www ualberta cakusp Research Utilization and its many

www. ualberta. ca/~kusp Research Utilization: and its (many) determinants Carole A. Estabrooks Professor, Faculty of Nursing & Canada Research Chair in Knowledge Translation University of Alberta University of Melbourne, AU October, 2005 k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Edmonton, Alberta k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp University of Alberta k n o w l e d g e i n p r a c t i c e. . .

PARi. HS Framework for Research Implementation Evidence-based practice Context Evidence PARi. HS Model (Kitson, et al. , 1998, QSHC Facilitation

Policy Analysis Framework Policy Framework Lomas, 2000

www. ualberta. ca/~kusp First…… what do we know about the determinants of research utilization? k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Common barriers encountered in knowledge transfer in hospital settings Commonly identified barriers include: • Time • Resources • Support • Knowledge & skills • Adequate evidence • Culture, context, environment…. Less commonly identified barriers include: • Disincentives • Irrationality of decision-making environment • Decision-making “errors” • Attitudes & beliefs • Inability to see consequences k n o w l e d g e i n p r a c t i c e. . .

Best strategies for transferring research findings? Ø Imperfect evidence base for decision makers Ø Many current rigorous evaluations have methodological weaknesses Ø Poor reporting of study settings, barriers to change, content and rationale of intervention Ø Generalisability of study findings is frequently uncertain Ø Reminders most consistently observed to be effective Ø Educational outreach only led to modest effects Ø Dissemination of educational materials may lead to modest but potentially important effects (similar effects to more intensive interventions) Ø Multifaceted interventions not necessarily more effective than single interventions Grimshaw JM, Thomas RE, Mac. Lennan G, Fraser C, Ramsay C, Vale L et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004. (Available from: http: //www. hta. nhsweb. nhs. uk/)

