Research Utilization

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• Research Utilization the Individual
• What do we know?
• Carole A. Estabrooks, RN, PhD
• University of Alberta
• Edmonton, Canada

2nd Annual Knowledge Utilization
Colloquium Oxford, July 2002
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Acknowledgements

• AHFMR, Alberta Heritage Foundation for Medical
  Research
• CIHR, Canadian Institutes of Health Research

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Centre for Knowledge Transfer

• To increase research-based
• decision-making in KT through

• Graduate training
• Research
• Collaboration with policy makers

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Summer UG students Kristin Brigidear Sara Katz
Kathy OLeary Graduate Margaret
Milner Shannon Scott-Findlay Kim Fraser Greta
Cummings Anastasia Mallidou
STAFF Huey Chong Katie Hesketh Kylie Hugo Jarmila
Sazavsky Connie Winther James Kropfreiter Selena
Wong
POST-DOC Joanne Profetto-McGrath
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Outline

• Some background
• Individual vs. organizational
• Conclusions

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History of Evidence Based Practice?
1920 - 1960
2002
1903 G.Tardé
1992 EBM
1997 NFH Canada
1955 Menzel Katz
Agricultural extension model
1993 Cochrane Collaboration
1970s CURN Project
1943 Ryan Gross
1985 Conceptual Papers in Nursing
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KNOWLEDGE UTILIZATION STUDIES PROGRAM
Professionalization and
Evidence-based medicine Evidence-based
nursing Evidence-based practice Evidence-based
policy Evidence-based decision-making
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  RU Research Publications (Nursing)
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  Individual v/s Organizational (Nursing)
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RU Models in Nursing

• WICHEN (Krueger, et al.)
• CURN (Horsley, et al.)
• NCAST (Barnard, King Hoehn)
• RNABC
• Goode
• Horn (Goode, et al.)
• Iowa (Titler, et al.)
• Stetler
• CRU (Dufault)
• Ottawa (Logan, et al.)
• Kitson, et al.
• Change to EBP (Rosswurm Larrabee)

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Common Features

• Generally premised on individual, rational actor
  assumptions
• Good decision-makers use research
• Research makes it better
• Tend to be prescriptive
• Frequently use Rogers theory
• Generally have not been developed as
  interdisciplinary

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Individual v/s Organizational

• Systematic review
• KUSP RU studies (Estabrooks, PI)

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Research utilisation and the individual nurse A
systematic review   Carole A. Estabrooks, RN,
PhD Judith A. Floyd, RN, PhD Shannon
Scott-Findlay, RN, MN Katherine A. OLeary,
BA Matthew Gushta, BA  

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Search and retrieval process
Online database yield 1063
Articles requested and screened for
inclusion/exclusion 104
Studies meeting inclusion criteria 20
(representing 22 articles)
Studies excluded 82
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Systematic ReviewIncluded Studies(N22)
Barta (1995) Logsdon et al. (1998) Bostrum
Suter (1993) Kirchoff (1982) Brett
(1989) Lacey (1994) Butler (1995) Parahoo
(1998 1999) Champion Leach (1989) Michel
Sneed (1995) Coyle Sokop (1990) Rodgers
(2000) Davies (1999) Rutledge et al.
(1996) Estabrooks (1999a 1999b) Tsai
(2000) Hatcher Tramner (1997) Varcoe Hilton
(1995) Lia-Hoagberg et al. (1999) Winter (1990)
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Individual Determinants

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

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Beliefs Attitudes

• Most frequently assessed determinant (N10) was
  attitude toward research
• significant in 5 out of 6 studies
• most frequently replicated result in all
  categories
• only predictor with a consistent pattern of
  positive effect

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Results

• Methodological problems
• Only 2 studies considered strong
• Unit of analysis issues
• Little to suggest that individual determinants
  influence RU

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Implications

• Design/analysis
• Theoretical framing
• Predictors
• Dependant variable
• Solo work

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The Determinants of Research Utilization Studies
Pain Management in Adults Pain Management in
Infants Children
Funded by CIHR and AHFMR
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Study Team
University of Alberta Carole Estabrooks, RN, PhD
(PI) Janice Lander, RN, PhD Judy Norris, RN,
PhD Charles K. Humphrey, MA Karen Golden-Biddle,
PhD Francis Lau, PhD
University of Toronto Bonnie Stevens, RN, PhD
Judy Watt-Watson, RN, PhD Linda OBrien-Pallas,
RN, PhD Gail Donner, RN, PhD J. I. (Jack)
Williams, PhD
University of Calgary Geertje Boschma, RN, PhD
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RU Studies

• Ethnographic case studies (n7)
• Multi-site (6 mo./unit)
• Qualitative data (interviews, focus groups,
  observation)
• Quantitative data (2 weeks in each unit)
• Documentary data ( 600 total)

two adult and five pediatric units
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RU StudiesSources of Practice Knowledge

• Prefer socially driven sources
• Co-workers
• Patients
• Experiential Learning
• Traditional dissemination methods rank poorly
• e.g., Medical/Nursing journals

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Sources of Practice Knowledge
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KUSP RU Studies7 Unit Archetype
Conceptualized factors from the RU literature
which also existed in our datasets
Social organizational environmental
characteristics became paramount
Comparison analysis across units which reduced
variables to only those of significance
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KUSP RU Studies Social Interaction Archetype
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Environment
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Conclusions

• Impact of organizational context
• Future directions

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Organizational Determinants

• Kitson, Harvey McCormack, 1998
• McCormack, Kitson, Harvey, Rycroft-Malone,
  Titchen Seers, 2002

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Stages and phases

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

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KNOWLEDGE UTILIZATION STUDIES PROGRAM
We know . . .

• Insufficient theorizing
• Measurement problems
• Lack of causal analyses
• Over reliance on rational actor models
• Lack of models that include organizational
  interests, interaction and linkage
• Over examination KU as product
• Fragmentation

Knowledge in Practice
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KNOWLEDGE UTILIZATION STUDIES PROGRAM
We need . . .

• Organizational approaches
• Practice environment, context, climate culture
  addressed
• Linkages, interactions, social relational
  capitol
• KU as an independent variable
• Sustainable, interdisciplinary programs of
  research

Knowledge in Practice
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E-Mail us at kusp_at_ualberta.ca Visit our
web site http//www.ualberta.ca/kusp/
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