8427768
Knowledge ‘Translation’ as social learning: negotiating the uptake of research-based knowledge in practice
BackgroundKnowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles.DiscussionThe discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge.SummaryThis article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.
22578715
Continuing education at the cutting edge: promoting transformative knowledge translation.
As the evidence-based practice movement gains momentum, continuing education practitioners increasingly confront the challenge of developing and conducting opportunities for achieving research uptake. Recent thinking invites new approaches to continuing education for health professionals, with due consideration of what knowledge merits uptake by practitioners, who should play what role in the knowledge transfer process, and what educational approach should be used. This article presents an innovative theory-based strategy that encompasses this new perspective. Through a facilitated experience of perspective transformation, clinicians are engaged in an on-the-job process of developing a deeply felt interest in research findings relevant to everyday practice, as well as ownership of that knowledge and its application. The strategy becomes a sustainable, integrated part of clinical practice, fitting naturally within its dynamic, unique environment, context, and climate and overcoming the barrier of time. Clinician experience of a top-down push toward prescribed practice change is avoided. With an expanded role encompassing facilitation of active learning partnerships for practice change, the continuing educator fosters a learning organization culture across the institution. The resultant role changes and leadership and accountability issues are elaborated.
145378602
The politics of the evidencebased practice movements
In the United Kingdom the election of the Labour government in 1997 signalled the arrival of evidence-based policy making based on a philosophy of ‘what counts is what works’. Mirroring the emphasis on evidence-based policy-making has been a concern about encouraging the use of evidence in practice. As an ideology it has penetrated the consciousness, discourse and working practices of professionals. However, despite the apparent engagement with evidence-based approaches to care, there remain a number of key areas that stimulate discussion and warrant debate. This discussion paper highlights some of these issues and considers their implications. Specifically, the political context of the evidence-based movements is considered and the resulting consequences outlined. These include issues about how nursing has signed up to evidence-based practice, the way in which evidence is conceptualised and the continuing gap between evidence and practice. Finally, a number of issues are presented that need to be tackled if there is a genuine desire to improve the evidence base and increase its influence on policy and practice.
31066759
A review of evidence-based practice, nursing research and reflection: levelling the hierarchy.
AIM
This paper examines the evidence-based practice movement, the hierarchy of evidence and the relationship between evidence-based practice and reflective practice.


BACKGROUND
Evidence-based practice is equated with effective decision making, with avoidance of habitual practice and with enhanced clinical performance. The hierarchy of evidence has promoted randomized control trials as the most valid source of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process of reflection, provide useful information for individualized and effective practice.


METHOD
A literature search was undertaken using CINAHL, medline and Ovid electronic databases in early 2006. The search terms used were: evidence-based practice, research evidence, evidence for practice, qualitative research, reflective practice, reflection and evidence. Other sources included handpicking of books on evidence-based practice, reflection and research. Only material written in English was included.


FINDINGS
The hierarchy of evidence that has promoted randomized control trials as the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemological contradictions and limitations. Furthermore, evidence-based practice appears to share very similar definitions, aims and procedures with reflective practice. Hence, it appears that the evidence-based practice movement may benefit much more from the use of reflection on practice, rather than the use of the hierarchical structure of evidence.


CONCLUSION
Evidence-based practice is necessary for nursing, but its' effective implementation may be hindered by the hierarchy of evidence. Furthermore, evidence-based practice and reflection are both processes that share very similar aims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence-based practice movement.


