of responses to emerge. RESULTS: A majority of identified facilitators and barriers to nurses’ use of clinical practice guidelines were external (outside the individual nurse’s control). The most frequently mentioned facilitators and barriers were in the categories of communication, education/orientation/training, and time/staffing/workload. CONCLUSIONS: Social and organizational factors appear to play critical roles in nurses’ adoption and use of guidelines. Health care leaders seeking to improve clinical practice guideline use among nurses should ensure that facilitators and barriers-particularly those that are social and organizational-are considered and addressed.

Applying Social Sciences Research for Public Benefit Using Knowledge Mobilization and Social Media
David J. Phipps, Krista E. Jensen and J. Gary Myers. Book chapter in Theoretical and Methodological Approaches to Social Sciences and Knowledge Management Asunción López-Varela (ed).

This book chapter presents three perspectives on knowledge mobilization: 1) Knowledge To Action cycle (Ian Graham and colleagues in Ottawa); 2) Collaborative Entanglement (Bennet & Bennet) and 3) Research Use by Sandra Nutley and colleague from the Research Unit for Research Utilization, University of Edinburgh. We challenged each of these three perspectives but chose them because they each built on the other conceptually drawing the reader into deeper and more contextualized understandings of the subject but concluded that there were three take away messages from these literature reviews: (1)Knowledge Mobilization (KMb) is a social process (2)Efforts to enhance KMb need to be interactive and focus on the relationships between researchers and decision makers (3)KMb happens at the level of the individual and is only beginning to emerge at the organization and the system/sectoral level.

Evidence-based practice models for organizational change: overview and practical applications.
Schaffer MA, Sandau KE, Diedrick L.
Journal of advanced nursing 2012 Aug 9

To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature. BACKGROUND: The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting. DATA SOURCES: The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of ‘evidence’, ‘evidence-based practice’, ‘models’, ‘nursing’ and ‘research’; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice. DISCUSSION: Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change. IMPLICATIONS FOR NURSING: The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting. CONCLUSION: The Johns Hopkins Model and the Academic Center for Evidence-Based Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change. © 2012 Blackwell Publishing Ltd.

Clinical nurses’ attitudes towards research, management and organisational resources in a university hospital: part 1.
Akerjordet K, Lode K, Severinsson E.
Journal of nursing management 2012 Sep;20(6):814-823

The aim of this study was to determine clinical nurses’ interest in and motivation for research. An additional aim was to identify management and organisational resources in order to improve nurses’ research capacity in practice. BACKGROUND: Clinical nurses find conducting research challenging, which accords with observations of the continuing research-practice gap. METHODS: This descriptive cross-sectional survey sampled 364 clinical nurses from a university hospital on the west coast of Norway. RESULTS: The response rate was 61%. An increasingly positive attitude towards research emerged (40%), despite the fact that few were engaged in research-based activities. Clinical nurses emphasised that lack of designated time (60%), interest (31%) and knowledge (31%) constituted important research barriers, as did lack of research supervision and support (25%). Research supervision was one of the most significant needs to enhance clinical nurses’ research skills, management and organisation of research activities (30%). CONCLUSION: Conscious efforts strategically built on clinical and academic collaborative networks are required to promote and sustain clinical nurses’ research capacity. IMPLICATION FOR NURSING MANAGEMENT: The findings of this survey should be useful in the building of clinical nurses’ research capacity. © 2012 Blackwell Publishing Ltd.

An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.
Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, et al.
Implementation science : IS 2012 May 24;7(1):48

BACKGROUND: Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. Methods and design The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 21 intervention, n = 19 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed [greater than or equal to]800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D ([greater than or equal to]800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION: Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC. Trial registration ClinicalTrials.gov NCT01398527.

Translation and validation of two evidence-based nursing practice instruments.
Thorsteinsson HS.
International nursing review 2012 Jun;59(2):259-265

Using existing instruments when assessing nurses’ readiness for evidence-based practice facilitates comparison of research findings and adds to nursing knowledge in a global context. AIM: The study aims to: (1) translate the Information Literacy for Evidence Based Nursing Practice(©) (ILNP(©)) questionnaire and the Evidence-based Practice Beliefs Scale(©) (EBP Beliefs Scale(©)), (2) assess their appropriateness for use in Iceland, and 3) estimate the psychometric properties of the translated EBP Beliefs Scale [Icelandic-EBP Beliefs Scale (I-EBP Beliefs Scale)]. METHODS: The instruments were evaluated for appropriateness and relevancy before translation, and the ILNP(©) was modified to fit the Icelandic context. Translation followed recommended approaches, including back-translation. Pilot testing of both instruments ensued. A random sample of 540 nurses answered and returned the questionnaires. Reliability and validity of the I-EBP Beliefs Scale were tested on 471 complete I-EBP Beliefs Scale. Data were collected in 2007. RESULTS: The translated instruments demonstrated clarity and conciseness; however, the ILNP(©) needed to be further modified. For the I-EBP Beliefs Scale, Cronbach’s α was 0.86 and Spearman-Brown r was 0.87. Principal components analysis supported the I-EBP Beliefs Scale’s construct validity and unidimensional structure. Criterion validity was established by known-groups comparison (t-tests and one-way analyses of variance). CONCLUSIONS: The ILNP(©) and the EBP Beliefs Scale(©) can be used in contexts other than those for which they were developed. The I-EBP Scale is a psychometrically sound instrument and its performance supports the validity of the original scale. The instruments can be used to gather valuable information about nurses’ readiness for evidence-based practice. © 2012 The Author. International Nursing Review © 2012 International Council of Nurses.

