Aim: This paper is a report on a study that explored the professional development of intensive care unit nurses in journal clubs. Background: Evidence-based practice is important in nursing care (Krom, Batten, & Bautista, 2010). However few nurses feel comfortable using evidence to guide their practice (Pravikoff, Tanner, & Pierce, 2005). Journal clubs are a way to establish science as conversation (Wright, 2004) and foster knowledge translation for evidence-based nursing practice (Goodfellow, 2004). Methods: Monthly journal club meetings were held with the participation of a total of 71 healthcare professionals (65 nurses, 2 physicians, 2 pharmacists, 1 physiotherapist, and 1 respiratory therapist), who worked in two intensive care units of an Ontario hospital. After six months of meetings, 21 individual interviews were conducted with nurses, physicians, pharmacists, and nurse educators. Additional data collection included two focus groups, surveys, a review of staff meeting minutes, and researcher field notes. Findings: Journal clubs provided nurses with incentive to read research articles, improved nurses’ confidence in reading research, created a community of peers who worked collaboratively to improve clinical practice, provided a structure for nurses to reflect-on-practice, and led to reported changes in clinical practice. However, the data suggests that any gains in competence of nurses with the critical appraisal of research articles were probably modest. Barriers to participating in journal clubs and evidence-based practice are also identified. Conclusion: Journal clubs can foster knowledge translation and evidence-based practice through creating a community of practice and by providing nurses with motivation, structure, and confidence to read research articles. However, nurses reported a lack of critical appraisal skills and uncertainty about how to implement evidence into practice. Journal clubs may have a greater impact when implemented alongside other knowledge translation strategies such as working with clinical nurse specialists in order to enhance evidence-based practice.

This study examined the knowledge relevant to reducing crime affecting urban Aboriginal people through a risk-focused approach to prevention and a growing body of knowledge about how it gets implemented. It then examined this knowledge in a case study of its application in Winnipeg. Interviews were undertaken using a structured questionnaire with program stakeholders and policy planners involved in crime prevention initiatives, programming and policy in Winnipeg. Approximately half of the stakeholders were involved primarily with Aboriginal people and the other half were involved with programs that included both Aboriginal people and non-Aboriginal people. The interviews took place from September to November 2009. The interviews show that many stakeholders agree with the risk-focused prevention literature on risk factors and that there are prevention programs operating in Winnipeg serving at-risk Aboriginal people. Therefore, there exists the possibility of reducing crime given that they are tackling risk factors in a way which is consistent with crime prevention research. However, when the interviews turned to issues of implementation, it showed: • There is no responsibility centre to mobilize different sectors to tackle crime • Many programs are not implemented comprehensively • There is a lack of localized coordinated action (including support from the police chief and public engagement) • There is a lack of political leadership • There is no city-wide strategic plan, and • Programs are in constant competition for funding in order to continue operations. If we are to reduce the disproportionate rates of victimization and offending affecting urban Aboriginal peoples, we need to find more effective ways to implement the strategies that are proven to tackle risk factors. There must be support from the mayor and police chief, training and capacity development, and public engagement which fosters strong use of proven strategies. A responsibility centre with Aboriginal representation must be created. Funding must be expanded to support the community based organizations that are tackling established risk factors. Finally, sustained and adequate funding must be provided to these programs and the responsibility centre.

Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses. Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.

Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses. Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.

Adoption of evidence-based parenting programs by community agencies requires an understanding of the variables that affect their implementation. This study examined variables associated with the implementation of Triple P – Positive Parenting Program in Ontario. Surveys were completed on-line by 63 administrators, 54 supervisors, and 215 service providers from 69 different agencies. In a first article, I report on agencies’ pre-implementation openness, readiness, and resistance as well as on service providers’ self-reported use of and adherence to the program. Respondents from the vast majority of agencies reported openness to change prior to implementation but approximately half reported that they were not ready and experienced resistance. Although the majority of trained service providers used the program, a significant minority had not delivered it since training. The average adherence rate reported by service providers who used the program was 85.9%. In the second article, I report on the variables associated with implementation. The majority of respondents reported that they had adequate office resources to implement Triple P. Over half the managers (administrators and supervisors) and over two thirds of service providers reported that their agency had received adequate training. The most commonly identified barrier to implementation was agency characteristics which included organizational climate, service provider characteristics, and supervision. Adequate office resources and positive agency characteristics were associated with higher program usage by service providers. Service providers’ reports impacted their individual adherence rates whereas managers had broader perspectives of the quality of implementation in their organizations. Differences in reports between managers and service providers were not associated with usage or adherence.