www. ualberta. ca/~kusp From some of our work in KUSP In nursing… • Most common interventions tend to be education, • • • protocol & guideline implementation Little audit & feedback, this is emphasized more among physicians Individual patient information, personal experience, and social interactions are main information sources Limited use of journals, textbooks, and other media, including the internet 1 k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Scott-Findlay’s doctoral work on culture and RU (in progress) 1. 2. Structure of Authority Nature of nurses’ work • • 3. location of work expected level of activity routinized work expected ways to get work done Workplace climate • • • 4. ethical issues the response to errors the receptivity to innovation Types of knowledge valued • • • clinical knowledge (practical, often tacit) specialized knowledge (e. g. , PICU) research k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Scott-Findlay (in progress) Nature of nurses’ work Hierarchical structure of authority Through ongoing interpretation of events and dialogues members ‘learn’ what is important Workplace ethos Manifestations of culture Types of knowledge Creation of values that result in behavioral expectations Intervening factor – inconsistency from superiors that creates unclear expectations Members resort to doing what they are told to do because of inconsistent and shifting expectations Decision not to conform Conformity k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp From work in KUSP For interventions we also need to consider (from ethnographic case studies) • • Information needs and how these relate to the sources of knowledge used in practice How the knowledge sources used bear on the packaging and dissemination of “evidence” How dissemination strategies need to focus on what is needed and useful regardless of what we perceive may be the most relevant approach A focus on those determinants of research use with the potential to be manipulated in order to develop interventions with potential utility 4 k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp From work in KUSP Organizationally (causal and multi-level modeling) nursing control over practice opportunity for nurse-to-nurse collaboration support for innovation facilitation of research use positive culture (characterized by good leadership, evaluation and performance feedback) Ø increased time to nurse (-ve) Ø emotional exhaustion (-ve) Ø Ø Ø Higher nurse education levels Greater control over practice Greater freedom to make decisions Having a good nursing leader on unit Low levels of emotional exhaustion A sense of personal accomplishment 5 k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp KUSP Studies A. Theorizing the determinants of research utilization (2000 – 2005) B. KUPI - The knowledge utilization & policy implementation program (2002 – 2007) C. The Bibliometric study (2004 – 2006) D. Measuring research utilization (2005 – 2008) E. New and future studies k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp A. Theorizing the determinants of research utilization (2000 – 2005) Research Utilization Studies The Determinants of Research Utilization: Pain Management in Adults & Children Purpose: To understand how nurses use research in their practice and what influences their ability to use or not use research. k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp METHODS Ethnographic case studies Ø Four hospitals (two in Ontario, two in Alberta) Ø Adult and pediatric surgical units Ø Qualitative and quantitative data collected Ø Six months of participant observation each unit Ø Nurses, patients, physicians, social workers, physiotherapists, and administrators participated k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Data Sources • Documents and records • Interviews (individual & group) • Participant observations • Physical artifacts • Measures (e. g. , Research utilization, unit culture, critical thinking, pain, workload, environmental complexity) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Quantitative findings (selected - sources only) • In this study the patient care unit was unit • • of analysis Our goal: to understand the role of context in shaping RU We mapped relationship of contextual factors using correspondence analysis k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Quantitative findings (cont’d) • Units with highest RU clustered together on factors such as: • Critical thinking • Unit culture • Workload and people support clustered more closely to units with lowest RU scores k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp The 7 Units on knowledge sources Top five sources: 1. Personal experience & individual patient 2. In-services in the workplace 3. Nursing school 4. Discussions with physicians & fellow nurses 5. Intuition k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Five least used sources: 5. Nursing journals 4. “Ways nurses have always done it” 3. Nursing research journals 2. Medical journals 1. Media k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Number of Sources Used by Nurses • 20% of nurses use 1 – 5 sources • 50% of nurses uses 6 – 10 sources • 25% of nurses use 11 -15 sources k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp 7 Unit Comparison Overall, few differences in the sources used by nurses across units Information Source Ranking by Means Unit 1 Unit 2 Unit 3 Unit 4 Unit 5 Unit 6 Unit 7 Individual patient 3 1 1. 5 2 2 1 2. 5 Intuitions 8 8 4 5 8 7 4. 5 Personal experience 1. 5 2 1. 5 1 1 2 1 Nursing school 1. 5 4 3 3 6. 5 9 8 Physicians disc’ns w nurses 9 5. 5 7 7 6. 5 3 9 Physician’s orders 7 7 9. 5 8 12. 5 Medical journals 15 15 16 14. 5 15 14 15 Nursing journals 13 12 13 11 13 10 10 Nursing research journals 14 13 14 16 15. 5 13 11 Textbooks 11 9 11 12. 5 11 12 14 6 11 7 7 4. 5 11 4. 5 12 14 12 10 12 15 12. 5 Fellow nurses 4. 5 5. 5 7 4 3 6 7 In-services in workplace 4. 5 3 5 12. 5 4. 5 5 2. 5 Policy & procedure manuals 10 10 9. 5 9 9. 5 4 6 The media 16 16 15 14. 5 15. 5 16 16 ‘What has worked for years’ ‘Ways nurse has always done it k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Sources of Knowledge Patterns Over Time Note. Mean scores were transformed to fit a five-point likert scale (0 -4), with 0 as ‘never’ and 4 as ‘always’. k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Qualitative findings (selected - sources only) Main Categories of Knowledge Sources A. B. C. D. Social interactions Experience Documents Intra-Personal k n o w l e d g e i n p r a c t i c e. . .