Information seeking for making evidence-informed decisions: a social network analysis on the staff of a public health department in Canada.
Yousefi-Nooraie R, Dobbins M, Brouwers M, Wakefield P.
BMC health services research 2012 May 16;12(1):118

Social network analysis is an approach to study the interactions and exchange of resources among people. It can help understanding the underlying structural and behavioral complexities that influence the process of capacity building towards evidence-informed decision making. A social network analysis was conducted to understand if and how the staff of a public health department in Ontario turn to peers to get help incorporating research evidence into practice. METHODS: The staff were invited to respond to an online questionnaire inquiring about information seeking behavior, identification of colleague expertise, and friendship status. Three networks were developed based on the 170 participants. Overall shape, key indices, the most central people and brokers, and their characteristics were identified. RESULTS: The network analysis showed a low density and localized information-seeking network. Interpersonal connections were mainly clustered by organizational divisions; and people tended to limit information-seeking connections to a handful of peers in their division. However, recognition of expertise and friendship networks showed more cross-divisional connections. Members of the office of the Medical Officer of Health were located at the heart of the department, bridging across divisions. A small group of professional consultants and middle managers were the most-central staff in the network, also connecting their divisions to the center of the information-seeking network. In each division, there were some locally central staff, mainly practitioners, who connected their neighboring peers; but they were not necessarily connected to other experts or managers. CONCLUSIONS: The methods of social network analysis were useful in providing a systems approach to understand how knowledge might flow in an organization. The findings of this study can be used to identify early adopters of knowledge translation interventions, forming Communities of Practice, and potential internal knowledge brokers.

Effectiveness of organisational infrastructures to promote evidence-based nursing practice.
Flodgren G, Rojas-Reyes MX, Cole N, Foxcroft DR.
Cochrane database of systematic reviews (Online) 2012 Feb 15;2:CD002212

Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. OBJECTIVES: To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011.We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations. SELECTION CRITERIA: We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3, 6, 12 and 24 months follow-up. MAIN RESULTS: We included one study from the USA (re-analysed as an ITS) involving one hospital and an unknown number of nurses and patients. The study evaluated the effects of a standardised evidence-based nursing procedure on nursing care for patients at risk of developing healthcare-acquired pressure ulcers (HAPUs). If a patient’s admission Braden score was below or equal to 18 (i.e. indicating a high risk of developing pressure ulcers), nurses were authorised to initiate a pressure ulcer prevention bundle (i.e. a set of evidence-based clinical interventions) without waiting for a physician order. Re-analysis of data as a time series showed that against a background trend of decreasing HAPU rates, if that trend was assumed to be real, there was no evidence of an intervention effect at three months (mean rate per quarter 0.7%; 95% confidence interval (CI) 1.7 to 3.3; P = 0.457). Given the small percentages post intervention it was not statistically possible to extrapolate effects beyond three months. AUTHORS’ CONCLUSIONS: Despite extensive searching of published and unpublished research we identified only one low-quality study; we excluded many studies due to non-eligible study design. If policy-makers and healthcare organisations wish to promote evidence-based nursing successfully at an organisational level, they must ensure the funding and conduct of well-designed studies to generate evidence to guide policy

Tracking and understanding the utility of Cochrane reviews for public health decision-making.
Armstrong R, Pettman T, Burford B, Doyle J, Waters E.
Journal of public health (Oxford, England) 2012 Jun;34(2):309-313.

Cochrane reviews aim to support policy and practice decisions. Developing systematic strategies to understand the pathway from their production to actually making a difference in practice is difficult but extremely valuable. Such an exercise can help to determine meaningfulness of the reviews, identify their use in highlighting the spectrum of the primary evidence, flag opportunities to update and stimulate research gap analyses. This paper briefly describes our emerging approach to tracking and understanding the use, and usefulness, of published Cochrane Public Health Group (CPHG) reviews to date.

Exploring sources of knowledge utilized in practice among Jordanian registered nurses.
Al-Ghabeesh SH, Abu-Moghli F, Salsali M, Saleh M.
Journal of evaluation in clinical practice 2012 May 29

Rationale, aims and objectives  Understanding sources of knowledge used in everyday practice is very helpful in improving the quality of health care services. There is a consensus in the literature that nurses mostly relied in their practice on experiential knowledge gained through their interactions with other members of health care professionals and patients. The general aim of this study is to explore the sources of knowledge Jordanian registered nurses use during their practice. Method  A descriptive correlational design was used to collect data from 539 Jordanian registered nurses from 10 hospitals using a self-administered questionnaire. Results  The mean year of experience of the sample was 7.08 years. Of the 615 questionnaires distributed, 555 were returned. This yields a response rate of 87.6%. Results revealed that the top five ranked sources used by Jordanian registered nurses include: the information that nurses learned during nursing education, personal experience in nursing over time, what was learned through providing care to patients, information gained through discussion between physicians and nurses about patients, and information from policy and procedure manuals. Conclusion  Jordanian registered nurses recognize the value of research and that research utilization (RU) is an important issue and must not be ignored. The study has many implications for practice, education and research. Health care managers and decision makers need to play a more visible and instrumental role in encouraging RU to improve patients’ quality of life. © 2012 Blackwell Publishing Ltd.

