Organizational theory can assist in better understanding how changes made in clinical practice can be sustained in healthcare organizations. Organizational learning and knowledge transfer theories were used to develop and test a theoretical model, “Sustaining in Memory” (SIM) model, to explore how organizations disperse or distribute newly transferred knowledge in knowledge reservoirs situated in the organization. Three hypotheses were generated from the theoretical model and tested with data from a cross sectional postal survey of 148 patient/resident care units in one large Canadian province where a CPG on prevention of falls was widely disseminated. Findings confirmed that fall prevention practice knowledge was transferred and embedded in all six knowledge reservoirs; however, there were three specific knowledge reservoirs that were found to be significant predictors of perceived CPG adherence (activities consistent with the CPG recommendations). These were staff, policy and role expectation knowledge reservoirs. There was variation in the adherence to the eight CPG recommendations with greater adherence to recommendations that were mandatory. Additionally, findings showed that the relationship between staff knowledge reservoir and CPG adherence was the only relationship moderated by the practices that helped to prevent/address knowledge loss through various activities designed for reviewing and updating practice knowledge. Interestingly, although CPG adherence was reported significantly greater in LTC resident care units, its association with patient outcomes was much weaker than in hospital patient care units. Hospital units had significantly greater correlation between perceived CPG adherence and all four of the falls prevention outcomes reported by study participants. Lastly, quality management culture as managed by senior leaders in the organization was also found to be a significant predicator of adherence to the CPG. The research study validated key assumptions made in the theoretical model while helping to clarify the distinct influence of different knowledge reservoirs. The SIM model provided an alternate perspective within which to study knowledge transfer and sustainability of clinical practices and has potential to apply to other change initiatives. This study answered the call for greater theoretically driven studies of CPG implementation as well as attention on the organizational influences of CPG implementation and sustainability.

Knowledge is a critical element for the provision of quality health care. Optimal clinical decision making incorporates multiple types of knowledge including patient knowledge, clinical experiential knowledge and research knowledge. Understanding how knowledge is shared and used in best practice is challenging as a number of factors can facilitate or impede the process. Several authors have highlighted the value of using a theoretical framework when examining knowledge in health care. A theoretical framework provides direction for the generation and testing of hypotheses which can contribute to building a comprehensive body of knowledge in a field of study. Although the majority of knowledge exchanged in practice settings occurs between clinicians, current knowledge exchange and utilization models in health care generally focus specifically on the exchange of research knowledge between the scientific community and the practice community. Acknowledging and understanding the knowledge seeking and sharing behaviours of clinicians is a key element in the larger knowledge translation puzzle. Emergency medicine is a clinical speciality where there is evidence of a knowledge to practice gap, however, there is limited understanding of the factors that contribute to the gap. Emergency practitioners must make decisions in a busy and often chaotic environment that is prone to multiple interruptions and distractions. The challenge for consistent and quality care is also more pronounced in rural and some suburban areas where emergency care needs are similar but resources are limited. The purpose of this program of research is to identify factors relevant to knowledge exchange and utilization in rural and urban emergency departments with the aim of developing a Model for Knowledge Exchange and Utilization in Emergency Practice. A series of studies were carried out using a mixed method research design to further develop and describe 3 key dimensions (individual, context of practice, knowledge) which were identified through a review of the literature. Data was collected using surveys, participant observations and interviews with nurses and physicians working in rural and urban emergency departments in Nova Scotia. Triangulation of results across the studies contributed to developing a comprehensive and rigorous description of the 3 dimensions of interest.

This report investigates the efficacy of using constraint-induced language therapy (CILT) for treating acquired apraxia of speech (AOS). CILT is a treatment method used with individuals with aphasia in which communication is restricted to verbal output in order to isolate the damaged language areas of the brain and reactivate impaired neural connections (Pulvermuller et al., 2001). CILT employs repetitive, massed practiced stimuli and structured shaping of expressive output within the confines of verbal expression (Pulvermuller et al., 2001). Kirmess and Maher (2010) indirectly discovered that two patients with aphasia and apraxia of speech made gains in both language output and articulatory accuracy after receiving intensive CILT, suggesting possible efficacy for the use of CILT with patients with AOS. / text

Child maltreatment (CM) is a major public health problem in the United States which affects millions of children each year. Because parents are responsible for the majority of substantiated CM reports, behavioral parent training is recommended as the primary prevention strategy. In recent years, researchers and clinicians have begun work examining the relevance and effectiveness of making cultural adaptations to parent training programs. The purpose of this study was to explore the need for systemic cultural adaptations to SafeCare®, an evidence-based parent-training child maltreatment prevention program. SafeCare is currently implemented in nine states and SafeCare providers are serving families representing a wide array of cultures and ethnicities. Eleven SafeCare providers, representing six states, participated in individual, semi-structured interviews to determine what, if any, cultural adaptations were in place in the field and whether there was a need for systematic culture-specific or general cultural adaptations to the SafeCare model. The interviews provided evidence that, across sites and populations, adaptations are being made when implementing SafeCare with diverse families. Providers expressed a need to make the language/reading levels of the model materials more relevant for all the populations served. Overall, however, providers found the model to be flexible and amenable to working with families of various cultures and ethnicities. Providers recommended against systematic adaptations of the model for specific ethnic groups.

