Family members are in an optimal position to identify changes in behaviour of loved ones suffering from delirium. To date there are no known studies on educational interventions specifically targeting families of the elderly related to delirium outside of the hospital setting. Using the Knowledge to Action Process, families became involved in the development of a knowledge translation product related to delirium. It was found from two focus groups that participants’ knowledge of delirium was limited. Also, it was determined that participants were most interested in receiving an educational session in a group setting. The education session was developed using feedback from the focus groups as well as evidence based resources. The focus for the education session was on prevention and identification of delirium. There were a total of seven education sessions held and 16 eligible participants. In each session a pre and post-test for delirium knowledge was given to the participants. There was a significant increase in scores on the post-test following the session. Participants were also given a post session questionnaire to evaluate the education session. Overall the session was well received; participants were often interested in learning more about delirium. Half of the participants felt they would be able to identify delirium in someone close to them. The majority of participants thought that it is important for other families of the elderly to receive a similar session on delirium. Four to six weeks following the education session, semi-structured telephone interviews were conducted with five participants from the second phase in order to receive further feedback on the intervention. Most participants were able to recall information related to risk factors and signs of delirium. Three participants stated that the education sessions should be longer in order to provide more time for discussion. Participants still thought they would be able to recognize delirium as long as they were close to the person experiencing it. Since the education session none of the participants had witnessed anyone who was delirious. / Thesis (Master, Nursing) -- Queen's University, 2010-09-03 12:50:12.792

abstract: The greatest challenge facing humanity in the twenty-first century is our ability to reconcile the capacity of natural systems to support continued improvement in human welfare around the globe. Over the last decade, the scientific community has attempted to formulate research agendas in response to what they view as the problems of sustainability. Perhaps the most prominent and wide-ranging of these efforts has been sustainability science, an interdisciplinary, problem-driven field that seeks to address fundamental questions on human-environment interactions. This project examines how sustainability scientists grapple with and bound the deeply social, political and normative dimensions of both characterizing and pursuing sustainability. Based on in-depth interviews with leading researchers and a content analysis of the relevant literature, this project first addresses three core questions: (1) how sustainability scientists define and bound sustainability; (2) how and why various research agendas are being constructed to address these notions of sustainability; (3) and how scientists see their research contributing to societal efforts to move towards sustainability. Based on these results, the project explores the tensions between scientific efforts to study and inform sustainability and social action. It discusses the implications of transforming sustainability into the subject of scientific analysis with a focus on the power of science to constrain discourse and the institutional and epistemological contexts that link knowledge to societal outcomes. Following this analysis, sustainability science is repositioned, borrowing Herbert Simon's concept, as a "science of design." Sustainability science has thus far been too focused on understanding the "problem-space"--addressing fundamental questions about coupled human-natural systems. A new set objectives and design principles are proposed that would move the field toward a more solutions-oriented approach and the enrichment of public reasoning and deliberation. Four new research streams that would situate sustainability science as a science of design are then discussed: creating desirable futures, socio-technical change, sustainability values, and social learning. The results serve as a foundation for a sustainability science that is evaluated on its ability to frame sustainability problems and solutions in ways that make them amenable to democratic and pragmatic social action. / Dissertation/Thesis / Ph.D. Sustainability 2011

In just over a decade, exome sequencing and genome sequencing (ES/GS) has transitioned from a research method to an implemented test for patients with suspected rare genetic diseases (RGDs) worldwide, and healthcare systems are challenged to optimize its use within their jurisdictions. This thesis aimed to examine the rapidly evolving scientific evidence base related to ES/GS and how it has been translated into diagnostic care for families with RGDs to inform practice and policy in the future. Guided by the Knowledge-to-Action (KTA) conceptual framework, I designed and conducted three original studies: two aimed to generate evidence related to the KTA concept of Knowledge Creation, and the third studied the Action Cycle. In Article 1, we examined the knowledge base and determined that evidence related to the etiologies of RGDs and analytical processes related to ES/GS testing are progressing at a pace that has diagnostic implications. Next, in Article 2, we examined knowledge refinement and found that one knowledge user, organizations representing genetics professionals, have produced clinical recommendations related to a broad range of topics connected to ES/GS for RGD diagnosis, but the quality of clinical guidance documents is low, overall, and with specific reference to the rigour of the methods developers used. Finally, in Article 3, we studied the Action Cycle and found that implementing publicly-funded ES/GS using a set of clinical eligibility criteria in the Ontario healthcare system resulted in clinically-valid diagnoses for patients that met provincial benchmarks for diagnostic yield. Together, the results of these studies informed eight considerations for optimizing ES/GS testing with implications for healthcare practitioners, patients, guidance developers, payers, and researchers. Importantly, this thesis provides evidence of the necessity for continued evaluation and improved guidance development related to ES/GS to optimize this testing. It offers a foundation for future studies that may investigate knowledge translation into policy and practice in this and other rapidly evolving fields. Ultimately, these findings will enable better diagnostic care for families with RGDs.