RELEVANCE TO CLINICAL PRACTICE
Provides an elaborated analysis for clinical nurses on the definition and implementation of evidence in practice.
205464476
Fundamental Patterns of Knowing in Nursing: The Challenge of Evidence‐Based Practice
This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrow empirics in the form of evidence-based practice. Objections to the dominance of evidence-based practice are reviewed, and the reasons for it are examined. It is argued that it is partially the result of weaknesses in the alternative patterns of ethical, personal, and esthetic knowing, the ineffability of which compromises accountability. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidence-based practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent.
11397745
Collective inquiry: understanding the essence of best practice construction in mental health.
Delivering quality services has become a committed aspiration of mental health services over the past decade. Service planners look to validated care models to give guidance on what constitutes best practice. While there are many different views of what is 'best', there is a growing acknowledgement that services need to listen to the experiences of a network of frontline stakeholders in order to create quality mental health services. This paper describes an exploratory study within a regional mental health service that aimed to understand the meaning and enactment of best practice from the perspectives of a representative sample of service users and providers. A number of themes emerged as important and include the inherent value placed on consistent familial style relationships between service user and provider. This was deemed pivotal to the provision of expertise, good clinical decision-making, choice and collaboration. The study also highlighted stakeholder preference for autonomy and openness to inquiry into developing practice. In deconstructing the meaning of best practice, the study prompts a closer consideration of how best practice is created and suggests a view of best practice as a fluid dialogic process that is co-constructed by its participants in ongoing dialogic communication and reflection.
37675856
Continuing education, guideline implementation, and the emerging transdisciplinary field of knowledge translation
&NA; This article discusses continuing education and the implementation of clinical practice guidelines or best evidence, quality improvement, and patient safety. Continuing education focuses on the perspective of the adult learner and is guided by well‐established educational principles. In contrast, guideline implementation and related concepts borrow from the fields of quality improvement and patient safety and from health services research. Relative to the question of improved clinical outcomes, both to some extent afford only partial understanding of a complex issue. Knowledge translation (KT) is a transformative concept that links the best elements of both broad fields and, in particular, adds educational elements to the work of health services researchers and others. Interdisciplinary in the extreme, KT is explored in some detail: its major elements (information, facilitation, context, the clinician‐learner, among others) considered as variables in an equation leading to knowledge uptake and improved health care outcomes and an improved functioning health care system.
30709307
Lost in knowledge translation: Time for a map?
&NA; There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned‐action theories to be better able to understand and influence change in practice settings.
36697950
Towards a sociology of knowledge translation: the importance of being dis-interested in knowledge translation
Over the last 15 years there has been an increasingly energetic search for theories and definitions in the burgeoning area of knowledge translation (KT) in the health care context. The focus has been on the design and evaluation of KT activities with little attention to developing a considered KT theoretical/methodological approach that takes a more distanced critical inquiry to the studying of KT interventions. As such, what has been overlooked in the health professions KT literature to date is a suitably complex conceptualisation of translation that encompasses the multiplicity of KT interventions, the dynamic environments in which they are occurring, and the production of new knowledge which arises from their interactions. Attending to these epistemological issues; i.e. issues of the type of knowledge and how it is produced, is crucial to developing a relational understanding of the production and emergence of context-specific clinical knowledge and practice in KT processes. Such an approach is compared to the traditional KT evaluations by KT practitioners themselves of the compliance or non-compliance of individual and organisational behaviour change. A Sociology of KT (SKT) is proposed to complement the applied and evaluative research practice of implementing planned action KT activities. The purpose of a SKT basic research agenda is to understand both the context-specific nature of KT interventions and the epistemological premises of the activities of KT implementers themselves, in order to advance the science of KT and inform, complement and add to the success of applied and evaluative KT research in the future.
40229836
Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: towards a programme theory
Objectives In theory, greater interaction between researchers and practitioners should result in increased potential for implementation. However, we know little about whether this is the case, or what mechanisms might operate to make it happen. This paper reports findings from a study that is identifying and tracking implementation mechanisms, processes, influences and impacts in real time, over time in the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). Methods This is a longitudinal, realist evaluation case study. The development of the conceptual framework and initial hypotheses involved literature reviewing and stakeholder consultation. Primary data were collected through interviews, observations and documents within three CLAHRCs, and analysed thematically against the framework and hypotheses. Results The first round of data collection shows that the mechanisms of collaborative action, relationship building, engagement, motivation, knowledge exchange and learning are important to the processes and outcomes of CLAHRCs' activity, including their capacity for implementation. These mechanisms operated in different contexts such as competing agendas, availability of resources and the CLAHRCs’ brand. Contexts and mechanisms result in different impact, including the CLAHRCs’ approach to implementation, quality of collaboration, commitment and ownership, and degree of sharing and managing knowledge. Conclusion Emerging features of a middle range theory of implementation within collaboration include alignment in organizational structures and cognitive processes, history of partnerships, responsiveness and resilience in rapidly changing contexts. CLARHCs’ potential to mobilize knowledge may be further realized by how they develop insights into their function as collaborative entities.
5876137
Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review
The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ‘embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant élites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know–do gap’ to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.
38611588
Exploring knowledge exchange: a useful framework for practice and policy.
Knowledge translation is underpinned by a dynamic and social knowledge exchange process but there are few descriptions of how this unfolds in practice settings. This has hampered attempts to produce realistic and useful models to help policymakers and researchers understand how knowledge exchange works. This paper reports the results of research which investigated the nature of knowledge exchange. We aimed to understand whether dynamic and fluid definitions of knowledge exchange are valid and to produce a realistic, descriptive framework of knowledge exchange. Our research was informed by a realist approach. We embedded a knowledge broker within three service delivery teams across a mental health organisation in the UK, each of whom was grappling with specific challenges. The knowledge broker participated in the team's problem-solving process and collected observational fieldnotes. We also interviewed the team members. Observational and interview data were analysed quantitatively and qualitatively in order to determine and describe the nature of the knowledge exchange process in more detail. This enabled us to refine our conceptual framework of knowledge exchange. We found that knowledge exchange can be understood as a dynamic and fluid process which incorporates distinct forms of knowledge from multiple sources. Quantitative analysis illustrated that five broadly-defined components of knowledge exchange (problem, context, knowledge, activities, use) can all be in play at any one time and do not occur in a set order. Qualitative analysis revealed a number of distinct themes which better described the nature of knowledge exchange. By shedding light on the nature of knowledge exchange, our findings problematise some of the linear, technicist approaches to knowledge translation. The revised model of knowledge exchange which we propose here could therefore help to reorient thinking about knowledge exchange and act as a starting point for further exploration and evaluation of the knowledge exchange process.
30855008
Research Pyramid: a new evidence-based practice model for occupational therapy.
In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.
8256410
The deconstructing angel: nursing, reflection and evidence-based practice.
This paper explores Jacques Derrida's strategy of deconstruction as a way of understanding and critiquing nursing theory and practice. Deconstruction has its origins in philosophy, but I argue that it is useful and relevant as a way of challenging the dominant paradigm of any discipline, including nursing. Because deconstruction is notoriously difficult to define, I offer a number of examples of deconstruction in action. In particular, I focus on three critiques of reflective practice by the meta-narrative of evidence-based practice (EBP) and attempt to show how those critiques can be directed back at EBP itself. I conclude with the observation that EBP is open to many of the criticisms that it directs at other discourses, including problems of a lack of empirical evidence, of distortions due to memory, and of falsification of the 'facts'.
45096550
Hierarchies of evidence in education.
The trend toward providing evidence-based education has emerged in part from the precedent set by the evidence-based practice movement in medicine. Historically, the medical model specified that evidence should be informed by experimental research. However, more contemporary models draw on a variety of evidence to determine best practices. Quantitative, qualitative, and mixed-methods designs, as well as the incorporation of professional expertise, are recognized as acceptable approaches to interpreting evidence in the educational arena. This article describes an integrated level of evidence model to assist educators in identifying the best evidence to inform teaching and learning practices.
19679393
Knowledge generation and utilisation in occupational therapy: towards epistemic reflexivity.
AIM
The purpose of this article is to consider the ways in which theory generation, and hence knowledge generation, in occupational therapy is a complex social process, and therefore carries (often hidden) responsibilities for those who are part of our epistemic community. An epistemic community is a knowledge-producing community, who apply their standards of credibility, and epistemic values, to theory choice. In occupational therapy this community is comprised of a worldwide group of scholars and practitioners.