Taxonomy of nurses’ sources of knowledge

www. ualberta. ca/~kusp Why? Time Nurses typically work not only on multiple schedules; high and frequent levels of resequencing are required Context Nurses tend to be motivated to seek knowledge when they have context specific patient care situations, problems to deal with Trust Nurses tend to seek information , knowledge from those they trust (knowledgeable, empathetic) Hierarchy An environment where norms of organizational hierarchy are strictly adhered to may negatively affect knowledge transfer between nurses and CNS’s, clinical leaders, and physicians. k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Summary & Conclusions • Individual patient information, personal experience, and social interactions are main information sources • Limited use of journals, textbooks, and popular media, including the internet • The structure and organization of nurses’ work has a major influence on their choice of knowledge sources • Researchers need to merge nurses’ information-seeking behavior with dissemination strategies k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Summary & Conclusions Ø The nurses in this study overwhelmingly relied on social interactions and experience as their primary sources of practice knowledge Ø Time, trust, and unit environment played an important role in determining the nurse’s sources of knowledge k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp B. KUPI: The knowledge utilization & policy implementation program (2002 – 2007) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Evidence-based practice Context Ø PARISH Promoting Action on Research Implementation in Health Services Ø SI = f (E, C, F) Evidence Successful Facilitation implementation is a function of evidence, context and facilitation Kitson et al, 1998 Rycroft-Malone et al, 2002 k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Knowledge utilization and policy implementation (KUPI) A five year research program whose purpose is to develop theory in the knowledge utilization field that increases (research) knowledge use by clinicians and decisionmakers across multiple levels - by using existing data k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Objectives of the larger KUPI program To study: Ø how predictors of research use vary across levels of decision-making Ø how research use is accomplished in organizations, and Ø how research use shapes policy implementation k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Modeling Sub-Projects Designed to study factors influencing knowledge use, specifically research utilization (RU), at different levels of decision-making among nurses in Alberta hospitals. k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Modeling sub-project: Five studies 1. 2. 3. 4. 5. DV derivation & outcome validation A structural equation (SEM) assessment of the PARi. SH (Kitson) model Multi-level (HLM) modeling Hierarchical structural equation modeling (HSEM) A methodological evaluation of HLM vs. H-SEM and their usefulness for the study of research utilization k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Example: Multi-level (HLM) study objectives Ø To determine which nursing factors at the individual, unit, and hospital levels predict research utilization Ø To measure the contribution of the significant factors to variation in research utilization across units and hospitals k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp The Alberta Nurse Survey (1998) A census population of all 12, 345 registered nurses from 129 hospitals in Alberta, Canada. Useable returns 6526 (52. 8%) A: Employment Characteristics B: Nursing Work Index (NWI) C: Maslach Burnout Inventory(MBI) D: Job characteristics E: Last shift F: Demographics G: Site specific questions k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp The Research Utilization Survey (1996) A randomly selected sample of staff nurses in Alberta, Canada. Useable returns 600 (42%) I. Research utilization II. Background and daily demands III. Individual and professional factors IV. The research itself V. Your organization k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Final Sample Hospitals 109 90 Nurses 6, 526 5, 228 Selection criteria: 5 nurses per hospital k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp The 3 level model Organization factors (hospital level) Specialty factors (unit level) Nurse factors (individual level) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Significant univariate predictors: Individual, specialty (unit), and hospital levels Individual level Ø Ø Ø Higher nurse education Control over practice Freedom to make decisions Emotional exhaustion Lack of personal accomplishment Specialty (unit) level Ø Leadership Ø Relational capital Ø Consulting opportunity Ø Participate in policy Organizational level Ø Climate Ø Innovativeness Ø Organizational slack k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Summary Greater research utilization among nurses was predicted in the final model by: Ø Ø Ø Higher nurse education levels Greater control over practice Greater freedom to make decisions Having a good nursing leader on unit Low levels of emotional exhaustion A sense of personal accomplishment k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Components (%) of research explained at the individual, specialty (unit), and hospital levels 4. 5% 3. 7% 91. 8% k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Summary Variation in research utilization was mainly due to differences in individual characteristics of nurses, with organizational factors contributing less. Of the latter, however, having good leadership on the unit was the most significant determinant of research utilization k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Structural equation (SEM) modeling objective Ø to develop a theoretical model of hospital characteristics that predict research use by nurses k n o w l e d g e i n p r a c t i c e. . .

The Structural Equation Model (SEM) Innovation Facilitation Hospital Size Nursing Education Staff Development Programs Responsive Administration Control over Practice Relational Capital Nurse to Nurse Collaboration RU Time to Nurse Staffing and Support Services Internet Use Emotional Exhaustion