Practice-based evidence and qualitative inquiry.
Leeman J, Sandelowski M.
Journal of nursing scholarship 2012 Jun;44(2):171-179

Nurses and other healthcare providers continue to underuse interventions demonstrated to be effective at improving health outcomes. We propose in this article that if more evidence-based practice is wanted, greater use must be made of qualitative inquiry to obtain practice-based evidence derived from the experiences and practices of healthcare providers and the contexts of healthcare provision. APPROACH: We present a framework for the use of qualitative methods to contribute to the following categories of practice-based evidence: (a) practice-based interventions and implementation strategies, (b) causal mechanisms, (c) approaches to adaptation, (d) how-to guidance, (e) unanticipated effects, and (f) relevant contextual factors. CONCLUSIONS: Qualitative inquiry has an essential role to play in incorporating more practice-based evidence into the evidence base for nursing practice. CLINICAL RELEVANCE: This framework can be used by clinicians to plan for the implementation of interventions in practice, by researchers to discuss the practice implications of their findings, and by researchers to launch qualitative studies explicitly designed to capture practice-based evidence. © 2012 Sigma Theta Tau International.

CHSRF’s Knowledge Brokering Program: A Review of Conditions and Context for Success
May 2012

Between 2004 and 2007, the Canadian Health Services Research Foundation (CHSRF) funded a Knowledge Brokering Demonstration Site Program (hereafter, KB program). The program provided funding support to six healthcare organizations to pilot innovative approaches in the field of knowledge brokering. All six healthcare organizations were supported in hiring staff specialized in the promotion of evidence-based decision-making. The role of the “knowledge brokers” was largely focused on bringing researchers, managers, and decision-makers together to engage in collaborative problem solving. The budget for the KB program totaled $1, 400,000 over the three-year period. This review provides a description of the ways in which the hired knowledge brokers facilitated the use of research evidence in decision-making processes of each healthcare organization funded under the KB program. It finds that targeted investment in knowledge brokering can offer some promise in promoting evidence-based decision-making among frontline staff and middle- and senior-level leaders of healthcare organizations. The key conditions and context for success as they arose in this initiative include:

• solid leadership and commitment from senior management
• dedicated resources
• clear objectives and good project management and evaluation
• flexibility and variation in tools and approaches, and
• persistent effort throughout the project.

Understanding the performance and impact of public knowledge translation funding interventions: Protocol for an evaluation of Canadian institutes of health research knowledge translation funding programs.
McLean RK, Graham ID, Bosompra K, Choudhry Y, Coen SE, Macleod M, et al.
Implementation science : IS 2012 Jun 22;7(1):57

BACKGROUND: The Canadian Institutes of Health Research (CIHR) has defined knowledge translation (KT) as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities. DESIGN: The study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement. DISCUSSION: The protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding interventions, and how KT can best be evaluated.

Leadership facilitation strategies to establish evidence-based practice in an acute care hospital.
Hauck S, Winsett RP, Kuric J.
Journal of advanced nursing 2012 Jun 15

Aim.  To assess the impact of leadership facilitation strategies on nurses’ beliefs of the importance and frequency of using evidence in daily nursing practice and the perception of organizational readiness in an acute care hospital. Background.  Integrating evidence in practice is a prominent issue for hospital nursing as knowledge and skills, beliefs, organizational infrastructure and nursing leadership must all be addressed. Design.  Prospective, descriptive comparative. Method.  Three surveys were used in this prospective descriptive comparative study. Evidence-Based Practice Beliefs Scale, the Implementation Scale and Organizational Culture & Readiness for System-Wide Integration Survey measured change before and after facilitating strategies for evidence-based practice enculturation. Data were collected in December 2008 (N = 427) and in December 2010 (N = 469). Results.  Leadership facilitated infrastructure development in three major areas: incorporating evidence-based practice outcomes in the strategic plan; supporting mentors; and advocating for resources for education and outcome dissemination. With the interventions in place, the total group scores for beliefs and organizational readiness improved significantly. Analyses by job role showed that direct care nurses scores improved more than other role types. No differences were found in the implementation scores. Conclusion.  Successful key strategies were evidence-based practice education and establishing internal opportunities to disseminate findings. Transformational nursing leadership drives organizational change and provides vision, human and financial resources and time that empowers nurses to include evidence in practice. © 2012 Blackwell Publishing Ltd.