METHODS
We propose that epistemic reflexivity can be used to critique and contribute to our disciplinary knowledge and to critically consider 'who' makes epistemological choices in our profession, and the consequent implications for the theories we adopt. The purpose of this article is to make these relations explicit so that scholars and therapists can become increasingly conscious and empowered with respect to their contributions to occupational therapy's epistemic community. To demonstrate an application of epistemic reflexivity, we critically consider a theoretical construction that has been widely adopted by the international occupational therapy community: evidence-based practice.


RESULTS
As authors, we engage in epistemic reflexivity to critically consider the challenge posed by evidence-based practice. We propose a conception of practice knowledge that is informed by evidence yet based on a conception of wise practice.


CONCLUSION
Our intention is to stimulate discussion and debate in occupational therapy's epistemic community, a number of approaches for fostering epistemic reflexivity in occupational therapy are suggested.
10553520
Redescribing reflective practice and evidence-based practice discourses.
This paper provides an analysis on the discourses of reflective practice and evidence-based practice. It commences by examining the role of discourse in describing and defining our beliefs and attitudes. Consequently, it argues that each discourse is based on a certain epistemology, which in effect are language constructs that create realities and like all language constructs, the epistemology of each discourse is open to the possibility of being restructured. Sequentially, any discourse can (re)describe a different type of reality by providing a set of different words, values and beliefs. Eventually, by exposing the language play and the engineered binary of the reflective practice and the evidence-based practice discourses it is concluded that these discourses are not mutually exclusive as they have been portrayed by most of the literature, but complementary ones. Finally, reflective practice and evidence-based practice are re-described as supplementary discourses and practitioners can simultaneously utilize both through the process of critical reflexivity.
206452013
“It’s a Feel. That’s What a Lot of Our Evidence Would Consist of ”: Public Health Practitioners’ Perspectives on Evidence
This article describes how evidence is defined and used in two British Columbia public health departments during the implementation of a Healthy Living initiative in 2009. Through interviews with 21 public health staff and decision makers, the author sought to investigate how “evidence” was defined by both frontline and management staff and how it was used in decision making. The authors found public health staff, particularly frontline practitioners, to be drawn to grassroots and local “lived experience” evidence. This tacit wisdom, in combination with evidence from academia and clinical evidence accessed through disciplinary or professional networks, offered a knowledge transition opportunity to inform decision making, rather than what can be characterized in the literature as unidirectional knowledge translation. It is often difficult for staff to digest and interpret research as part of their work day because of the volume and density of information that typically counts as evidence. Moreover, there exist challenges to identify and gather indicators as evidence of their work.
25968484
Reflexivity and metapositions: strategies for appraisal of clinical evidence.
According to Sackett, evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. In this article, clinical reasoning is depicted as multilayered processes of evidence construction by means of social interaction and human interpretation. A basic set of knowledge is the doctors initial capital at the onset of the individual encounter. This is a necessary, but insufficient, presumption for the elaboration of clinical knowledge required to solve the particular problem. A diagnostic conclusion may appear to constitute the most obvious part of knowledge. Yet the formulation of hypotheses and the choice of adequate strategies for the pursuit of evidence are perhaps even more significant dimensions of clinical knowledge. Potential biases affect the ways in which evidence is gathered and used. When clinicians are not committed to appraising the evidence constituting the foundations of their enterprise, quality assessment of clinical practice becomes casual and unreliable. Reflexivity implies having a self-conscious account of the production of knowledge as it is being produced. From metapositions, critical questions can be asked and sometimes answered. Evidence-based practice in the original sense requires that doctors reflect upon their own positions as knowers, in the process of situated knowing, where certain rhetorical spaces rule.
2909879
Developing person-centred care: addressing contextual challenges through practice development.
Developing person-centred care is not a one-time event; rather it requires a sustained commitment from organisations to the ongoing facilitation of developments, a commitment both in clinical teams and across organizations. Contextual factors pose the greatest challenge to person-centredness and the development of cultures that can sustain person-centred care. We will begin with a general comment on 'context' and its meaning before exploring three particular factors that influence the practice context, namely, workplace culture, learning culture, and the physical environment. Next we explore a particular approach to developing person-centred care through emancipatory practice development. We highlight the importance of facilitation through emancipatory practice development programmes and describe how person-centred care can be developed through the presentation of a case study that illustrates the principles and processes of emancipatory practice development as well as the outcomes achieved. We conclude with an application to clinical practice. A key consideration for all organisations in the development of person-centred care is to move from what we suggest are 'person-centred moments' (individual, ad hoc experiences of person-centredness) to 'person-centred care' as an underpinning culture of teams and organisations.
77212498
Positioning continuing education: boundaries and intersections between the domains continuing education, knowledge translation, patient safety and quality improvement
Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the similarities and differences amongst the four domains in relation to their missions,
24444335
Research utilization and evidence-based practice in occupational therapy: a scoping study.
Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists' evaluation and integration of research evidence.
22626408
Whose evidence counts? An exploration of health professionals' perceptions of evidence-based practice, focusing on the maternity services.
OBJECTIVES
to gain an insight into how health professionals in the maternity services define evidence and how they perceive different types of evidence are valued in maternity care.


DESIGN
using a qualitative approach data were collected by semi-structured interviews: the content of each was analysed thematically.


SETTING
England.


PARTICIPANTS
a purposeful sample of ten midwives, two obstetricians and one research nurse.


FINDINGS
definitions of evidence vary widely among health practitioners. These definitions are affected by individuals' own beliefs and give rise to a hierarchy in which some types of evidence are valued above others. All the participants made direct or indirect reference to cultural beliefs inherent within the health service, and indicated that these beliefs determine the extent to which different types of evidence are seen as legitimate.


