A gaze through the lens of decision theory toward knowledge translation science

Research findings become evidence when an individual decides that the information is relevant and useful to a particular circumstance. Prior to that point, they are unrelated facts. For research translation to occur, research evidence needs filtering, interpretation, and application by individuals to the specific situation. For this reason, decision science is complementary to knowledge translation science. Both aim to support the individual in deciding the most appropriate action in a dynamic environment where there are masses of uncensored and nonprioritized information readily available. Decision science employs research theories to study the cognitive processes underpinning the filtering and integration of current scientific information into changing contexts. Two meta-theories, coherence and correspondence theories, have been used to provide alternative views and prompt significant debate to advance the science. The aim of this article is to stimulate debate about the relationship between decision theory and knowledge translation. Discussed is the critical role of cognition in clinical decision making, with a focus on knowledge translation. A critical commentary of the knowledge utilization modeling papers is presented from a decision science perspective. The article concludes with a discussion on the implications for knowledge translation when viewed through the lens of decision science.

Using activity theory in researching young children's use of calculators

Constructivist and socio-cultural perspectives in mathematics education highlight the crucial role that activity plays in mathematical development and learning. Activity theory provides a socio-cultural lens to help analyse human behaviour, including that which occurs in classrooms. It provides a framework for co-ordinating constructivist and socio-cultural perspectives in mathematics learning. In this paper, we adopt Cole and Engeström's (1991) model of activity theory to examine the mediation offered by the calculator as a tool for creating and supporting learning processes of young children in the social environment of their classroom. By adopting this framework, data on young children's learning outcomes in number, when given free access to calculators, can be examined not only in terms of the mediating role of the calculator, but also within the broader context of the classroom community, the teachers' beliefs and intentions, and the classroom norms and the division of labour. Use of this model in a post hoc situation suggests that activity theory can play a significant role in the planning of future classroom research.

Opting in and opting out: a grounded theory of nursings contribution to inpatient rehabilitation

Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.

Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable.

Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.

The Copenhagen school on your in Kyrgyzstan : is securitization theory useable outside Europe?

The article argues that the theoretical framework presented by the Copenhagen School is currently unsuited to empirical studies outside the West owing to two factors. First, the presence of the ‘Westphalian straitjacket’ has prevented explicit interrogation of the normative concepts underlying the framework: there is a presumption that European understandings of society and the state are universal. Second, the centrality of the speech-act for securitization to the exclusion of other forms of expression, such as physical action, results in the theoretical framework producing a Westernized description of a given situation. The extent to which these factors limit the utility of the concepts of securitization and societal security in a non-Western setting is illustrated through the case of the overthrow of the government in Kyrgyzstan in March 2005. This example forms an empirical critique to highlight how theoretical shortcomings result in a simplified and Westernized description of the situation that does not take into account the specific local socio-political context. The article concludes that if the Copenhagen School’s theoretical framework is to be considered suitable for universal application, future theoretical developments must explicitly address the issues discussed to enable progress in escaping International Relations’ Westphalian straitjacket.

Ethical challenges associated with providing continence care in residential aged care facilities : findings from a grounded theory study

A person-centred approach to care in residential aged care facilities should uphold residents’ rights to independence, choice, decision-making, participation, and control over their lifestyle. Little is known about how nurses and personal care assistants working in these facilities uphold these ideals when assisting residents maintain continence and manage incontinence. The overall aim of the study was to develop a grounded theory to describe and explain how Australian residents of aged care facilities have their continence care needs determined, delivered and communicated. This paper presents and discusses a subset of the findings about the ethical challenges nurses and personal care assistants encountered whilst providing continence care. Grounded theory methodology was used for in-depth interviews with 18 nurses and personal care assistants who had experience of providing, supervising or assessing continence care in any Australian residential aged care facility, and to analyse 88 hours of field observations in two facilities. Data generation and analysis occurred simultaneously using open coding, theoretical coding, and selective coding, until data were saturated. While addressing the day-to-day needs of residents who needed help to maintain continence and/or manage incontinence, nurses and personal care assistants struggled to enable residents to exercise choice and autonomy. The main factor that contributed to this problem was that the fact that nurses and personal care assistants had to respond to multiple, competing, and conflicting expectations about residents’ care needs. This situation was compounded by workforce constraints, inadequate information about residents’ care needs, and an unpredictable work environment. Providing continence care accentuated the ethical tensions associated with caregiving. Nurses’ and personal care assistants’ responses were mainly characterised by highly protective behaviours towards residents. Underlying structural factors that hinder high quality continence care to residents of aged care facilities should be urgently addressed.