www. ualberta. ca/~kusp Structural Equation Modeling Results Positive impact on research use: • • • nursing control over practice opportunity for nurse-to-nurse collaboration support for innovation facilitation of research use positive culture (characterized by good leadership, evaluation and performance feedback) Negative impact on research use: • Increased time to nurse • emotional exhaustion k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp C. The Bibliometric study (2004 – 2006) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp C. The Bibliometric study (2004 – 2006) Objectives Ø Map the development of the field of knowledge utilization Ø Identify the structure of the scientific community Ø Provide direction to investigators & decision -makers in the field k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Terminology Tangle k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Pilot study: A bibliometric analysis of the RU literature in nursing • 600 articles • Findings/Conclusions Limited collaborations • Primarily opinion pieces with little research or theoretical work • UK & US most prolific in the field • Increased productivity since early 1990’s with change in terminology • Estabrooks, C. A. , Winther, C. , & Derksen, L. (2004). Mapping the field. A bibliometric analysis of the research utilization literature in nursing. Nursing Research, 53(5), 293 -303. k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Larger Study: Methods Overview • Web of Science 1945 -2004 • Articles related to KU in general Three case studies related to KU • Guidelines • Policy & management • Nursing k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Preliminary findings Key authors: 15 most cited authors k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Key journals Ø Ø Ø Ø Ø Journal of Evaluation in Clinical Practice Journal of Advanced Nursing British Medical Journal Knowledge: Creation, Diffusion, Utilization Lancet Journal of General Internal Medicine Research Policy Journal of the American Medical Association Science Communication Social Science & Medicine k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp D. Measuring research utilization (2005 – 2008) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Systematic Review Findings Existing measures Ø Ø Nursing Practice Questionnaire (NPQ) NPQ (Modified) Research Utilization Questionnaire (RUQ) Edmonton Research Orientation Survey (EROS) Ø Other multi-item measures (N=3) Ø Single item measures (N=19) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Systematic Review Findings Ø Ø Ø Poor construct clarity Lack of theoretical framing Lack of measurement theory Lack of psychometric assessment Presumption of linearity Absence of longitudinal work Ø Ø Ø Self-report Recall Social desirability Scaling Unit of analysis k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Instrument Development Study Objectives: 1. to clarify and validate the construct 2. to develop observable indicators 3. to develop a set of “items” that measure research use 4. to conduct a pilot test of the instrument k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Instrument Development study Approach: 1. Construct clarity Series of focus groups with three sets of experts a. b. c. d. Local (research team) expert panel (complete) International panel (May 2005) Managers and educators Providers (RNs, LPNs, assistants, aides) 2. Indicator and item development Series of focus groups with two sets of experts a. b. Managers and educators Providers of nursing care (RNs, LPNs, RPNs, assistants, aides) 3. Pilot test the draft instrument(s) k n o w l e d g e i n p r a c t i c e. . .

“Thinking” (i. e. , Clinical Decision Making Clinical Reasoning ) Action in Practice www. ualberta. ca/~kusp “Action” Instrumental Use Task completion Relational Assessment Screening Research Use Conceptual Use Research Non-Use Conceptual Use Non-use A. Informed (non-defensible) B. Informed (defensible) Uninformed k n o w l e d g e i n p r a c t i c e. . .

HI Research utilization Conceptual www. ualberta. ca/~kusp Instrumental LO HI LO k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp E. New and future studies F. Ø Health research utilization in hospitals (start up) Under review Ø SHARP (Share and House Accessible Research Products) Ø TROPIC team grant Ø (KUSP) Team grant (letter of intent stage): The influence of context on research use (long term care settings) k n o w l e d g e i n p r a c t i c e. . .

Health research utilization in hospitals (start up) (2 nd in a series of 3 -4 studies) Objectives of the first (completed) study 1. To describe two groups (researchers and users) 2. To compare research dissemination behaviour among the researcher sub-groups 3. To compare research utilization behaviour among the users sub-groups 4. To explore which factors contribute to research dissemination (researchers) and research use (users)

www. ualberta. ca/~kusp Key Messages (from the first study) About Researchers Ø Research infrastructure matters Ø Not all academic researchers are equal Ø Researchers do contribute to research use About Users Ø Organizational capacity matters Ø Intermediaries matter Ø Talking with researchers matters k n o w l e d g e i n p r a c t i c e. . .

Plain Dissemination By Group Engaged Dissemination By Group Number of Publication By Group

Correlations ** Correlation is significant at the 0. 01 level (2 -tailed). * Correlation is significant at the 0. 05 level (2 -tailed). Plain Dissemination Engaged Dissemination Contribution provided by users . 507(**) . 448(**) Perceived impact . 624(**) . 590(**) Relational capital . 561(**) . 495(**) Barriers to uptake of research . 241(**) . 267(**) Perceived importance of dissemination activities (A) . 306(**) . 164(*) Perceived importance of dissemination activities (B) . 404(**) . 341(**) Recognition of expertise . 618(**) . 448(**) Years of experience (as service provider) . 364(**) . 331(**) Research focus – users’ need . 464(**) . 542(**) Research focus – scholarly advancement -. 144(*) Perceived importance of original studies leading to publication -. 133(*) -. 191(**) -. 157(*) Number of Publications . 192(**). 316(**) Cost of utilization . 213(**) Number of research personnel . 247(**) Years of experience (post grad) . 303(**)