IMPLICATIONS FOR PRACTICE
the concept of evidence-based practice is not value-free. Evidence that reinforces notions of authoritative knowledge may be transposed into clinical practice quickly and easily. Conversely, health practitioners may have difficulty putting evidence into practice that challenges the cultural norms of the profession. There is a need for further work to make explicit the values that underpin different sources of knowledge and expose the hierarchies of evidence that exist.
41243592
Practice as the Site of Knowing: Insights from the Field of Telemedicine
This paper aims to shift the unit of analysis in the study of organisational knowledge from individuals and their actions to practices and their relationships. It introduces the concept of “site” to help advance an understanding of the relationship between practice and knowing. The notion of site supports the intuition that knowing is both sustained in practice and manifests itself through practice. It also evokes the idea of knowledge as being rooted in an extended pattern of interconnected activities that only when taken in its living and pulsating entirety constitutes the site of knowing. In this paper, I review the different ways to conceptualise the relationships between knowing and practice, and I show how the idea of site adds to the existing body of work. Building on the results of a longitudinal study in the field of telemedicine, I then offer suggestions on aspects of practice where knowing manifests itself, and I use the concepts of “translation by contact” and “at distance” to explain how dispersed knowings are woven together and the power effect that can derive from these. I conclude by reflecting on the implications of this radical view and the direction for future research.
143559790
Rethinking Polanyi’s Concept of Tacit Knowledge: From Personal Knowing to Imagined Institutions
Half a century after Michael Polanyi conceptualised ‘the tacit component’ in personal knowing, management studies has reinvented ‘tacit knowledge’—albeit in ways that squander the advantages of Polanyi’s insights and ignore his faith in ‘spiritual reality’. While tacit knowing challenged the absurdities of sheer objectivity, expressed in a ‘perfect language’, it fused rational knowing, based on personal experience, with mystical speculation about an un-experienced ‘external reality’. Faith alone saved Polanyi’s model from solipsism. But Ernst von Glasersfeld’s radical constructivism provides scope to rethink personal tacit knowing with regard to ‘other people’ and the intersubjectively viable construction of ‘experiential reality’. By separating tacit knowing from Polanyi’s metaphysical realism and drawing on Benedict Anderson’s concept of ‘imagined communities’, it is possible to conceptualise ‘imagined institutions’ as the tacit dimension of power that shapes human interaction. Whereas Douglass North claimed institutions could be reduced to rules, imagined institutions are known in ways we cannot tell.
21943721
Bridging epistemologies: The generative dance between organizational knowledge and organizational knowing
Bridgin Epistemologies: The Generative Dance between Organizational Knowledge and Organizational Knowing - Much current work on organizational knowledge, intellectual capital, knowledge-creating organizations, knowledge work, and the like rests on a single, traditional understanding of the nature of knowledge. We call this understanding the epistemology of possession. since it treats knowledge as something people possess. Yet, this epistemology cannot account for the knowing found in individual and group practice. Knowing as action calls for an epistemology of practice, Moreover, the epistemology of possession tends to privilege explicit over tacit knowledge, and knowledge possessed by individuals over that possessed by groups. Current work on organizations is limited by this privileging and by the scant attention given to knowing in its own right. Organizations are better understood if explicit, tacit, individual and group knowledge are treated as four distinct and coequal forms of knowledge (each doing work the others cannot), and if knowledge and knowing are seen as mutually enabling (not competing). We hold that knowledge Is a tool of knowing, that knowing is an aspect of our interaction with the social and physical world, and that the interplay of knowledge and knowing can generate new knowledge and new ways of knowing. We believe this generative dance between knowledge and knowing is a powerful source of organizational innovation. Harnessing this innovation calls for organizational and technological infrastructures that support the interplay of knowledge and knowing. Ultimately, these concepts make possible a more robust framing of such epistemologically-centered concerns as core competencies, the management of intellectual capital, etc. We explore these views through three brief case studies drawn from recent research.
2951496
Uncovering Tacit Knowledge: A Pilot Study to Broaden the Concept of Knowledge in Knowledge Translation
BackgroundAll sectors in health care are being asked to focus on the knowledge-to-practice gap, or knowledge translation, to increase service effectiveness. A social interaction approach to knowledge translation assumes that research evidence becomes integrated with previously held knowledge, and practitioners build on and co-create knowledge through mutual interactions. Knowledge translation strategies for public health have not provided anticipated positive changes in evidence-based practice, possibly due in part to a narrow conceptualization of knowledge. More work is needed to understand the role of tacit knowledge in decision-making and practice. This pilot study examined how health practitioners applied tacit knowledge in public health program planning and implementation.MethodsThis study used a narrative approach, where teams from two public health units in Ontario, Canada were conveniently selected. Respondents participated in individual interviews and focus groups at