Use of health systems evidence by policymakers in eastern Mediterranean countries: views, practices, and contextual influences.
El-Jardali F, Lavis JN, Ataya N, Jamal D, Ammar W, Raouf S.
BMC health services research 2012 Jul 16;12:200

Health systems evidence can enhance policymaking and strengthen national health systems. In the Middle East, limited research exists on the use of evidence in the policymaking process. This multi-country study explored policymakers’ views and practices regarding the use of health systems evidence in health policymaking in 10 eastern Mediterranean countries, including factors that influence health policymaking and barriers and facilitators to the use of evidence. METHODS: This study utilized a survey adapted and customized from a similar tool developed in Canada. Health policymakers from 10 countries (Algeria, Bahrain, Jordan, Lebanon Oman, Pakistan, Palestine, Sudan, Tunisia, and Yemen) were surveyed. Descriptive and bi-variate analyses were performed for quantitative questions and thematic analysis was done for qualitative questions. RESULTS: A total of 237 policymakers completed the survey (56.3% response rate). Governing parties, limited funding for the health sector and donor organizations exerted a strong influence on policymaking processes. Most (88.5%) policymakers reported requesting evidence and 43.1% reported collaborating with researchers. Overall, 40.1% reported that research evidence is not delivered at the right time. Lack of an explicit budget for evidence-informed health policymaking (55.3%), lack of an administrative structure for supporting evidence-informed health policymaking processes (52.6%), and limited value given to research (35.9%) all limited the use of research evidence. Barriers to the use of evidence included lack of research targeting health policy, lack of funding and investments, and political forces. Facilitators included availability of health research and research institutions, qualified researchers, research funding, and easy access to information. CONCLUSIONS: Health policymakers in several countries recognize the importance of using health systems evidence. Study findings are important in light of changes unfolding in some Arab countries and can help undertake an analysis of underlying transformations and their respective health policy implications including the way evidence will be used in policy decisions.

Measurement properties of a novel survey to assess stages of organizational readiness for evidence-based interventions in community chronic disease prevention settings.
Stamatakis KA, McQueen A, Filler C, Boland E, Dreisinger M, Brownson RC, et al.
Implementation science : IS 2012 Jul 16;7:65

There is a great deal of variation in the existing capacity of primary prevention programs and policies addressing chronic disease to deliver evidence-based interventions (EBIs). In order to develop and evaluate implementation strategies that are tailored to the appropriate level of capacity, there is a need for an easy-to-administer tool to stage organizational readiness for EBIs. METHODS: Based on theoretical frameworks, including Rogers’ Diffusion of Innovations, we developed a survey instrument to measure four domains representing stages of readiness for EBI: awareness, adoption, implementation, and maintenance. A separate scale representing organizational climate as a potential mediator of readiness for EBIs was also included in the survey. Twenty-three questions comprised the four domains, with four to nine items each, using a seven-point response scale. Representatives from obesity, asthma, diabetes, and tobacco prevention programs serving diverse populations in the United States were surveyed (N = 243); test-retest reliability was assessed with 92 respondents. RESULTS: Confirmatory factor analysis (CFA) was used to test and refine readiness scales. Test-retest reliability of the readiness scales, as measured by intraclass correlation, ranged from 0.47-0.71. CFA found good fit for the five-item adoption and implementation scales and resulted in revisions of the awareness and maintenance scales. The awareness scale was split into two two-item scales, representing community and agency awareness. The maintenance scale was split into five- and four-item scales, representing infrastructural maintenance and evaluation maintenance, respectively. Internal reliability of scales (Cronbach’s α) ranged from 0.66-0.78. The model for the final revised scales approached good fit, with most factor loadings >0.6 and all >0.4. CONCLUSIONS: The lack of adequate measurement tools hinders progress in dissemination and implementation research. These preliminary results help fill this gap by describing the reliability and measurement properties of a theory-based tool; the short, user-friendly instrument may be useful to researchers and practitioners seeking to assess organizational readiness for EBIs across a variety of chronic disease prevention programs and settings.

Translating research into practice: the role of provider-based research networks in the diffusion of an evidence-based colon cancer treatment innovation.
Carpenter WR, Meyer AM, Wu Y, Qaqish B, Sanoff HK, Goldberg RM, et al.
Medical care 2012 Aug;50(8):737-748

Provider-based research networks (PBRNs)–collaborative research partnerships between academic centers and community-based practitioners–are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute’s (NCI’s) Community Clinical Oncology Program (CCOP)–a nationwide cancer-focused PBRN–is associated with accelerated innovation adoption. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin’s Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education. RESULTS: Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically. CONCLUSIONS: These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research policy.

The Effect of a Translating Research into Practice (TRIP)-Cancer Intervention on Cancer Pain Management in Older Adults in Hospice.
Herr K, Titler M, Fine PG, Sanders S, Cavanaugh JE, Swegle J, et al.
Pain medicine (Malden, Mass.) 2012 Aug;13(8):1004-1017

Background.  Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain-free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective.  This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence-based pain practices for older adults with cancer in community-based hospices. Setting.  This Institutional Human Subjects Review Board-approved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. Methods.  Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results.  Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence-based practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to post-intervention in the experimental group was greater; however, the result was not statistically significant (P = 0.1032). Conclusions.  Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a community-based hospice intervention, including determining and measuring intervention fidelity prospectively. Wiley Periodicals, Inc.

Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities.
Gaskin S, Georgiou A, Barton D, Westbrook J.
BMC geriatrics 2012 Aug 2;12:40-2318-12-40

The provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals. METHODS: A survey of staff (n = 119), including managers, health informatics officers (HIOs), quality improvement staff, registered nurses (RNs), enrolled nurses (ENs)/endorsed enrolled nurses (EENs) and assistants in nursing (AINs) was carried out in four residential aged care facilities in New South Wales and Victoria, Australia. Sites varied in size and displayed a range of information technology (IT) capabilities. The survey investigated how and by whom information is collected, retrieved and exchanged, and the frequency and amount of time devoted to these tasks. Descriptive analysis was performed using SPSS, and open responses to questions were coded into key themes. RESULTS: Staff completed a median of six forms each, taking a median of 30 min per shift. 68.8% of staff reported transferring information from paper to a computer system, which took a median of 30 min per shift. Handover and face-to-face communication was the most frequently used form of information exchange within facilities. There was a large amount of faxing and telephone communication between facility staff and General Practitioners and community pharmacists, with staff reporting sending a median of 2 faxes to pharmacy and 1.5 faxes to General Practitioners, and initiating 2 telephone calls to pharmacies and 1.5 calls to General Practitioners per shift. Only 38.5% of respondents reported that they always had information available at the point-of-care and only 35.4% of respondents reported that they always had access to hospital stay information of residents after hospital discharge. CONCLUSIONS: This survey identified a high volume of information exchange activities, as well as inefficient procedures, such as the transfer of information from paper to computer systems and the reliance upon faxes for communication with external providers. These findings contribute to evidence for the need for interoperable IT systems to allow more efficient and reliable information exchange between facilities and external providers.

Overcoming barriers to research utilization and evidence-based practice among staff nurses.
Grant HS, Stuhlmacher A, Bonte-Eley S.
Journal for nurses in staff development 2012 Jul;28(4):163-165

Several barriers exist to research utilization among staff nurses. Two barriers that appear in the research are lack of knowledge about research utilization and perceived lack of organizational support. The goal of this article is to present recommendations to overcome these barriers so that staff development educators can promote research utilization and evidence-based practice.

Translating research findings into practice – the implementation of kangaroo mother care in Ghana.
Bergh AM, Manu R, Davy K, van Rooyen E, Asare GQ, Williams JK, et al.
Implementation science : IS 2012 Aug 13;7:75

Kangaroo mother care (KMC) is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival. Many countries find it difficult to take KMC to scale in healthcare facilities providing newborn care. KMC Ghana was an initiative to scale up KMC in four regions in Ghana. Research findings from two outreach trials in South Africa informed the design of the initiative. Two key points of departure were to equip healthcare facilities that conduct deliveries with the necessary skills for KMC practice and to single out KMC for special attention instead of embedding it in other newborn care initiatives. This paper describes the contextualisation and practical application of previous research findings and the results of monitoring the progress of the implementation of KMC in Ghana. METHODS: A three-phase outreach intervention was adapted from previous research findings to suit the local setting. A more structured system of KMC regional steering committees was introduced to drive the process and take the initiative forward. During Phase I, health workers in regions and districts were oriented in KMC and received basic support for the management of the outreach. Phase II entailed the strengthening of the regional steering committees. Phase III comprised a more formal assessment, utilising a previously validated KMC progress-monitoring instrument. RESULTS: Twenty-six out of 38 hospitals (68 %) scored over 10 out of 30 and had reached the level of ‘evidence of practice’ by the end of Phase III. Seven hospitals exceeded expected performance by scoring at the level of ‘evidence of routine and institutionalised practice.’ The collective mean score for all participating hospitals was 12.07. Hospitals that had attained baby-friendly status or had been re-accredited in the five years before the intervention scored significantly better than the rest, with a mean score of 14.64. CONCLUSION: The KMC Ghana initiative demonstrated how research findings regarding successful outreach for the implementation of KMC could be transferred to a different context by making context-appropriate adaptations to the model.

Digging into construction: social networks and their potential impact on knowledge transfer.
Carlan NA, Kramer DM, Bigelow P, Wells R, Garritano E, Vi P.
Work (Reading, Mass.) 2012;42(2):223-232

A six-year study is exploring the most effective ways to disseminate ideas to reduce musculoskeletal disorders (MSDs) in the construction sector. The sector was targeted because MSDs account for 35% of all lost time injuries. This paper reports on the organization of the construction sector, and maps potential pathways of communication, including social networks, to set the stage for future dissemination. PARTICIPANTS: The managers, health and safety specialists, union health and safety representatives, and 28 workers from small, medium and large construction companies participated. METHODS: Over a three-year period, data were collected from 47 qualitative interviews. Questions were guided by the PARIHS (Promoting Action on Research Implementation in Health Services) knowledge-transfer conceptual framework and adapted for the construction sector. FINDINGS: The construction sector is a complex and dynamic sector, with non-linear reporting relationships, and divided and diluted responsibilities. Four networks were identified that can potentially facilitate the dissemination of new knowledge: worksite-project networks; union networks; apprenticeship program networks; and networks established by the Construction Safety Association/Infrastructure Health and Safety Association. CONCLUSIONS: Flexible and multi-directional lines of communication must be used in this complex environment. This has implications for the future choice of knowledge transfer strategies.

