Knowledge ‘Translation’ as social learning: negotiating the uptake of research-based knowledge in practice

BackgroundKnowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles.DiscussionThe discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge.SummaryThis article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.

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Evidence-based practice is equated with effective decision making, with avoidance of habitual practice and with enhanced clinical performance. The hierarchy of evidence has promoted randomized control trials as the most valid source of evidence. However, this is problematic for practitioners as randomized control trials overlook certain types of knowledge that, through the process of reflection, provide useful information for individualized and effective practice.



A literature search was undertaken using CINAHL, medline and Ovid electronic databases in early 2006. The search terms used were: evidence-based practice, research evidence, evidence for practice, qualitative research, reflective practice, reflection and evidence. Other sources included handpicking of books on evidence-based practice, reflection and research. Only material written in English was included.



The hierarchy of evidence that has promoted randomized control trials as the most valid form of evidence may actually impede the use of most effective treatment because of practical, political/ideological and epistemological contradictions and limitations. Furthermore, evidence-based practice appears to share very similar definitions, aims and procedures with reflective practice. Hence, it appears that the evidence-based practice movement may benefit much more from the use of reflection on practice, rather than the use of the hierarchical structure of evidence.



Evidence-based practice is necessary for nursing, but its' effective implementation may be hindered by the hierarchy of evidence. Furthermore, evidence-based practice and reflection are both processes that share very similar aims and procedures. Therefore, to enable the implementation of best evidence in practice, the hierarchy of evidence might need to be abandoned and reflection to become a core component of the evidence-based practice movement.


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abstract: to gain an insight into how health professionals in the maternity services define evidence and how they perceive different types of evidence are valued in maternity care.



using a qualitative approach data were collected by semi-structured interviews: the content of each was analysed thematically.



England.



a purposeful sample of ten midwives, two obstetricians and one research nurse.



definitions of evidence vary widely among health practitioners. These definitions are affected by individuals' own beliefs and give rise to a hierarchy in which some types of evidence are valued above others. All the participants made direct or indirect reference to cultural beliefs inherent within the health service, and indicated that these beliefs determine the extent to which different types of evidence are seen as legitimate.



the concept of evidence-based practice is not value-free. Evidence that reinforces notions of authoritative knowledge may be transposed into clinical practice quickly and easily. Conversely, health practitioners may have difficulty putting evidence into practice that challenges the cultural norms of the profession. There is a need for further work to make explicit the values that underpin different sources of knowledge and expose the hierarchies of evidence that exist.

title: Practice as the Site of Knowing: Insights from the Field of Telemedicine
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title: Rethinking Polanyi’s Concept of Tacit Knowledge: From Personal Knowing to Imagined Institutions
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title: Uncovering Tacit Knowledge: A Pilot Study to Broaden the Concept of Knowledge in Knowledge Translation
abstract: BackgroundAll sectors in health care are being asked to focus on the knowledge-to-practice gap, or knowledge translation, to increase service effectiveness. A social interaction approach to knowledge translation assumes that research evidence becomes integrated with previously held knowledge, and practitioners build on and co-create knowledge through mutual interactions. Knowledge translation strategies for public health have not provided anticipated positive changes in evidence-based practice, possibly due in part to a narrow conceptualization of knowledge. More work is needed to understand the role of tacit knowledge in decision-making and practice. This pilot study examined how health practitioners applied tacit knowledge in public health program planning and implementation.MethodsThis study used a narrative approach, where teams from two public health units in Ontario, Canada were conveniently selected. Respondents participated in individual interviews and focus groups at each site. Questions were designed to understand the role of tacit knowledge as it related to the program planning process. Data were analyzed through a combination of content analysis and thematic comparison.ResultsThe findings highlighted two major aspects of knowledge that arose: the use of tacit knowledge and the integration of tacit and explicit knowledge. Tacit knowledge included: past experiences, organization-specific knowledge, community contextual knowledge, and the recognition of the tacit knowledge of others. Explicit knowledge included: research literature, the Internet, popular magazines, formal assessments (surveys and interviews), legislation and regulations. Participants sometimes deliberately combined tacit and explicit knowledge sources in planning.ConclusionsThis pilot demonstrated that front-line public health workers draw upon both tacit knowledge and explicit knowledge in their everyday lived reality. Further, tacit knowledge plays an important role in practitioners' interpretation and implementation of explicit research findings. This indicates a need to broaden the scope of knowledge translation to include other forms of knowledge beyond explicit knowledge acquired through research. Strategies that recognize and support the use of tacit knowledge, such as communities of practice or networks, may be important components of a comprehensive approach to knowledge translation. This study provides support for further investigation of the role of tacit knowledge in the planning and delivery of effective public health services.

title: Values-based health and social care : beyond evidence-based practice
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title: Technical rationality in Schön's reflective practice: dichotomous or non-dualistic epistemological position.
abstract: Donald Schön's theory of reflective practice has received unprecedented attention as an approach to professional development in nursing and other health and social care professions. This paper examines technical rationality in Schön's theory of reflective practice and argues that its critique is a broad and often overlooked epistemological underpinning in this work. This paper suggests that the popularity of Schön's theory is tied in part to his critique of technical rationality, and to his acknowledgement of the significance of practitioner experience and indeterminate zones of practice in the development of expertise. Schön tapped into a growing disillusionment with technical rationality that coincided with a crisis of knowledge across a range of disciplines. The question is raised as to whether Schön's critique sets up a dichotomy between technical rationality and experience, or overcomes it. The conclusions suggest that Schön is not discarding research-based professional knowledge, but rather challenging conflated views of its practical significance. In this way, it is proposed that his critique of technical rationality can be interpreted as an attempt to overcome dualistic thinking as it pertains to professional knowledge.