each site. Questions were designed to understand the role of tacit knowledge as it related to the program planning process. Data were analyzed through a combination of content analysis and thematic comparison.ResultsThe findings highlighted two major aspects of knowledge that arose: the use of tacit knowledge and the integration of tacit and explicit knowledge. Tacit knowledge included: past experiences, organization-specific knowledge, community contextual knowledge, and the recognition of the tacit knowledge of others. Explicit knowledge included: research literature, the Internet, popular magazines, formal assessments (surveys and interviews), legislation and regulations. Participants sometimes deliberately combined tacit and explicit knowledge sources in planning.ConclusionsThis pilot demonstrated that front-line public health workers draw upon both tacit knowledge and explicit knowledge in their everyday lived reality. Further, tacit knowledge plays an important role in practitioners' interpretation and implementation of explicit research findings. This indicates a need to broaden the scope of knowledge translation to include other forms of knowledge beyond explicit knowledge acquired through research. Strategies that recognize and support the use of tacit knowledge, such as communities of practice or networks, may be important components of a comprehensive approach to knowledge translation. This study provides support for further investigation of the role of tacit knowledge in the planning and delivery of effective public health services.
161951642
Values-based health and social care : beyond evidence-based practice
Introduction - Jill McCarthy and Pat Rose The Emergence of Evidence-based Practice - Mike Thomas, Mike Burt and Joy Parkes Evidence-based Practice within Values-based Care - Pat Rose and Jan Gidman Caring: Values and Evidence - Pat Rose and Sue Phillips Values of Reductionism and Values of Holism - Tom Mason, Pete Hinman, Ruth Sadik, Doreen Collyer, Neil Hosker and Adam Keen Valuing Professional Judgement - Jill McCarthy, Pauline Alexander, Moyra Baldwin and Jan Woodhouse The Value and Values of Service Users - Annette McIntosh, Julie Dulson and Julie Bailey-McHale, Vignettes by Joanne Greenwood A Values-based Era in Professional Caring - Jill McCarthy and Sue Grumley
38482284
Technical rationality in Schön's reflective practice: dichotomous or non-dualistic epistemological position.
Donald Schön's theory of reflective practice has received unprecedented attention as an approach to professional development in nursing and other health and social care professions. This paper examines technical rationality in Schön's theory of reflective practice and argues that its critique is a broad and often overlooked epistemological underpinning in this work. This paper suggests that the popularity of Schön's theory is tied in part to his critique of technical rationality, and to his acknowledgement of the significance of practitioner experience and indeterminate zones of practice in the development of expertise. Schön tapped into a growing disillusionment with technical rationality that coincided with a crisis of knowledge across a range of disciplines. The question is raised as to whether Schön's critique sets up a dichotomy between technical rationality and experience, or overcomes it. The conclusions suggest that Schön is not discarding research-based professional knowledge, but rather challenging conflated views of its practical significance. In this way, it is proposed that his critique of technical rationality can be interpreted as an attempt to overcome dualistic thinking as it pertains to professional knowledge.
55919296
Pathways to practice: praxiography and international politics
Political scientists have started to focus on ‘practice’ as the smallest unit of analysis. Following a broader turn in the social sciences, the practice focus provides multiple advantages, including better conceptualizations of short-term social change, getting closer to the everyday activities of those speaking, writing and doing politics, appropriate conceptualization of agency-structure dynamics, or forms of analysis resonating with other communities than scholarly ones. This contribution asks what the methodological implications of the practice turn are. It is argued that the practice focus does not only imply a certain ‘theory’ but also a certain methodology. I advance the term praxiography to speak about the forms of analysis produced by practice researchers. I discuss key guidelines of praxiographic research on two levels: first, general research strategies that provide empirical access points, second, guidelines for data collection in the frame of participant observation, expert interviews, and document analysis. I conclude in arguing that although praxiography is context driven, and hence requires to be tailored to the research problem, it is vital to reflect on the methodological repertoire of praxiographic research.
53060774
Surfacing the multiple : diffractive methods for rethinking professional practice and knowledge
In this chapter we argue that professional knowledge is necessarily singular and multiple. We add that this is an inherent characteristic of professional knowledge heightened by recent developments. Our point of departure is that practical knowledge is over-determinate by nature: multiple and often dissonant causes, forces, histories intersect at the point where practice is accomplished. In the process, the adoption of a given modus operandi leads to the deferral and suppression of all the possible alternatives. In this sense, the ideal of professional practice as a stable, coherent, bounded phenomenon is largely a myth and a convenient fiction that is part and parcel of the process of normalization and disciplining that is inherent in professionalization. To become a professional means both expanding and constraining one's repertoire of conducts. This is because on the one hand, becoming a professional allows one to expand the possibilities of action (i.e., 'what to do next') by tapping into the repertoire of actions developed by former members and sedimented in the professional community's collective experience. On the other hand, joining a profession means observing certain canons and norms and to submit to the profession's authority — something that automatically limits what is do-able, say-able and often thinkable (Foucault's disciplinary project).