Social network analysis in healthcare settings: a systematic scoping review.
Chambers D, Wilson P, Thompson C, Harden M.
PloS one 2012;7(8):e41911

Social network analysis (SNA) has been widely used across a range of disciplines but is most commonly applied to help improve the effectiveness and efficiency of decision making processes in commercial organisations. We are utilising SNA to inform the development and implementation of tailored behaviour-change interventions to improve the uptake of evidence into practice in the English National Health Service. To inform this work, we conducted a systematic scoping review to identify and evaluate the use of SNA as part of an intervention to support the implementation of change in healthcare settings. METHODS AND FINDINGS: We searched ten bibliographic databases to October 2011. We also searched reference lists, hand searched selected journals and websites, and contacted experts in the field. To be eligible for the review, studies had to describe and report the results of an SNA performed with healthcare professionals (e.g. doctors, nurses, pharmacists, radiographers etc.) and others involved in their professional social networks. We included 52 completed studies, reported in 62 publications. Almost all of the studies were limited to cross sectional descriptions of networks; only one involved using the results of the SNA as part of an intervention to change practice. CONCLUSIONS: We found very little evidence for the potential of SNA being realised in healthcare settings. However, it seems unlikely that networks are less important in healthcare than other settings. Future research should seek to go beyond the merely descriptive to implement and evaluate SNA-based interventions.

Knowledge translation efforts in child and youth mental health: a systematic review.
Barwick MA, Schachter HM, Bennett LM, McGowan J, Ly M, Wilson A, et al.
Journal of evidence-based social work 2012;9(4):369-395

The availability of knowledge translation strategies that have been empirically studied and proven useful is a critical prerequisite to narrowing the research-to-practice gap in child and youth mental health. Through this review the authors sought to determine the current state of scientific knowledge of the effectiveness of knowledge translation approaches in child and youth mental health by conducting a systematic review of the research evidence. The findings and quality of the 12 included studies are discussed. Future work of high methodological quality that explores a broader range of knowledge translation strategies and practitioners to which they are applied and that also attends to implementation process is recommended.

Knowledge translation: principles and practicalities for trainees within interdisciplinary health research teams.
Collisson BA, Benzies K, Mosher AA, Rainey KJ, Tanaka S, Tracey C, et al.
Clinical and investigative medicine.Medecine clinique et experimentale 2011 Dec 1;34(6):E336

Within a dynamic health research environment with trends toward increasing accountability, governments and funding agencies have placed increased emphasis on knowledge translation (KT) as a way to optimize the impact of research investments on health outcomes, research products and health service delivery. As a result, there is an increasing need for familiarity with the principles of KT frameworks and components of KT strategies. Accordingly, health research trainees (graduate students and post-doctoral fellows) must be supported to enhance their capacity to understand KT principles and the practicalities of implementing effective KT practices.In this paper, the unique opportunities and challenges that trainees within an interdisciplinary research team encounter when they begin to understand and apply constructive and relevant KT practices are considered. Our commentary is based on trainee experiences within the Preterm Birth and Healthy Outcomes Team (PreHOT), an interdisciplinary research team.

A framework for production of systematic review based briefings to support evidence-informed decision-making
Chambers D, Wilson P.
Systematic reviews 2012 Jul 9;1(1):32

We have developed a framework for translating existing sources of synthesized and quality-assessed evidence, primarily systematic reviews, into actionable messages in the form of short accessible briefings. The service aims to address real-life problems in response to requests from decision-makers.Development of the framework was based on a scoping review of existing resources and our initial experience with two briefing topics, including models of service provision for young people with eating disorders. We also drew on previous experience in dissemination research and practice. Where appropriate, we made use of the SUPporting POlicy relevant Reviews and Trials (SUPPORT) tools for evidence-informed policymaking. FINDINGS: To produce a product that it is fit for this purpose it has been necessary to go beyond a traditional summary of the available evidence relating to effectiveness. Briefings have, therefore, included consideration of cost effectiveness, local applicability, implications relating to local service delivery, budgets, implementation and equity. Our first evidence briefings produced under this framework cover diagnostic endoscopy by specialist nurses and integrated care pathways in mental healthcare settings. CONCLUSIONS: The framework will enable researchers to present and contextualize evidence from systematic reviews and other sources of synthesized and quality-assessed evidence. The approach is designed to address the wide range of questions of interest to decision-makers, especially those commissioning services or managing service delivery and organization in primary or secondary care. Evaluation of the use and usefulness of the evidence briefings we produce is an integral part of the framework and will help to fill a gap in the literature.

Barriers to GPs’ use of evidence-based medicine: a systematic review.
Zwolsman S, te Pas E, Hooft L, Wieringa-de Waard M, van Dijk N.
The British journal of general practice : the journal of the Royal College of General Practitioners 2012 Jul;62(600):e511-21

GPs report various barriers to the use and practice of evidence-based medicine (EBM). A review of research on these barriers may help solve problems regarding the uptake of evidence in clinical outpatient practice. AIM: To determine the barriers encountered by GPs in the practice of EBM and to come up with solutions to the barriers identified. DESIGN: A systematic review of the literature. METHOD: The following databases were searched: MEDLINE (PubMed), Embase, CINAHL, ERIC, and the Cochrane Library, until February 2011. Primary studies (all methods, all languages) that explore the barriers that GPs encounter in the practice of EBM were included. RESULTS: A total of 14 700 articles were identified, of which 22 fulfilled all inclusion criteria. Of the latter, nine concerned qualitative, 12 concerned quantitative, and one concerned both qualitative and quantitative research methods. The barriers described in the articles cover the categories: evidence (including the accompanying EBM steps), the GP’s preferences (experience, expertise, education), and the patient’s preferences. The particular GP setting also has important barriers to the use of EBM. Barriers found in this review, among others, include lack of time, EBM skills, and available evidence; patient-related factors; and the attitude of the GP. CONCLUSION: Various barriers are encountered when using EBM in GP practice. Interventions that help GPs to overcome these barriers are needed, both within EBM education and in clinical practice.

