Methodological issues in interviews involving people with communication impairments after acquired brain damage.

Qualitative research has made a significant contribution to the body of knowledge related to how people experience living with various chronic diseases and disabilities; however, the voices of certain vulnerable populations, particularly those with impairments that affect their ability to communicate, are commonly absent. In recent years, a few researchers have attempted to explore the most effective ways to ensure that the voices of people with communication impairments from acquired brain damages can be captured in qualitative research interviews; yet several methodological issues related to including this population in qualitative research remained unexamined. In this article, the authors draw on insights derived from their research on the experiences of adult survivors of stroke and traumatic brain injury to describe methodological issues related to sampling, informed consent, and fatigue in participant and researcher while also making some recommendations for conducting qualitative interviews with these populations.

Sources of practice knowledge among nurses.

Several studies have been published listing sources of practice knowledge used by nurses. However, the authors located no studies that asked clinicians to describe comprehensively and categorize the kinds of knowledge needed to practice or in which the researchers attempted to understand how clinicians privilege various knowledge sources. In this article, the authors report findings from two large ethnographic case studies in which sources of practice knowledge was a subsidiary theme. They draw on data from individual and card sort interviews, as well as participant observations, to identify nurses' sources of practice knowledge. Their findings demonstrate that nurses categorize their sources of practice knowledge into four broad groupings: social interactions, experiential knowledge, documents, and a priori knowledge. The insights gained add new understanding about sources of knowledge used by nurses and challenge the disproportionate weight that proponents of the evidence-based movement ascribe to research knowledge.

Mapping the journey of cancer patients through the health care system. Part 3: An approach to staging.

This is the third in a series of articles relating results from a line of research whose intent was to construct a complete history of patient interactions with the health care system using available data sources for all patients diagnosed in 1990 with a primary breast, colorectal, or lung tumour in Manitoba. This article presents details of the development and application of methods to produce TNM staging data on the roughly 2,000 patients in this population. The operational definitions constructed for this research can be adapted for other tumour sites and data sources. Findings include methods developed to overcome the sometimes ambiguous and inconsistent available documentation, which ultimately produced reliable TNM staging data. Survival data for this population by stage of disease are given.

Critical issues in interviewing people with traumatic brain injury.

People with cognitive impairments often cannot effectively recall and articulate experiences, feelings, and perceptions. Therefore, interviewing them can be fraught with pragmatic and methodological difficulties. Given this situation, the authors' experience in a study on the allocation of rehabilitative services to survivors of traumatic brain injury is discussed. Participants had physiological impairments affecting their ability to focus on interview questions. The authors discuss the unique challenges, including participants' recall of events, intolerance to stimuli, and image management and offer strategies for mitigating these concerns. The traditional view that reality is captured only in the subjective accounts of articulate people who can remember events in a precise and reflective manner is challenged.

Mapping the journey of cancer patients through health care system. Part 1: developing the research question.

This is the first in a series of articles relating results from research which constructed a complete history of interactions with the health care system from available data sources for all patients diagnosed in 1990 with primary breast, colorectal, or lung tumours in Manitoba from one year prior to diagnosis through to two years post-diagnosis. This article presents the motivation and genesis for this line of research. The study evolved from the question of "What happens to a person who is diagnosed with cancer?" into a major research endeavour encompassing a broad spectrum of philosophic and clinical research questions. A large interdisciplinary team collaborated on developing operational methods to combine existing data sources into unified cancer patient histories.

Mapping the journey of cancer patients through the health care system. Part 2: Methodological approaches and basic findings.

This is the second in a series of articles from a line of research whose intent was to construct a complete history of interactions with the health care system. This paper provides details of the methods developed to collect and collate the scattered information regarding the event history (trajectory) that a cancer patient experiences in traveling through the Manitoba health care system from one year prior to diagnosis through to two years post-diagnosis. Survival data were obtained through 1994. Basic population data obtained from this work are also presented, including survival information through to four years post-diagnosis. Issues regarding standardized data recording and detail level of clinical events in the chart record are discussed. This part of the research demonstrates that diverse data sources in the health care system can be linked with a high degree of accuracy and completeness of data.

The relationship between busyness and research utilization: it is about time.