18831564
Informal learning in the workplace
This paper focuses mainly on theoretical frameworks for understanding and investigating informal learning in the workplace, which have been developed through a series of large‐ and small‐scale projects. The main conclusions are included but readers are referred to other publications for more detailed accounts of individual projects. Two types of framework are discussed. The first group seeks to deconstruct the ‘key concepts’ of informal learning, learning from experience, tacit knowledge, transfer of learning and> intuitive practice to disclose the range of different phenomena that are embraced by these popular terms. The second group comprises frameworks for addressing the three central questions that pervaded the research programme: what is being learned, how is it being learned and what are the factors that influence the level and directions of the learning effort?
16012075
Organizational Learning and Communities-of-Practice: Toward a Unified View of Working, Learning, and Innovation
Recent ethnographic studies of workplace practices indicate that the ways people actually work usually differ fundamentally from the ways organizations describe that work in manuals, training programs, organizational charts, and job descriptions. Nevertheless, organizations tend to rely on the latter in their attempts to understand and improve work practice. We examine one such study. We then relate its conclusions to compatible investigations of learning and of innovation to argue that conventional descriptions of jobs mask not only the ways people work, but also significant learning and innovation generated in the informal communities-of-practice in which they work. By reassessing work, learning, and innovation in the context of actual communities and actual practices, we suggest that the connections between these three become apparent. With a unified view of working, learning, and innovating, it should be possible to reconceive of and redesign organizations to improve all three.
27816563
Within and Beyond Communities of Practice: Making Sense of Learning Through Participation, Identity and Practice
Situated learning theory offers a radical critique of cognitivist theories of learning, emphasizing the relational aspects of learning within communities of practice in contrast to the individualist assumptions of conventional theories. However, although many researchers have embraced the theoretical strength of situated learning theory, conceptual issues remain undeveloped in the literature. Roberts, for example, argues in this issue that the notion of 'communities of practice' - a core concept in situated learning theory - is itself problematic. To complement her discussion, this paper explores the communities of practice concept from several perspectives. Firstly, we consider the perspective of the individual learner, and examine the processes which constitute 'situated learning'. Secondly, we consider the broader socio-cultural context in which communities of practice are embedded. We argue that the cultural richness of this broader context generates a fluidity and heterogeneity within and beyond communities. Finally, we argue that it is sometimes difficult to distinguish conceptually between the terms 'participation' and 'practice' because of occasional duplication of meaning. We propose, instead, a refinement of the definition to allow for greater conceptual clarity.
145110051
Toward a 3-P Model of Workplace Learning: a Literature Review
The interest in research focusing on learning taking place at work, through work and for work has considerably increased over the past two decades. The purpose of the paper is to review and structure this wide and diverse research field. A tentative holistic model—the 3-P model of workplace learning—is presented, in relation to which the following six lines of research are identified: (1) studies describing the nature of workplace learning, (2) research on work identities and agency in workplace learning, (3) studies on the development of professional expertise, (4) analyses of competence development in education–work contexts in vocational education and training as well as in higher education, (5) research on communities of practice, and (6) research on organisational learning. The research lines and the holistic 3-P model should be seen as analytic tools for understanding the diversity in workplace learning research. They may also serve as a kind of map for individual researchers, helping them to locate their main areas of interest in this broad field of research and to outline research designs for future studies.
19659403
Practice development: Realising active learning for sustainable change
Abstract This paper explores the concept of practice development in the context of professional development and strategies for facilitating learning in practice. In this paper we present the background to the methodology of emancipatory and transformational practice development. Key concepts underpinning a contemporary definition of practice development are unravelled and nine principles for effective practice development proposed. An example of a large-scale national practice development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which practice development systematically uncovers the deeply embedded characteristics of practice cultures – characteristics that often inhibit effective person-centred practice to be realised.
116568037
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders
boomer c.a.& mccormack b. (2010) Journal of Nursing Management 18, 633–644 
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders 
 