A pragmatic cluster randomised trial evaluating three implementation interventions.
Rycroft-Malone J, Seers K, Crichton N, Chandler J, Hawkes CA, Allen C, et al.
Implementation science : IS 2012 Aug 30;7:80

Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. METHODS: A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients’ experiences, and stakeholders’ experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. RESULTS: Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. CONCLUSIONS: This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions’ impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. TRIAL REGISTRATION: ISRCTN18046709 – Peri-operative Implementation Study Evaluation (POISE).

Bridging research and practice: models for dissemination and implementation research.
Tabak RG, Khoong EC, Chambers DA, Brownson RC.
American Journal of Preventive Medicine 2012 Sep;43(3):337-350

Theories and frameworks (hereafter called models) enhance dissemination and implementation (D &I) research by making the spread of evidence-based interventions more likely. This work organizes and synthesizes these models by (1) developing an inventory of models used in D&I research; (2) synthesizing this information; and (3) providing guidance on how to select a model to inform study design and execution. EVIDENCE ACQUISITION: This review began with commonly cited models and model developers and used snowball sampling to collect models developed in any year from journal articles, presentations, and books. All models were analyzed and categorized in 2011 based on three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities (D/I), and the socioecologic framework (SEF) level. Five-point scales were used to rate construct flexibility from broad to operational and D/I activities from dissemination-focused to implementation-focused. All SEF levels (system, community, organization, and individual) applicable to a model were also extracted. Models that addressed policy activities were noted. EVIDENCE SYNTHESIS: Sixty-one models were included in this review. Each of the five categories in the construct flexibility and D/I scales had at least four models. Models were distributed across all levels of the SEF; the fewest models (n=8) addressed policy activities. To assist researchers in selecting and utilizing a model throughout the research process, the authors present and explain examples of how models have been used. CONCLUSIONS: These findings may enable researchers to better identify and select models to inform their D&I work. Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.

The evaluation of an interdisciplinary pain protocol in long term care.
Kaasalainen S, Brazil K, Akhtar-Danesh N, Coker E, Ploeg J, Donald F, et al.
Journal of the American Medical Directors Association 2012 Sep;13(7):664.e1-664.e8

To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents. DESIGN: A controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data. SETTING: Four LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group. PARTICIPANTS: Data were collected from 200 LTC residents; 99 for the intervention and 101 for the control group. INTERVENTION: Implementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities. MEASUREMENTS: Resident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews. RESULTS: Pain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol. CONCLUSIONS: These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents. Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Barriers to the uptake of evidence from systematic reviews and meta-analyses: a systematic review of decision makers’ perceptions.
Wallace J, Nwosu B, Clarke M.
BMJ open 2012 Sep 1;2(5):10.1136/bmjopen-2012-001220.

To review the barriers to the uptake of research evidence from systematic reviews by decision makers. SEARCH STRATEGY: We searched 19 databases covering the full range of publication years, utilised three search engines and also personally contacted investigators. Reference lists of primary studies and related reviews were also consulted. SELECTION CRITERIA: Studies were included if they reported on the views and perceptions of decision makers on the uptake of evidence from systematic reviews, meta-analyses and the databases associated with them. All study designs, settings and decision makers were included. One investigator screened titles to identify candidate articles then two reviewers independently assessed the quality and the relevance of retrieved reports. DATA EXTRACTION: Two reviewers described the methods of included studies and extracted data that were summarised in tables and then analysed. Using a pre-established taxonomy, the barriers were organised into a framework according to their effect on knowledge, attitudes or behaviour. RESULTS: Of 1726 articles initially identified, we selected 27 unique published studies describing at least one barrier to the uptake of evidence from systematic reviews. These studies included a total of 25 surveys and 2 qualitative studies. Overall, the majority of participants (n=10 218) were physicians (64%). The most commonly investigated barriers were lack of use (14/25), lack of awareness (12/25), lack of access (11/25), lack of familiarity (7/25), lack of usefulness (7/25), lack of motivation (4/25) and external barriers (5/25). CONCLUSIONS: This systematic review reveals that strategies to improve the uptake of evidence from reviews and meta-analyses will need to overcome a wide variety of obstacles. Our review describes the reasons why knowledge users, especially physicians, do not call on systematic reviews. This study can inform future approaches to enhancing systematic review uptake and also suggests potential avenues for future investigation.

Cognizance and consultation of randomized controlled trials among ministerial policy analysts
Bédard P-, Ouimet M.
Review of Policy Research 2012;29(5):625-644

Consultation of scientific evidence by policy actors has been the foci of attention of knowledge utilization scholars for decades. The present study questioned the extent to which randomized controlled trials (RCTs)-generally seen as the gold standard of scientific research-are known and consulted by policy analysts in ministerial settings. Using cross-sectional data collected in 17 ministries in Québec (Canada), our study showed that fairly high levels of policy analysts report never having heard of RCTs, thus possibly hindering effective communication of scientific results to relevant policy makers. Statistical analyses reveal the importance of cognitive factors in explaining both phenomena. © 2012 by The Policy Studies Organization.