Occupational therapy practitioners (OTPs) are reporting low levels of research application in everyday practice, causing a low frequency of evidence-based practice (EBP) implementation (Krueger et al., 2020; Myers, 2019a). A review of the literature demonstrates that individual level factors, such as lack of knowledge, skill, time, and resources for research use, coupled with organizational factors, such as low priority, support, and expectation for EBP, act as barriers to EBP (Wang et al., 2019). This doctoral project aims to build the capacity for research use at both the practitioner and the organization levels through an evidence-based multifaceted intervention program. It will impact the knowledge and skill for understanding and applying research evidence in practice and the frequency of research use in daily practice among school-based occupational therapy practitioners (Sb-OTPs), as well as the organization’s resources, priorities, and environment to support EBP. A mixed-methods design will be used, with a convenience sample of nineteen Sb-OTPs employed at a therapy agency that provides services through contract positions to local school districts. The program consists of four main components of education, provision of resources, working in groups, and organizational supports. The Knowledge-To-Action (KTA) framework (Graham et al., 2009) provides a context-focused iterative process to the program design, from problem identification to sustainability. Continual involvement of all stakeholders, assessment of barriers to tailor the intervention, and adaptation of the knowledge for use in the practice context are KTA-based core program features. The education component is informed by Social Cognitive Theory (SCT) (Bandura, 1986), brain-based learning strategies (Willis, 2006; Yee & Boyd, 2018), and literature supporting blended learning and digital health education formats (Brown et al., 2020; Hew & Lo, 2018; Liu et al., 2016). The program description, implementation, research evaluation plan, and program funding and dissemination are described in detail.

Background: Health technology assessment (HTA) is a form of policy analysis to inform recommendations for decision-makers. An equity-focused HTA recommendation consists of one that explicitly addresses the impact of health technologies on individuals disadvantaged in society because of their social conditions. However, there is a need for more evidence on the relationships between patient engagement and the development of equity-focused HTA recommendations. Objectives: The objectives of this dissertation were to examine the association between patient engagement and equity-focused HTA recommendations and identify implementation considerations for patient engagement in HTA. Methods: I used explanatory sequential mixed methods to analyze 60 HTA reports and 11 interviews with patients and analysts from Canadian organizations: the Canadian Agency for Drugs and Technologies in Health (CADTH) and Health Quality Ontario (HQO). Results: Quantitative analysis of the HTA reports showed that patient engagement significantly predicts equity-focused HTA recommendations (OR: 0.26; 95% CI: [0.16 – 0.41]). HTA reviews where HTA analysts directly interviewed patients (OR: 3.85; 95% CI: [2.40 – 6.20]) and where an advisory committee used consensus were more likely to contain equity-focused recommendations (OR: 2.27; 95% CI: [1.35 – 3.84]). Qualitative analysis of the interviews identified strategies for engaging diverse patients in HTA. Conclusion: The findings of this dissertation can inform the designing of patient engagement in HTA.