Aim  To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. 
 
Background  The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. 
 
Methods  Programme evaluation methodology to determine the ‘worth’ of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. 
 
Results  Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. 
 
Conclusions  Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. 
 
Implications for nursing management  Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators.
45520475
Transformative learning and research utilization in nursing practice: a missing link?
BACKGROUND
Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions.


AIM
The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice.


APPROACH
Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice.


ISSUES AND CONCLUSIONS
(1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.
29114489
The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.
BACKGROUND
While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system.


AIM
To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations.


METHODS
A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2.


RESULTS
Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context.


CONCLUSIONS AND IMPLICATIONS
Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.
28316706
Evidence Equals Excellence: The application of an evidence-based practice model in an academic medical center.
An evidence-based practice (EBP) program that is designed to develop mentors in both clinical and academic settings has the potential for transforming a health care organization. This article describes an innovative program, Evidence Equals Excellence, which consists of two components: a clinical practice component for health care clinicians and an academic program for baccalaureate and graduate nursing students. The development of EBP mentors creates a core group of clinicians who can assist fellow staff members apply evidence at the bedside. An academic program prepares new graduates to partner easily with clinical mentors to support and initiate successful practice changes.
206861275
A collaborative approach to building the capacity for research and evidence-based practice in community hospitals.
The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care.
22113313
An Advanced Educational Program Promoting Evidence-Based Practice
Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses’ organization. Program evaluations are extremely positive, and the long-term impact is described.
418110
Professional differences in interprofessional working
UK government policy is encouraging healthcare staff to blur traditional roles, in the drive to increase joint working between practitioners. However, there is currently a lack of clarity regarding the impact that changes to traditional working practice might have on staff delivering the services, or on patient care. In this article, we report findings from three qualitative case studies examining interprofessional practice in stroke care, in which the influence of professional differences emerged as a significant theme. We draw on findings from individual semi-structured interviews, as well as fieldwork observations, to describe the influence of professional knowledge and skills, role and identity, and power and status considerations in interprofessional working. The insights that were gained contribute to the understanding of how professional differences impact on healthcare staff joint working, and suggest that the elements identified need to be fully considered in drives towards changed working practice.
167923865
The Nonspread of Innovations: the Mediating Role of Professionals
Two qualitative studies in the U.K. health care sector trace eight purposefully selected innovations. Complex, contested, and nonlinear innovation careers emerged. Developing the nonlinear perspective on innovation spread further, we theorize that multi-professionalization shapes "nonspread." Social and cognitive boundaries between different professions retard spread, as individual professionals operate within unidisciplinary communities of practice. This new theory helps explain barriers to the spread of innovation in multiprofessional organizations in both health care and other settings.
22731034
An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?
This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships.
22223937
Integration of health and social care: a case of learning and knowledge management.
This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies.
3130158
What fosters or prevents interprofessional teamworking in primary and community care? A literature review.
BACKGROUND
The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved.


OBJECTIVES
This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century.


DESIGN
A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods.


FINDINGS
Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed.