AIMS AND OBJECTIVES: To explore the concept of busyness in nursing and to understand the relationship between busyness and nurses' research utilization better. BACKGROUND: Lack of time and busyness are consistently reported as barriers to research utilization. Current literature fails to identify the dimensions of busyness and offers little insight into the relationship between busyness and nurses' research utilization. DESIGN/METHODS: We performed a secondary analysis of qualitative data and created a conceptual map of busyness in nursing. RESULTS: Our results suggested that busyness consists of physical and psychological dimensions. Interpersonal and environmental factors influenced both dimensions. Cultural and intrapersonal factors contributed to psychological elements. The effects of busyness reported included missed opportunities, compromised safety, emotional and physical strain, sacrifice of personal time, incomplete nursing care and the inability to find or use resources. CONCLUSIONS: Our beginning description of busyness contributes to a greater understanding of the relationship between busyness and research utilization. Our findings suggest that lack of time as a barrier to research utilization is more complex than depicted in the literature. Instead, the mental time and energy required to navigate complex environments and a culture of busyness more accurately reflect what may be meant by 'lack of time' as a barrier to research utilization. RELEVANCE TO CLINICAL PRACTICE: Future interventions aimed at increasing research utilization may be more effective if they focus on factors that contribute to a culture of busyness in nursing and address the mental time and energy required for nurses to use research in practice.

Taking stock of current societal, political and academic stakeholders in the Canadian healthcare knowledge translation agenda.

BACKGROUND: In the past 15 years, knowledge translation in healthcare has emerged as a multifaceted and complex agenda. Theoretical and polemical discussions, the development of a science to study and measure the effects of translating research evidence into healthcare, and the role of key stakeholders including academe, healthcare decision-makers, the public, and government funding bodies have brought scholarly, organizational, social, and political dimensions to the agenda. OBJECTIVE: This paper discusses the current knowledge translation agenda in Canadian healthcare and how elements in this agenda shape the discovery and translation of health knowledge. DISCUSSION: The current knowledge translation agenda in Canadian healthcare involves the influence of values, priorities, and people; stakes which greatly shape the discovery of research knowledge and how it is or is not instituted in healthcare delivery. As this agenda continues to take shape and direction, ensuring that it is accountable for its influences is essential and should be at the forefront of concern to the Canadian public and healthcare community. This transparency will allow for scrutiny, debate, and improvements in health knowledge discovery and health services delivery.

Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine.

In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.

Interventions aimed at increasing research use in nursing: a systematic review.

BACKGROUND: There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians. However, most work has focused on medical practices; and nursing is not well represented in existing systematic reviews. The purpose of this article is to report findings from a systematic review of interventions aimed at increasing research use in nursing. OBJECTIVE: To assess the evidence on interventions aimed at increasing research use in nursing. METHODS: A systematic review of research use in nursing was conducted using databases (Medline, CINAHL, Healthstar, ERIC, Cochrane Central Register of Controlled Trials, and Psychinfo), grey literature, ancestry searching (Cochrane Database of Systematic Reviews), key informants, and manual searching of journals. Randomized controlled trials and controlled before- and after-studies were included if they included nurses, if the intervention was explicitly aimed at increasing research use or evidence-based practice, and if there was an explicit outcome to research use. Methodological quality was assessed using pre-existing tools. Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy. RESULTS: Over 8,000 titles were screened. Three randomized controlled trials and one controlled before- and after-study met the inclusion criteria. The methodological quality of included studies was generally low. Three investigators evaluated single interventions. The most common intervention was education. Investigators measured research use using a combination of surveys (three studies) and compliance with guidelines (one study). Researcher-led educational meetings were ineffective in two studies. Educational meetings led by a local opinion leader (one study) and the formation of multidisciplinary committees (one study) were both effective at increasing research use. CONCLUSION: Little is known about how to increase research use in nursing, and the evidence to support or refute specific interventions is inconclusive. To advance the field, we recommend that investigators: (1) use theoretically informed interventions to increase research use, (2) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use, as well as, measuring patient outcomes relevant to the intervention, and (3) use more robust and methodologically sound study designs to evaluate interventions. If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use.

Knowledge translation consensus conference: research methods.

The authors facilitated a workshop session during the 2007 Academic Emergency Medicine Consensus Conference to address the specific research methodologies most suitable for studies investigating the effectiveness of knowledge translation interventions. Breakout session discussions, recommendations, and examples in emergency medicine findings are presented.

Mapping the organizational culture research in nursing: a literature review.

