Publications (51) View all
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Article: Leading on the frontlines with passion and persistence: a necessary condition for Breastfeeding Best Practice Guideline uptake.
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ABSTRACT: AIMS AND OBJECTIVES: The research question explored was what are the processes and strategies used by frontline leaders to support the uptake of the Breastfeeding Best Practice Guideline by nurses in maternity care practice settings? BACKGROUND: Best Practice Guidelines have been shown to enhance client care and outcomes. Leadership is known to have a key role in moving Best Practice Guidelines into nursing practice yet how this happens is poorly understood. This insight is needed to consistently and efficiently facilitate Best Practice Guideline uptake into clinical practice. DESIGN: Constructivist grounded theory was used to explore the social processes and strategies involved in facilitating Best Practice Guideline uptake. METHODS: Purposive, criterion-based, theoretical and negative case sampling were used recruiting 58 health professionals and 54 clients. Triangulation and constant comparison of data sources and types (interviews, documents and field notes) were used for analysis and rigour. RESULTS: Passionate, persistent, respected frontline leaders using tailored, multifaceted strategies aimed at three groups of nurse adopters effectively support the uptake of the Breastfeeding Best Practice Guideline in nursing practice. Successful uptake strategies used by frontline leaders that are new or underdeveloped in the previous literature are presented. CONCLUSIONS: The study findings illuminated multidimensional, tailored strategies that frontline leaders use to facilitate the uptake of Best Practice Guidelines. Attention to individual attitudes and beliefs, as well as organisational, interorganisational and interprofessional partnerships are vital to uptake. Organisations that aspire to foster Best Practice Guideline uptake must invest in frontline leaders to 'make it happen' and sustain Best Practice Guideline uptake in practice. RELEVANCE TO CLINICAL PRACTICE: Understanding how frontline leaders facilitate Best Practice Guideline uptake is essential to selecting, educating and supporting them to foster desired practice changes. Strategies are explicated that frontline leaders can adopt and tailor to their own practice contexts.Journal of Clinical Nursing 11/2012; · 1.12 Impact Factor -
Article: Institutionalization of evidence-informed practices in healthcare settings.
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ABSTRACT: BACKGROUND: The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, most KT research has been directed toward implementation strategies that apply cognitive, behavioral, and, to a lesser extent, organizational theories. In this paper, we discuss the potential of institutional theory to inform KT-related research. DISCUSSION: Despite significant research, there is still much to learn about how to achieve KT within healthcare systems and practices. Institutional theory, focusing on the processes by which new ideas and concepts become accepted within their institutional environments, holds promise for advancing KT efforts and research. To propose new directions for future KT research, we present some of the main concepts of institutional theory and discuss their application to KT research by outlining how institutionalization of new practices can lead to their ongoing use in organizations. In addition, we discuss the circumstances under which institutionalized practices dissipate and give way to new insights and ideas that can lead to new, more effective practices. SUMMARY: KT research informed by institutional theory can provide important insights into how knowledge becomes implemented, routinized, and accepted as institutionalized practices. Future KT research should employ both quantitative and qualitative research designs to examine the specifics of sustainability, institutionalization, and deinstitutionalization of practices to enhance our understanding of these complex constructs.Implementation Science 11/2012; 7(1):112. · 3.10 Impact Factor -
Article: The effectiveness of knowledge translation strategies used in public health: a systematic review.
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ABSTRACT: BACKGROUND: Literature related to the effectiveness of knowledge translation (KT) strategies used in public health is lacking. The capacity to seek, analyze, and synthesize evidence-based information in public health is linked to greater success in making policy choices that have the best potential to yield positive outcomes for populations. The purpose of this systematic review is to identify the effectiveness of KT strategies used to promote evidence-informed decision making (EIDM) among public health decision makers. METHODS: A search strategy was developed to identify primary studies published between 2000--2010. Studies were obtained from multiple electronic databases (CINAHL, Medline, EMBASE, and the Cochrane Database of Systematic Reviews). Searches were supplemented by hand searching and checking the reference lists of included articles. Two independent review authors screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using standardized tools. RESULTS: After removal of duplicates, the search identified 64, 391 titles related to KT strategies. Following title and abstract review, 346 publications were deemed potentially relevant, of which 5 met all relevance criteria on full text screen. The included publications were of moderate quality and consisted of five primary studies (four randomized controlled trials and one interrupted time series analysis). Results were synthesized narratively. Simple or single KT strategies were shown in some circumstances to be as effective as complex, multifaceted ones when changing practice including tailored and targeted messaging. Multifaceted KT strategies led to changes in knowledge but not practice. Knowledge translation strategies shown to be less effective were passive and included access to registries of pre-processed research evidence or print materials. While knowledge brokering did not have a significant effect generally, results suggested that it did have a positive effect on those organizations that at baseline perceived their organization to place little value on evidence-informed decision making. CONCLUSIONS: No singular KT strategy was shown to be effective in all contexts. Conclusions about interventions cannot be taken on their own without considering the characteristics of the knowledge that was being transferred, providers, participants and organizations.BMC Public Health 09/2012; 12(1):751. · 2.00 Impact Factor -
Article: Deliberative dialogues as a mechanism for knowledge translation and exchange in health systems decision-making.
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ABSTRACT: Models that describe the key features and intended effects of specific knowledge translation and exchange (KTE) interventions are much less prominent than models that provide a more general understanding of KTE. Our aim was to develop a model in order to describe the key features and intended effects of deliberative dialogues used as a KTE strategy and to understand how deliberative dialogues can support evidence-informed policymaking. By using critical interpretive synthesis, we identified 17 papers representing four fields of enquiry and integrated our findings into a model. The key features described in the model are: 1) an appropriate (i.e., conducive to the particular dialogue) meeting environment; 2) an appropriate mix of participants; and, 3) an appropriate use of research evidence. These features combine to create three types of intended effects: 1) short-term individual-level; 3) medium-term community/organizational-level; and, 3) long-term system-level. The concept of capacity building helps to explain the relationship between features and effects. The model is a useful contribution to the KTE field because it is a practical tool that could be used to guide the development and evaluation of deliberative dialogues in order to understand more about achieving particular outcomes in relation to specific issues or contexts.Social Science [?] Medicine 08/2012; 75(11):1938-45. · 2.70 Impact Factor -
Article: Supporting the Uptake of Nursing Guidelines: What You Really Need to Know to Move Nursing Guidelines into Practice.
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ABSTRACT: Background: There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. Methods: Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n= 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. Results: Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. Conclusions: A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG.Worldviews on Evidence-Based Nursing 06/2012; · 1.24 Impact Factor