Aim: This paper is a report on a study that explored the professional development of intensive care unit nurses in journal clubs. Background: Evidence-based practice is important in nursing care (Krom, Batten, & Bautista, 2010). However few nurses feel comfortable using evidence to guide their practice (Pravikoff, Tanner, & Pierce, 2005). Journal clubs are a way to establish science as conversation (Wright, 2004) and foster knowledge translation for evidence-based nursing practice (Goodfellow, 2004). Methods: Monthly journal club meetings were held with the participation of a total of 71 healthcare professionals (65 nurses, 2 physicians, 2 pharmacists, 1 physiotherapist, and 1 respiratory therapist), who worked in two intensive care units of an Ontario hospital. After six months of meetings, 21 individual interviews were conducted with nurses, physicians, pharmacists, and nurse educators. Additional data collection included two focus groups, surveys, a review of staff meeting minutes, and researcher field notes. Findings: Journal clubs provided nurses with incentive to read research articles, improved nurses’ confidence in reading research, created a community of peers who worked collaboratively to improve clinical practice, provided a structure for nurses to reflect-on-practice, and led to reported changes in clinical practice. However, the data suggests that any gains in competence of nurses with the critical appraisal of research articles were probably modest. Barriers to participating in journal clubs and evidence-based practice are also identified. Conclusion: Journal clubs can foster knowledge translation and evidence-based practice through creating a community of practice and by providing nurses with motivation, structure, and confidence to read research articles. However, nurses reported a lack of critical appraisal skills and uncertainty about how to implement evidence into practice. Journal clubs may have a greater impact when implemented alongside other knowledge translation strategies such as working with clinical nurse specialists in order to enhance evidence-based practice.

This study examined the knowledge relevant to reducing crime affecting urban Aboriginal people through a risk-focused approach to prevention and a growing body of knowledge about how it gets implemented. It then examined this knowledge in a case study of its application in Winnipeg. Interviews were undertaken using a structured questionnaire with program stakeholders and policy planners involved in crime prevention initiatives, programming and policy in Winnipeg. Approximately half of the stakeholders were involved primarily with Aboriginal people and the other half were involved with programs that included both Aboriginal people and non-Aboriginal people. The interviews took place from September to November 2009. The interviews show that many stakeholders agree with the risk-focused prevention literature on risk factors and that there are prevention programs operating in Winnipeg serving at-risk Aboriginal people. Therefore, there exists the possibility of reducing crime given that they are tackling risk factors in a way which is consistent with crime prevention research. However, when the interviews turned to issues of implementation, it showed: • There is no responsibility centre to mobilize different sectors to tackle crime • Many programs are not implemented comprehensively • There is a lack of localized coordinated action (including support from the police chief and public engagement) • There is a lack of political leadership • There is no city-wide strategic plan, and • Programs are in constant competition for funding in order to continue operations. If we are to reduce the disproportionate rates of victimization and offending affecting urban Aboriginal peoples, we need to find more effective ways to implement the strategies that are proven to tackle risk factors. There must be support from the mayor and police chief, training and capacity development, and public engagement which fosters strong use of proven strategies. A responsibility centre with Aboriginal representation must be created. Funding must be expanded to support the community based organizations that are tackling established risk factors. Finally, sustained and adequate funding must be provided to these programs and the responsibility centre.

ABSTRACT The Impact and Implementation of Learning Intervention on Management and Organizational Practice in a Non-Profit Setting BY Keisha Liggett - Nichols 2013 Committee Chair: Ram Sriram, PhD Major Academic Unit: Business Administration The intent of this research is to explore the concepts of organizational learning as it relates to “double loop” learning. Specifically, this research will test the concepts of double loop theory proposed by Argyris, (1976) in a seminal piece, and the paradigm of Evidence-based management (EBM) in the context of a non-profit organization. The paper will review the transition from a single loop learning organization to a double loop learning organization utilizing EBM as a learning intervention for change. The non-profit organization used in this research is significant as it is a monitoring agency; an intermediary between Public Administration, counties, and private agencies. The paper will demonstrate through a single case study the limitations of single loop learning, and how interventions or processes that lead to organizational learning could facilitate transitioning to a double loop learning organization. The study expects to contribute to the literature by highlighting the value of double loop learning and the use of EBM as a learning intervention mechanism. This study will also underscore how double loop learning and EBM can add value to organizational processes.