Knowledge is a critical element for the provision of quality health care. Optimal clinical decision making incorporates multiple types of knowledge including patient knowledge, clinical experiential knowledge and research knowledge. Understanding how knowledge is shared and used in best practice is challenging as a number of factors can facilitate or impede the process. Several authors have highlighted the value of using a theoretical framework when examining knowledge in health care. A theoretical framework provides direction for the generation and testing of hypotheses which can contribute to building a comprehensive body of knowledge in a field of study. Although the majority of knowledge exchanged in practice settings occurs between clinicians, current knowledge exchange and utilization models in health care generally focus specifically on the exchange of research knowledge between the scientific community and the practice community. Acknowledging and understanding the knowledge seeking and sharing behaviours of clinicians is a key element in the larger knowledge translation puzzle. Emergency medicine is a clinical speciality where there is evidence of a knowledge to practice gap, however, there is limited understanding of the factors that contribute to the gap. Emergency practitioners must make decisions in a busy and often chaotic environment that is prone to multiple interruptions and distractions. The challenge for consistent and quality care is also more pronounced in rural and some suburban areas where emergency care needs are similar but resources are limited. The purpose of this program of research is to identify factors relevant to knowledge exchange and utilization in rural and urban emergency departments with the aim of developing a Model for Knowledge Exchange and Utilization in Emergency Practice. A series of studies were carried out using a mixed method research design to further develop and describe 3 key dimensions (individual, context of practice, knowledge) which were identified through a review of the literature. Data was collected using surveys, participant observations and interviews with nurses and physicians working in rural and urban emergency departments in Nova Scotia. Triangulation of results across the studies contributed to developing a comprehensive and rigorous description of the 3 dimensions of interest.

This thesis aims to explore how medical social workers/counselors perform their work with people during crisis and how they accumulate and practice scientific crisis knowledge. This study is an empirical research paper based on qualitative interviews conducted with eight medical social workers. The data was analysed with Kvales model for categorization, which constitutes the basis of the research. The results of the research was then analysed with the use of Cullbergs crisis theory and a model of evidence based practice which is described by Topor and Denhov. The results show that the medical social workers practice the evidence based practice model, described by Topor and Denhov, in combination with Cullbergs crisis theory. The medical social workers acknowledged the individuals’ experiences in their work as well as their own experiences and scientific knowledge. Our conclusion is that the practice of medical social workers/counselors is varying, depending on the varying needs of the individuals. The social workers/counselor accumulates most knowledge through their own and the individuals’ experiences, but also from scientific crisis evidence.

The need to utilize research in decision making is considered critical in the present health care environment. For health research to be applied, it must have value. However, the question of the value of research has not been fully explored in the literature. The purpose of this study is to gain an understanding of occupational therapists’ perceptions of the value of research. Semi-structured interviews were completed in Winnipeg, Manitoba with 10 occupational therapists. The four themes in the study influencing their perceptions of the value of research were their experiences with research, the purpose of research, the resources to support research and the clinician and researcher culture. A number of elements were identified which may have informed the occupational therapists’ perceptions of the value of research. Having an understanding of the elements that may influence the perceptions of the value of research may assist with developing effective research utilization programs.

This thesis seeks to acknowledge the issues and challenges, as well as the opportunities and successes that continue to present for Māori learners accessing special education services in Aotearoa New Zealand. Year after year, strategic educational documents, policies and services are revisited, reviewed or restructured in order to effect a series of considered and realistic responses that are able to address the inequities that perpetuate for Māori learners. Discussions and debates specific to what needs to change, how this should be done, and who has the authority to decide, continue to be had. Perceptions vary between interested groups about the relevance and appropriateness of much of the research evidence that is drawn on to inform special education policy and practice directions for use with Māori learners. This research study investigates two key special education constructs; culturally responsive practice, and evidence based practice. The overall aims are to ascertain what Māori perceive to be the key components that comprise both of these individual terms; to determine if (and how) they are dissimilar or synonymous terms from a Māori perspective; and, to understand how these perceptions differ or are in tandem with special education (western) thinking. It is argued that these terms are regularly defined for Māori by non-Māori, without input or consultation from the former, and that this (in effect) perpetuates a cycle of special education service provision that is unable to respond adequately to, or connect culturally with, Māori realities. The scene is set wherein a three-circle evidence based practice framework that has been adopted by special education is used (in tandem with the Māori concept of mana), as the structure for selecting the research participants; all of whom are Māori / Māori affiliated. It is my contention that a range of Māori perspectives that are reflective of all of the three types of evidence that special education acknowledges is a worthy starting point for determining parallels and distinctions. From the three evidence domains of research, practice, and whānau, 18 leaders share their respective and collective knowledge, expertise, thoughts and wisdom about the two key constructs. What transpires throughout this study is the emergence of six strong components that are unanimously privileged by these leaders as critical to culturally responsive evidence based special education practice for Māori tamariki and whānau. These components are then drawn on to uncover a range of kaupapa Māori frameworks that are reflective of the participants’ discourses.

The need to utilize research in decision making is considered critical in the present health care environment. For health research to be applied, it must have value. However, the question of the value of research has not been fully explored in the literature. The purpose of this study is to gain an understanding of occupational therapists’ perceptions of the value of research. Semi-structured interviews were completed in Winnipeg, Manitoba with 10 occupational therapists. The four themes in the study influencing their perceptions of the value of research were their experiences with research, the purpose of research, the resources to support research and the clinician and researcher culture. A number of elements were identified which may have informed the occupational therapists’ perceptions of the value of research. Having an understanding of the elements that may influence the perceptions of the value of research may assist with developing effective research utilization programs.

This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background.¿ The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology.¿ Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results.¿ This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions.¿ Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice.¿ This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.