Vocations and Learning

, Volume 8, Issue 3, pp 319–334 | Cite as

Evidence Molded by Contact with Staff Culture and Patient Milieu: an Analysis of the Social Process of Knowledge Utilization in Nursing Homes

  • Christine Øye
  • Tone Elin Mekki
  • Randi Skaar
  • Hellen Dahl
  • Oddvar Forland
  • Frode F. Jacobsen
Original Paper

Abstract

Knowledge utilization is politically “hot” because it informs decisions on improving the quality of care in nursing homes (NHs). The difficulties encountered in implementing evidence-based knowledge into practice may be explained by contextual factors. Contextual factors are crucial to understanding the process of knowledge utilization; how the evidence’ is implemented and received locally by identifying facilitators, as well as barriers to change. This article is based on an evidence-based education intervention executed by four teams of two facilitators with care staff, which aimed to prevent the use of restraint in nursing home (NH) residents with dementia in 24 NHs in Norway. The study used a mixed method design combining cluster randomized controlled trial (C-RCT), participatory action research (PAR) and ethnography, where the aim was to document and examine the success or failure of the education intervention. The empirical material for this paper is primarily based on a post –intervention ethnographic investigation in three NHs in the sample, to investigate the relationship between an education intervention and staff culture. The ethnographic investigation gave a setting and context-specific plausible explanation of why the educational intervention failed or succeeded. This study has shown that the social process of knowledge utilization is influenced by contextual factors such as staff culture, patient mix and milieu as well as structural conditions. The NH conditions are not stable, but rather moving and constantly changing as a response to variation in the staff culture, the patient mix, the resources available and the nursing homes current situation. Therefore, the evidence in connection with staff culture could be understood as “a ball of clay” molding itself differently when coming in touch with staff culture and their collective and individual experiences. Potential for a successful process of knowledge utilization has to do with timing and organizational readiness, which is difficult to foresee when planning an education intervention.