AIM: This paper reports a critical review of nursing organizational culture research studies with the objectives of: (1) reviewing theoretical and methodological characteristics of the studies and (2) drawing inferences specific to the state of knowledge in this field. BACKGROUND: Organizational culture is regarded as significant in influencing research use in clinical practice yet it is not understood how culture shapes practitioners' behaviours. Only one review of this empirical literature in nursing has been completed. METHOD: Using selected computerized databases, published nursing research studies in English that examine organizational culture were accessed. Organizational culture studies were categorized using Hatch's three perspectives on organizational culture: (1) modern, (2) symbolic-interpretive and (3) postmodern. The review was conducted in 2005. RESULTS: Twenty-nine studies were in the final data set. Results pointed to variations in cultural definitions and incorporation of organizational sciences theory. In classifying the studies, modern perspectives dominated (n = 22), symbolic-interpretive approaches were an emerging group (n = 6) and one study was unclassifiable. Our results expand current cultural instrument reviews by pinpointing tools that have been previously overlooked and by identifying ongoing theoretical and methodological challenges for researchers. CONCLUSION: An exclusive reliance on modernistic approaches in organizational culture research cannot yield a complete understanding of the phenomenon. Rather, the field could benefit from a variety of cultural approaches. In a similar vein, researchers need to be mindful of the terminology and the unit of analysis they use in their research, as these are the two largest research challenges.

Understanding work contextual factors: a short-cut to evidence-based practice?

BACKGROUND: It has become increasingly clear that workplace contextual factors make an important contribution to provider and patient outcomes. The potential for health care professionals of using research in practice is also linked to such factors, although the exact factors or mechanisms for enhancing this potential are not understood. From a perspective of implementing evidence-based nursing practice, the authors of this article report on a study examining contextual factors. AIM: The objective of this study was to identify predictors of organizational improvement by measuring staff perceptions of work contextual factors. METHOD: The Quality Work Competence questionnaire was used in a repeated measurement survey with a 1-year break between the two periods of data collection. The sample consisted of 134 employees from four neonatal units in Sweden. FINDINGS: Over the study period significant changes occurred among staff perceptions, both within and between units, on various factors. Changes in staff perceptions on skills development and participatory management were the major predictors of enhanced potential of overall organizational improvement. Perceived improvement in skills development and performance feedback predicted improvement in leadership. Change in commitment was predicted by perceived decreases in work tempo and work-related exhaustion. CONCLUSIONS AND IMPLICATIONS: These findings indicate the potential for organizational improvement by developing a learning and supportive professional environment as well as by involving staff in decision-making at the unit level. Such initiatives are also likely to be of importance for enhanced use of research in practice and evidence-based nursing. On the other hand, high levels of work tempo and burnout appear to have negative consequences on staff commitment for improving care and the work environment. A better understanding of workplace contextual factors is necessary for improving the organizational potential of getting research into practice and should be considered in future implementation projects.

Understanding how organizational culture shapes research use.

In the climate of evidence-based practice, practitioners are expected to use research in their day-to-day clinical work; however, it is generally accepted that much healthcare is not based on research. The authors suggest 3 specific ways that organizational culture affects practitioner research use and propose leadership strategies that managers may find facilitate evidence-based practice. Through understanding how organizational culture can both hinder and facilitate practitioners' research use behaviors, managers are well positioned to leverage culture to improve evidence-based practice sustainability in their organizations.

Evidence, research, knowledge: a call for conceptual clarity.

OBJECTIVE: To dispel some of the conceptual confusion in the field of evidence-based practice that has resulted from the overlapping use of the terms research, evidence, and knowledge. APPROACH: Theoretical discussion. FINDINGS: Often the terms research and knowledge are used as synonyms for evidence, but the overlap is never complete. The term evidence has long been understood to mean the findings of research. DISCUSSION: Recent attempts to broaden the definition of evidence to include clinical experience and experiential knowledge have been misguided. Broadening our understanding of the basis for clinical decision making and conceptualizing evidence are quite different tasks. Other factors (not other forms of evidence) do shape the clinical decision-making process, but they are not evidence. We might better term them knowledge. Confusing evidence with these other factors has hindered research and the improvement of clinical decision making in health care. We argue that this confusion results from the use of the term evidence when we really mean either research findings or knowledge. CONCLUSIONS: In this article, we have argued for specificity in the use of the term evidence. We urge the restriction of the term evidence to research findings, and while we acknowledge the importance of other influences on the clinical decision-making process, we insist that they are not evidence. The time has come to value personal experience and experiential knowledge for what they are-we should not have to disguise them as types of evidence for them to be deemed of any value. Being specific to language, the goal is to improve clinical decision making by increasing practitioners' reliance on research findings (evidence) while acknowledging (and valuing) the important part played by other forms of knowledge in the decision-making process. The distinctions are important.