Research Utilization Index Summary of Comparisons • There is significant difference across groups. • Multiple comparison test revealed 4 homogeneous subsets: nurse providers, nurse decision-makers and other decision-makers, other decision-makers and intermediaries; and intermediaries and physician providers. • The physicians are significantly different from all nurses and other decision-makers.

www. ualberta. ca/~kusp Factors Influencing Dissemination and Publication Plain Dissemination: Contribution by users, Perceived impact, Perceived importance of dissemination activities (B), Recognition of expertise, Research focus – users’ need Engaged Dissemination: Perceived impact, Perceived importance of dissemination activities (B), Research focus – users’ need Publication: Number of research personnel, Research focus – scholarly advancement, Academic rank, Cost of utilization k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Present Study Objectives: Ø to determine the feasibility of undertaking a larger scale study in Western Canada Ø To validate a typology of providers To validate a revised survey instrument assessing individual and organizational characteristics Ø To identify predictors of research utilization Ø To assess provider group differences and similarities k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp The SHARP grant (infrastructure) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Why SHARP? Preserves data for future analyses Facilitates researcher collaboration Increases effectiveness of funding Provides opportunities for mentoring and education in data management Reduces duplication of data collection k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp TROPIC Purpose: to ameliorate pain in children by narrowing the gap between clinical practice and the research evidence supporting optimal patient care. Using the PARIHS framework Main applicants: Bonnie Stevens (PI), University of Toronto Celeste Johnston, Mc. Gill University Shoo Lee, University of Alberta Carole Estabrooks, University of Alberta Shannon Scott-Findlay, University of Alberta Patrick Mc. Grath, Dalhousie University Christine Chambers, Dalhousie University k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Figure 1. Working model of research utilization (Estabrooks, Scott-Findlay & Cummings, 2005) Evidence Context Facilitation INTERMEDIATE Research Utilization OUTCOMES Generic measures Research use Research uptake Specific measures (i. e. Process outcomes) Completed pain assessments Appropriate analgesic administration Implementation of other nonpharmacologic pain management interventions Pain intensity PARIHS model Research Use/Research Uptake (Process Outcomes) Clinical (Patient) Outcomes k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Three major TROPIC projects 1. The creation of a centralized Canadian Pediatric Pain Research Network Database (e. g. , collect demographics and information about pain) 2. Assess organizational context and determine its impact on the implementation of pain research in pediatric clinical practice 3. Evaluate the efficacy and effectiveness of (a) Evidence-based Practice In Change (EPIC; Lee et al. , 2002) and (b) Audit and Feedback k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Ø Culture • OCI, Cooke & Lafferty (1987) Ø Leadership Practice Inventory (LPI) Kouzes, & Posner (2002) • Leadership Empowering Behaviours (LEB) Hui (1994) • Ø Evaluation • Focused qualitative data Other overall contextual measures • Maslach Burnout Inventory • Nursing Work Index - Revised (NWI – R) • Environmental Complexity Scale (ECS) • Project Research in Nursing (PRN) Workload Measurement Instrument Research Utilization (revised) • Research Utilization Survey (Estabrooks 1997) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Ø A main goal of the analyses will be to assess the role of unit contextual variables on nurse research utilization behaviors Ø Additionally, to estimate the independent effects of these contextual variables, we have proposed Hierarchical Linear Modeling (HLM) and Structural Equation Modeling (SEM) k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp (KUSP) Team LOI (tentative and evolving) Ø Carole Estabrooks (PI, Canada Research Chair) Ø Lesley Degner (CHSRF Chair) Ø Michael Leiter (Canada Research Chair) Ø Heather Laschinger (UWO, leadership) Ø Greta Cummings (UA, leadership) Ø Joanne Profetto-Mc. Grath (UA, facilitation) Ø Malcolm Smith (Business, Univ of Manitoba) Ø Laurel Strain (Gerontology, sociology) UK Ø Joanne Rycroft-Malone Ø Sue Dopson USA Ø Anne Sales And others tba k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp Examining the context dimension of the PARIHS framework in LTC settings Context Evidence Facilitation k n o w l e d g e i n p r a c t i c e. . .

www. ualberta. ca/~kusp k n o w l e d g e i n p r a c t i c e. . .