Purpose. The purpose of this dissertation is to understand the state of recommended practice for sedation interruptions (SI) and to discover factors that hinder or facilitate critical care nurses’ use in practice. To garner insight about why this evidence-informed intervention is not being used as recommended to improve mechanically ventilated patient outcomes. Methods. A series of studies using a multi-methods design and guided by the Knowledge to Action Framework: study 1) a systematic review and critical appraisal examined the quality and reporting of all available guidelines and care bundles with recommendations related to SI for mechanically ventilated adults in critical care; study 2) a needs assessment included an environmental scan of the study site and gap-analysis using a retrospective chart audit to measure the nature and magnitude of the evidence-practice gap; study 3) a descriptive qualitative study used semi-structured theory-based interviews to deepen our understanding of the determinants that influence SI use in preparation for a future implementation study. Findings. Study 1 included 11 guidelines and care bundles with 15 recommendations about SI. Deficiencies in the methodological quality of the current guidelines and care bundles may impact overall credibility and applicability of the recommendations, though SI is currently recommended best-practice. Study 2 confirmed the existence of an evidence-practice gap related to SI and affirmed the need to discover barriers and drivers to best practice implementation (study 3). We identified nine facilitators and 20 barriers to SI use by nurses. Facilitators were associated with the innovation (e.g., the importance of protocols) and the potential adopters (e.g., SI are specific to the nurse's role). The barriers were associated with the potential adopters (e.g., nurses’ knowledge gaps and variable goals of SI) and the practice environment (e.g., lack of availability of extra staff and multidisciplinary rounds). Conclusion. Before adequately implementing SI and evaluating uptake by nurses, we need to address modifications to existing guidelines and recommendations, even though SI is considered best practice. A theory-informed implementation study can further activate the use of SI for mechanically ventilated adults in critical care.

Background: This thesis aimed to develop, implement, and evaluate a multi-faceted integrated knowledge translation (iKT) intervention to disseminate and support adoption of the ‘F-words in Childhood Disability’. Grounded in the WHO’s ICF framework, the ‘F-words’ (Function, Family, Fitness, Fun, Friends, and Future) offer a holistic family-centred approach to childhood disability. Methods: This thesis was guided by the action cycle of Graham et al.’s (2006) knowledge-to-action (KTA) framework. Chapter 2 reports a knowledge translation (KT) initiative (i.e., an online video) to disseminate the ‘F-words’ and explore people’s reception of these ideas. Chapter 3’s scoping review identifies and assesses KT strategies that directly target families raising children and youth with special health care needs. Chapter 4 describes a pilot study to evaluate the usability and utility of an online ‘F-words’ KT resource. Chapter 5 reports a case study of our longitudinal KT research program, and uses Diffusion of Innovation (DOI) theory to understand the factors that contributed to the adoption of the ‘F-words’. Results: Multi-faceted KT strategies, co-developed with stakeholders, were essential to moving the ‘F-words’ into practice. The video (Chapter 2) reached >700 views in two months and 98% of 137 survey respondents indicated they ‘extremely liked’/‘liked’ the ideas. The scoping review (Chapter 3) identified six studies, all of which evaluated educational materials and deemed them to be useful and important to families. The pilot evaluation (Chapter 4) revealed the online resource to have positive usability and utility for families and service providers. The case study (Chapter 5) highlighted that diffusion, dissemination and implementation strategies were all needed and that DOI factors (i.e., the innovation characteristics, communication channels, social networks, and time) contributed to the adoption of the ‘F-words’. Based on a multi-faceted integrated KT research program we now have extensive examples of ‘F-words’ adoption by families, service providers, and health care organizations. Conclusions: This thesis illustrates a step-wise theory-informed approach to the development and evaluation of a multi-faceted iKT intervention. By studying each step of the action cycle, this work contributes new knowledge to both the processes involved in disseminating research evidence, and associated outcomes from a multi-faceted iKT intervention. Findings from this thesis contribute new discoveries to both KT practice and science. / Thesis / Doctor of Philosophy (PhD) / In the 21st century, research supports a holistic family-centred approach to childhood disability. Unfortunately, a research to practice gap remains, and the professional-led biomedical approach still informs many practices. In 2012, Rosenbaum and Gorter published “The ‘F-words’ in childhood disability: I swear this is how we should think!” They highlighted the importance of ‘Function, Family, Fitness, Fun, Friends, and Future’, grounded in the World Health Organization’s framework for health. This thesis developed and evaluated a knowledge translation research program to move the ‘F-words’ into practice. Objectives, all achieved, were to: i) apply strategies to spread awareness of the ‘F-words’ and explore people’s reception of these ideas; ii) identify and assess strategies to share research with families; iii) develop and evaluate an online resource to support use of the ‘F-words’; and iv) study the processes involved and factors that contributed to the ‘F-words’ adoption. These findings have implications for both doing and studying knowledge translation.