CONCLUSIONS
These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.
154227002
Networks, Organizational Learning and Knowledge Management: NHS Cancer Networks
There has been increased interest in the UK in network-based modes of organizing in the public services, as opposed to markets or hierarchies. One supposed advantage of the network form is a greater capacity for the transfer of evidence-based or ‘best’ practices across the network and accelerated organizational learning. Such networks may have a knowledge management role and stimulate the formation of ‘communities of practice’. This article tests these arguments using data from a study of managed NHS cancer networks in London. The general pattern was for networks to concentrate on structural reconfiguration, while their knowledge management role remained marginal. Some alternative implications for future policy development are considered.
16453938
Knowledge for Theory and Practice
We examine three related ways in which the gap between theory and practice has been framed. One approach views it as a knowledge transfer problem, a second argues that theory and practice represent distinct kinds of knowledge, and a third incorporates a strategy of arbitrage--leading to the view that the gap is a knowledge production problem. We propose a method of engaged scholarship for addressing the knowledge production problem, arguing that engaged scholarship not only enhances the relevance of research for practice but also contributes significantly to advancing research knowledge in a given domain.
27783515
Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.
The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.
206739021
Health Promotion Practice and the Road Ahead: Addressing Enduring Gaps and Encouraging Greater Practice-to-Research Translation
A decade ago, Lancaster and Roe described four critical gaps (i.e., communications, accessibility, credibility, and expectations) between research and practice in health education and health promotion that formed the framework for this department. Despite considerable attention and some progress, these gaps persist and are barriers to interaction and translation between health promotion and health education research and practice. Looking to the next several years as the new Associate Editors for this department, we renew the department’s commitment toward addressing these enduring gaps around which we frame new questions and invite continued dialogue.
2248745
The art and science of clinical knowledge: evidence beyond measures and numbers
Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction-factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organisation, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science.
7279733
Sources of information used by nurses to inform practice: An integrative review.
BACKGROUND
We present an integrative review of the literature about sources of information nurses use to inform practice. The demand for access to more and better information has been fueled by the evidence-based healthcare movement. Although the expectations for evidence-based practice have never been higher, the demands on care environments have never been greater. The goals of professional nursing are served by using the best available information to inform practice. To influence such activity, we must understand what sources of information nurses rely on for guidance.


DATA SOURCES
We examined studies of any research design published between 1985 and 2006, as well as research dissertations in the same time frame. Databases searched included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, the Educational Resources Information Center, the Library and Information Science Abstracts and the Library Literature and Information Science databases.


REVIEW METHODS
The review question: what information sources do registered nurses turn to, to support direct patient care? Analysis included an overview of study design and practice setting, and an examination of sources accessed most frequently by nurses to guide practice.


RESULTS
We present, in ranked order, the sources nurses accessed in order to guide practice. We note the high reliance on informal, interactive sources. An unexpected finding of high reliance on journals is explored in greater detail and found to be equivocal at best. We conclude with a critical discussion of what we see as embedded assumptions and expectations about how information-seeking supports nursing practice.


CONCLUSION
Expectations embedded in the scope and context of nursing practice have influenced knowledge development in the area of information-seeking to support practice. It is important that future research in this area takes into account the expectations and information needs arising in emerging roles for nurses within evolving healthcare systems.
5782230
The use of tacit and explicit knowledge in public health: a qualitative study
BackgroundPlanning a public health initiative is both a science and an art. Public health practitioners work in a complex, often time-constrained environment, where formal research literature can be unavailable or uncertain. Consequently, public health practitioners often draw upon other forms of knowledge.MethodsThrough use of one-on-one interviews and focus groups, we aimed to gain a better understanding of how tacit knowledge is used to inform program initiatives in public health. This study was designed as a narrative inquiry, which is based on the assumption that we make sense of the world by telling stories. Four public health units were purposively selected for maximum variation, based on geography and academic affiliation.ResultsAnalysis revealed different ways in which tacit knowledge was used to plan the public health program or initiative, including discovering the opportunity, bringing a team together, and working out program details (such as partnering, funding).ConclusionsThe findings of this study demonstrate that tacit knowledge is drawn upon, and embedded within, various stages of the process of program planning in public health. The results will be useful in guiding the development of future knowledge translation strategies for public health organizations and decision makers.
3034983
Reflection and reflective practice in health professions education: a systematic review
The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.
161951642
Values-based health and social care : beyond evidence-based practice
Introduction - Jill McCarthy and Pat Rose The Emergence of Evidence-based Practice - Mike Thomas, Mike Burt and Joy Parkes Evidence-based Practice within Values-based Care - Pat Rose and Jan Gidman Caring: Values and Evidence - Pat Rose and Sue Phillips Values of Reductionism and Values of Holism - Tom Mason, Pete Hinman, Ruth Sadik, Doreen Collyer, Neil Hosker and Adam Keen Valuing Professional Judgement - Jill McCarthy, Pauline Alexander, Moyra Baldwin and Jan Woodhouse The Value and Values of Service Users - Annette McIntosh, Julie Dulson and Julie Bailey-McHale, Vignettes by Joanne Greenwood A Values-based Era in Professional Caring - Jill McCarthy and Sue Grumley