Objective: The effectiveness and efficiency of health promotion programs and policies relies on evidence to inform and guide these practices in an age of increased cost-efficiency and accountability. To achieve impact and continuous improvement requires the application of evidence to inform and guide population and public health decisions. To facilitate the broader use of knowledge derived from research and evaluation, we must identify the factors that facilitate or impede the use of such evidence among pubic health professionals. At the individual level, we have developed considerable understanding of these factors; however, at the organisational level this understanding lags. The purpose of this study was to examine how the organisational context of Ontario health units influences evidence-informed public health practice. Methods: The study employed a multiple case study design. Data sources included interviews, internal health unit documents and correspondence from three health units (reflecting high, moderate and low use of evidence) participating in the SHAPES-Ontario Knowledge Exchange Extension Project. Qualitative analyses using constant comparative methods intended to maximize trustworthiness identified macro-, meso- and micro-environmental level factors related to the use of local tobacco and physical activity data in public health program planning and evaluation. Individual and cross-case analyses determined the extent of each factor’s influence, how the factors inter-related and identified similarities and differences between sites. Results: Several internal contextual factors were directly and indirectly influential on knowledge use. The most directly influential factors were commitment/receptiveness to use evidence, and the leadership and internal co-ordinated action given to facilitate uptake and use. The degree of each of these factors directly influenced the level of knowledge use. Other internal contextual factors were also influential on utilisation however, through a less direct route. This included organisational mandates/priorities as well as previous experiences with knowledge use which were influential on the other contextual factors, as a result indirectly influencing knowledge use. Overall, it appears the more extensive the contextual factor the more extensive the influence, directly or indirectly, on knowledge use. Additionally, several external factors influential on the internal context and knowledge use within health units were identified, including external relationships, external processes and procedures, external mandates and priorities as well as external resources. The need to adapt to these external contextual factors was necessary in order for health units to have a strong working relationship with external parties (i.e., schools and school boards). As a result of this relationship, health units conformed and adapted to external contexts such as the processes/procedures, priorities and resources of schools. In turn, this adaptation process influenced the type of information utilised by health units as well as how the information was used and to what degree. At this point, the inter-relation between external contextual factors as well as direct connections to internal contextual factors was not entirely clear and requires further examination. Conclusions/Implications: Studying these cases has illuminated the processes and structures that contribute or impede evidence-informed practice. The findings and interpretations of this study help to identify organisational supports that facilitate the use of population health intervention research, in turn, contributing to more effective and efficient health programs and policies aimed at improving population health.

As more evidence-based programs are implemented in community settings, there is a strong need to ensure those models are implemented with integrity. Implementation of programs should be evaluated for fidelity, the degree of adherence to treatment protocols, and competence, the level of skill in implementation (Schoenwald et al., 2011). The purpose of this study was to review audio recordings of SafeCare home visiting sessions to discover the relationship between the measures of fidelity and competence. Six coders were assigned 209 SafeCare home visiting audiotapes to be coded for fidelity and competence. A sample of audios were double coded to evaluate fidelity and competence scores for inter-rater reliability. Fidelity and competence items were classified into process and content categories, forming the six main variables of process fidelity, content fidelity, total fidelity, process competence, content competence, and total competence. Total fidelity correlated with total competence at a level of .615, with process fidelity and process competence correlating at a much lower level than content items. The total correlation level can be interpreted as that fidelity and competence are strongly related measures, but are not identical constructs. The goal for SafeCare coders would be to continue refining competence definitions and attempting to remove the subjective nature from the competence coding process. With these two efforts, competence reliability should increase to an acceptable level. Given the main fidelity and competence correlation level, it is advisable for SafeCare coders to continue to code both fidelity and competence to avoid missing valuable components of the session. Additional research may be needed once the competence scale becomes better established.