Keywords

Knowledge utilization Education intervention Nursing homes Ethnography PARIHS 

References

  1. Andrè, B., Sjøvold, E., Rannestad, T., & Ringdal, G. I. (2013). The impact of work culture on quality of care in nursing homes—a review study. Scandinavian Journal of Caring Sciences, 28, 449–457.CrossRefGoogle Scholar
  2. Berta, W., Teare, G. F., Gilbart, E., Ginsburg, L. S., Lemieux-Charles, L., Davis, D., & Rappolt, S. (2010). Spanning the know-do gap: understanding knowledge application and capacity in long-term care homes. Social Science & Medicine, 70(9), 1326–1334.CrossRefGoogle Scholar
  3. Billett, S. (2004). Learning through work: Workplace participatory practices. In H. Rainbird, A. Fuller, & A. Munro (Eds.), Workplace learning in context (pp. 109–125). London: Routledge.Google Scholar
  4. Bonell, C., Fletcher, A., Morton, M., Lorenc, T., & Moore, L. (2012). Realist controlled trials: a new approach to evaluating complex public health interventions. Social Science & Medicine, 75, 2299–2306.CrossRefGoogle Scholar
  5. Boström, A.-M., Slaughter, S. E., Chojeckti, D., & Estabrooks, C. A. (2012). What do we know about knowledge translation in the care of older adults? A scoping review. JAMDA, 13, 210–219.Google Scholar
  6. Capezuti, E., Brush, B. L., Won, R. M., Wagner, L. M., & Lawson, W. T. (2008). Least restrictive or least understood? Waist restraints, provider practices, and risk of harm. Journal of Aging & Social Policy, 20(3), 305–322.CrossRefGoogle Scholar
  7. Engebretsen, E., Vøllestad, N., Wahl, A., Robinson, H. & Heggen, K. (2015). Unpacking the process of interpretation in evidence-based decision-making. Journal of Evaluation in Clinical Practice, 21(3), 1–3 DOI: 10.1111/jep.12362.
  8. Gibb, H. (2013). An environmental scan of an aged care workplace using the PARIHS model: assessing preparedness for change. Journal of Nursing Management, 21, 293–303.CrossRefGoogle Scholar
  9. Gjerberg, E., Hem, M. H., Førde, R., & Pedersen, R. (2013). How to avoid and prevent coercion in nursing homes: a qualitative study. Nursing Ethics, 20(6), 632–644.CrossRefGoogle Scholar
  10. Greenhalgh, T., & Swinglehurst, D. (2011). Studying technology use as social practice: the untapped potential for ethnography. BMC Medicine, 9, 45.CrossRefGoogle Scholar
  11. Grimshaw, J. M., Eccles, M. P., Lavis, J. N., Hill, S. J., & Squires, J. E. (2012). Knowledge translation of research findings. Implementation Science, 7, 50.CrossRefGoogle Scholar
  12. Huizing, A. R., Hamers, J. P., Gulpers, J. M., & Berger, M. P.-F. (2009). A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. The Clinical Investigations, 57, 1139–1148.Google Scholar
  13. Kirkevold, K., Laake, K., & Engedal, K. (2003). Use of constraints and surveillance in Norwegian wards for the elderly. International Journal of Geriatric Psychiatry, 18, 491–497.CrossRefGoogle Scholar
  14. Kitson, A., Rycroft-Malone, J., Harvey, G., McCormack, B., Seers, K., & Titchen, A. (2008). Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implementation Science, 3, 1.CrossRefGoogle Scholar
  15. Köpke, S., Mühlhauser, I., Gerlach, A., Haut, A., Haastert, B., Möhler, R., & Meyer, G. (2012). Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: a randomized controlled trial. JAMA, 307(20), 2177–2184.CrossRefGoogle Scholar
  16. Leykum, L., Pugh, J., Lanham, H., Harmon, J., & McDaniel, R. (2009). Implementation research design: integrating participatory action research into randomized controlled trials. Implementation Science, 4, 69.CrossRefGoogle Scholar
  17. Marchal, B., Westhorp, G., Wong, G., Van Belle, S., Greenhalgh, T., Kegels, G., & Pawson, R. (2013). Realist RCTs of complex interventions—an oxymoron. Social Science & Medicine, 94, 124–128.CrossRefGoogle Scholar
  18. Masso, M., McCarthy, G., & Kitson, A. (2014). Mechanisms which help explain implementation of evidence-based practice in residential age care facilities: a grounded theory study. International Journal of Nursing Studies, 51, 1014–1026.CrossRefGoogle Scholar
  19. McCormack, B., & McCance, T. V. (2010). Person-centered nursing, theory and practice. Oxford: Wiley-Blackwell.CrossRefGoogle Scholar
  20. McCormack, B., Kitson, A., Harvey, G., Rycroft-Malone, J., Titchen, A., & Seers, K. (2002). Getting evidence into practice: the meaning of ‘context’. Journal of Advanced Nursing, 38(1), 94–104.CrossRefGoogle Scholar
  21. Möhler, R., Richter, T., Köpke, S., & Meyer, G. (2011). Interventions for preventing and reducing the use of physical restraints in long-term geriatric care (review). The Cochrane Library, 4, 1–32.Google Scholar
  22. Moore, K., & Haralambous, B. (2007). Barriers to reducing the use of restraints in residential elder care facilities. Journal of Advanced Nursing, 58(6), 532–540.CrossRefGoogle Scholar
  23. Nes, S., & Moen, A. (2010). Constructing standards: a study of nurses negotiating with multiple modes of knowledge. Journal of Workplace Learning, 22(6), 376–393.CrossRefGoogle Scholar
  24. Patients’ Rights Act (2009). Retreived from http://lovdata.no/dokument/NL/lov/1999-07-02-63.
  25. Pentland, D., Forsyth, D. K., McCiver, D., Walsh, M., Murray, R., Irvine, L., & Sikora, S. (2011). Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review. Journal of Advanced Nursing, 67(7), 1408–1425.CrossRefGoogle Scholar
  26. Perry, L., Bellchambers, H., Howie, A., Moxey, A., Parkinson, L., Capra, S., & Byles, J. (2011). Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings. Journal of Advanced Nursing, 67(10), 2139–2150.CrossRefGoogle Scholar
  27. Rycroft-Malone, J. (2010). Promoting action on research implementation in health services (PARIHS). In J. Rycroft-Malone & T. Bucknall (Eds.), Models and framework for implementing evidence-based practice: Linking evidence to action. Oxford: Blackwell publishing.Google Scholar
  28. Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A., McCormack, B., & Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13(8), 913–924.CrossRefGoogle Scholar
  29. Silverman, D. (2011). Interpreting qualitative data: Methods for analyzing talk, text and interaction (4th ed.). Los Angeles: Sage Publications.Google Scholar
  30. Stetler, C. B., Damschroder, L. J., Helfrich, C. D., & Hagedom, H. J. (2011). A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science, 6, 99.CrossRefGoogle Scholar
  31. Testad, I. (2010). Agitation and use of restraint in nursing home residents with dementia. Prevalence, correlates and the effects of care staff training. University of Bergen, Faculty of Medicine.Google Scholar
  32. Testad, I., Mekki, T. E., Forland, O., Oeye, C., Tveit, E.-M., Jacobsen, F., & Kirkevold, Ø. (2015). Modelling and evaluating eviDence based continuing education program in nursing home dementia care (MEDCED). Training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial. International Journal of Geriatric Psychiatry. doi:10.1002/gps.4285.Google Scholar
  33. Timmermanns, S., & Berg, M. (1997). Standardization in action: achieving local universality through medical protocols’. Social Studies of Science, 27, 273–305.CrossRefGoogle Scholar
  34. Wallin, L. (2009). Knowledge translation and implementation research in nursing. International Journal of Nursing Studies, 46, 576–587.CrossRefGoogle Scholar
  35. Walshe, K. (2007). Understanding what works – and why – in quality improvement: the need for theory-driven evaluation. International Journal for Quality in Health Care, 19(2), 57–59.CrossRefGoogle Scholar
  36. Ward, V., Smith, S., House, A., & Hamer, S. (2012). Exploring knowledge exchange: a useful framework for practice and policy. Social Science & Medicine, 74, 297–304.CrossRefGoogle Scholar
  37. Zwijsen, S. A., Smalbrugge, M., Eefsting, J. A., Gerritsen, D. L., Hertogh, C. M., & Pot, A. M. (2014). Grip on challenging behavior: process evaluation of the implementation of a care program. Trials Journal, 15, 302.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Christine Øye
    • 1
  • Tone Elin Mekki
    • 2
  • Randi Skaar
    • 3
  • Hellen Dahl
    • 1
  • Oddvar Forland
    • 2
  • Frode F. Jacobsen
    • 2
  1. 1.Stord/Haugesund University CollegeStordNorway
  2. 2.Bergen University CollegeBergenNorway
  3. 3.Diakonhjemmet University CollegeOsloNorway

Personalised recommendations