Arts-informed research dissemination: Patients’ perioperative experiences of open-heart surgery.
Lapum J, Church K, Yau T, David AM, Ruttonsha P.
Heart & lung : the journal of critical care 2012 Sep;41(5):e4-e14

The integration of humanistic approaches, in which patients’ personal experiences are acknowledged and inform practice, is integral to optimal healthcare. OBJECTIVES: In this study, we used an arts-informed narrative approach to understand and highlight the experiential and subjective qualities of illness and recovery from heart surgery. METHODS: An arts-informed analysis was conducted and we represented participants’ stories of open-heart surgery through the media of poetry and photographic images. RESULTS: By using the arts as a method for analysis and dissemination, patients’ unique and deeply personal experiences of heart surgery were illuminated. CONCLUSIONS: The arts can be particularly beneficial in healthcare and cardiovascular research, because they can inspire practitioners to become refamiliarized with the emotional, embodied, and psychosocial perioperative experiences of heart surgery from patients’ perspectives. Copyright © 2012 Elsevier Inc. All rights reserved.

Using the Theory of Planned Behaviour to predict nurses’ intention to integrate research evidence into clinical decision-making.
Cote F, Gagnon J, Houme PK, Abdeljelil AB, Gagnon MP.
Journal of advanced nursing 2012 Oct;68(10):2289-2298

Using an extended Theory of Planned Behaviour, this article is a report of a study to identify the factors that influence nurses’ intention to integrate research evidence into their clinical decision-making. Background.  Health professionals are increasingly asked to adopt evidence-based practice. The integration of research evidence in nurses’ clinical decision-making would have an important impact on the quality of care provided for patients. Despite evidence supporting this practice and the availability of high quality research in the field of nursing, the gap between research and practice is still present. Design.  A predictive correlational study. Methods.  A total of 336 nurses working in a university hospital participated in this research. Data were collected in February and March 2008 by means of a questionnaire based on an extension of the Theory of Planned Behaviour. Descriptive statistics of the model variables, Pearson correlations between all the variables and multiple linear regression analysis were performed. Results/findings.  Nurses’ intention to integrate research findings into clinical decision-making can be predicted by moral norm, normative beliefs, perceived behavioural control and past behaviour. The moral norm is the most important predictor. Overall, the final model explains 70% of the variance in nurses’ intention. Conclusion.  The present study supports the use of an extended psychosocial theory for identifying the determinants of nurses’ intention to integrate research evidence into their clinical decision-making. Interventions that focus on increasing nurses’ perceptions that using research is their responsibility for ensuring good patient care and providing a supportive environment could promote an evidence-based nursing practice. © 2012 Blackwell Publishing Ltd.

How do we change practice when we have the evidence?
Burke JP, Gitlin LN.
The American Journal of Occupational Therapy 2012 Sep;66(5):e85-8

Translating research findings into practice includes myriad pragmatic realities, including understanding the suitability of the data to a particular patient group, writing new guidelines for occupational therapy practitioners, facilitating adoption of the guidelines, and instituting new patterns of care for patients. The process is more than a matter of disseminating the information to practitioners and expecting immediate change in patient treatment. Indeed, the field of implementation science is devoted to the identification of the numerous barriers and supports that constrain or expedite practice change in response to research. Moving forward and adopting evidence-based findings will require a focused understanding of the particular setting where change is warranted. Among the issues to address are the health system levels involved in change (professional, legislative, administrative, practitioner, and patient and family members), the values and beliefs of the participants, and knowledge of the communication channels that exist in the setting and how information and new ideas make their way through the setting. Copyright © 2012 by the American Occupational Therapy Association, Inc.

Creating a Knowledge Translation Platform: Nine Lessons from the Zambia Forum for Health Research.
Kasonde JM, Campbell S.
Health research policy and systems / BioMed Central 2012 Oct 3;10(1):31

The concept of the Knowledge Translation Platform (KTP) provides cohesion and leadership for national–level knowledge translation efforts. In this review, we discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. Lessons from ZAMFOHR’s organizational development include the necessity of selecting a multi-stakeholder and -sectoral Board of Directors; performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche; and selecting a leader that bridges the worlds of research and policy. Programmatic lessons include focusing on building the capacity of both policy-makers and researchers; building a database of local evidence and national-level actors involved in research and policy; and catalyzing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence, and fostering the next generation by mentoring both up-and-coming researchers and policy–makers. Ultimately, ZAMFOHR’s experience shows that an African KTP must pay significant attention to its organizational details. A KTP must also invest in the skill base of the wider community and, more importantly, of its own staff. Given the very real deficit of research-support skills in most low-income countries — in synthesis, in communications, in brokering, in training — a KTP must spend significant time and resources in building these types of in-house expertise. And lastly, the role of networking cannot be underestimated. As a fully-networked KTP, ZAMFOHR has benefited from the innovations of other KTPs, from funding opportunities and partnerships, and from invaluable technical support from both African and northern colleagues.