Managerial leadership for research use in nursing and allied health care professions : a narrative synthesis protocol

BACKGROUND: Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours.Methods/design: Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION: With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice.

Borlänge and Falun Brundtland cities

Development of an infrastructure for Brundtland Renewable Energy Network - BREN is a European Commission Alterner Project with Contract no XVII/4. 1030/Z96-032.The project has its origin in the UN-report “Our Common Future”, 1989. A change in and reduction of the use of energy was fundamental in order to reach the goals which the report proposed. Denmark decided on an action plan on how energy consumption could be reduced “Energi 2000 - Handlingsplan för en bäredygtig udvikling”. The ministries of energy in Denmark and Schleswig Holstein both agreed to start an energy saving project in a smaller town. The project was called “Brundtlandby” and the two first were Toftlund in South Jutland and Bredstedt in North Friesland. After a short period a further two German Cities, Rheinsberg and Viernheim, and Rajec in Slovakia joined the group. A network for the exchange of knowledge and experience between the cities was formed. The network, Brundtland City Project, inspired the participating cities in the continuing work with energy saving measures. The Brundtland City Project was presented at an international conference “Cities and Energy” in Trondheim, Norway,in December 1995. Great interest was shown in the project and it was decided that a network should be developed in northern European countries as a pilot project to be enlarged with other European countries later on. A steering committee was formed with representatives from the nordic countries.An application was sent to the European Commission, Alterner Program, and was approved in Juli 1996. The project was subdivided into nine activities. Activity 1, consisted of summarising the experiences of the Brundtland City Project in Toftlund, Denmark and the Brundtland Cities network in Slovakia, Germany and Denmark. The Scandinavian part started with Activity 2, to engage municipalities/cities in Finland, Norway and Sweden in the project. The Solar Energy Research Center, SERC, Högskolan Dalarna was appointed as co-ordinator for the Swedish part. The project was presented at a seminar on the 30th September for representatives from the municipalities of Borlänge and Falun. On the 10th of December 1996 the two municipalities accepted the invitation to join the Northern network. Pelle Helje, Borlänge Energi, has been informant for the municipality of Borlänge and Anders Goop, Department of Urban Planninginformant for the municipality of Falun with Jan Kaans, Estates department providing information to the basis for the Newsletter.Reports on the work in Borlänge and Falun municipalities have been made to Brundtland Center Denmark on three occasions; Activities 2-5, 16-12-1997, Activities 6-7, including parts of activities 8-9, 03-03-1998, and the basis for the Newsletter, 01-07-1998. The Nordic reports have been compiled at the Brundtland Center Denmark for submission to the European Commission. English has been the common language. After the report of activities 2 - 5 the participants wereinvited to a project meeting and a workshop at Brundtland Center the 23rd and 24th March 1998.This was the first occasion the participants in the project met and the network thus took a moreconcrete form. It also was decided that the next meeting should be in Borlänge in August 1998,with Borlänge Energi and Solar Energy Research Center SERC as organisers. As BrundtlandCentre Denmark was wound up for financial reasons, the project meeting in Borlänge wascancelled.Compilation of the Final Report was carried out by Esbensen Consultants in October 1998Future development of the networkIt is intended to continue the work with the Brundtland City Network as an “EU Thermie Bproject”and the network will be enlarged with the addition of four new Brundtland Cities from Austria, Germany, Italy and Great Britain. In addition the village of Putja in Estonia will join the network but this will be financed by the EU-Phare programme.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.