title: Pathways to practice: praxiography and international politics
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title: Surfacing the multiple : diffractive methods for rethinking professional practice and knowledge
abstract: In this chapter we argue that professional knowledge is necessarily singular and multiple. We add that this is an inherent characteristic of professional knowledge heightened by recent developments. Our point of departure is that practical knowledge is over-determinate by nature: multiple and often dissonant causes, forces, histories intersect at the point where practice is accomplished. In the process, the adoption of a given modus operandi leads to the deferral and suppression of all the possible alternatives. In this sense, the ideal of professional practice as a stable, coherent, bounded phenomenon is largely a myth and a convenient fiction that is part and parcel of the process of normalization and disciplining that is inherent in professionalization. To become a professional means both expanding and constraining one's repertoire of conducts. This is because on the one hand, becoming a professional allows one to expand the possibilities of action (i.e., 'what to do next') by tapping into the repertoire of actions developed by former members and sedimented in the professional community's collective experience. On the other hand, joining a profession means observing certain canons and norms and to submit to the profession's authority — something that automatically limits what is do-able, say-able and often thinkable (Foucault's disciplinary project).

title: Informal learning in the workplace
abstract: This paper focuses mainly on theoretical frameworks for understanding and investigating informal learning in the workplace, which have been developed through a series of large‐ and small‐scale projects. The main conclusions are included but readers are referred to other publications for more detailed accounts of individual projects. Two types of framework are discussed. The first group seeks to deconstruct the ‘key concepts’ of informal learning, learning from experience, tacit knowledge, transfer of learning and> intuitive practice to disclose the range of different phenomena that are embraced by these popular terms. The second group comprises frameworks for addressing the three central questions that pervaded the research programme: what is being learned, how is it being learned and what are the factors that influence the level and directions of the learning effort?

title: Organizational Learning and Communities-of-Practice: Toward a Unified View of Working, Learning, and Innovation
abstract: Recent ethnographic studies of workplace practices indicate that the ways people actually work usually differ fundamentally from the ways organizations describe that work in manuals, training programs, organizational charts, and job descriptions. Nevertheless, organizations tend to rely on the latter in their attempts to understand and improve work practice. We examine one such study. We then relate its conclusions to compatible investigations of learning and of innovation to argue that conventional descriptions of jobs mask not only the ways people work, but also significant learning and innovation generated in the informal communities-of-practice in which they work. By reassessing work, learning, and innovation in the context of actual communities and actual practices, we suggest that the connections between these three become apparent. With a unified view of working, learning, and innovating, it should be possible to reconceive of and redesign organizations to improve all three.

title: Within and Beyond Communities of Practice: Making Sense of Learning Through Participation, Identity and Practice
abstract: Situated learning theory offers a radical critique of cognitivist theories of learning, emphasizing the relational aspects of learning within communities of practice in contrast to the individualist assumptions of conventional theories. However, although many researchers have embraced the theoretical strength of situated learning theory, conceptual issues remain undeveloped in the literature. Roberts, for example, argues in this issue that the notion of 'communities of practice' - a core concept in situated learning theory - is itself problematic. To complement her discussion, this paper explores the communities of practice concept from several perspectives. Firstly, we consider the perspective of the individual learner, and examine the processes which constitute 'situated learning'. Secondly, we consider the broader socio-cultural context in which communities of practice are embedded. We argue that the cultural richness of this broader context generates a fluidity and heterogeneity within and beyond communities. Finally, we argue that it is sometimes difficult to distinguish conceptually between the terms 'participation' and 'practice' because of occasional duplication of meaning. We propose, instead, a refinement of the definition to allow for greater conceptual clarity.

title: Toward a 3-P Model of Workplace Learning: a Literature Review
abstract: The interest in research focusing on learning taking place at work, through work and for work has considerably increased over the past two decades. The purpose of the paper is to review and structure this wide and diverse research field. A tentative holistic model—the 3-P model of workplace learning—is presented, in relation to which the following six lines of research are identified: (1) studies describing the nature of workplace learning, (2) research on work identities and agency in workplace learning, (3) studies on the development of professional expertise, (4) analyses of competence development in education–work contexts in vocational education and training as well as in higher education, (5) research on communities of practice, and (6) research on organisational learning. The research lines and the holistic 3-P model should be seen as analytic tools for understanding the diversity in workplace learning research. They may also serve as a kind of map for individual researchers, helping them to locate their main areas of interest in this broad field of research and to outline research designs for future studies.

title: Practice development: Realising active learning for sustainable change
abstract: This paper explores the concept of practice development in the context of professional development and strategies for facilitating learning in practice. In this paper we present the background to the methodology of emancipatory and transformational practice development. Key concepts underpinning a contemporary definition of practice development are unravelled and nine principles for effective practice development proposed. An example of a large-scale national practice development programme with older people residential settings in the Republic of Ireland is presented to illustrate the processes in action. The findings of the first year of the programme are offered and these findings demonstrate the ways in which practice development systematically uncovers the deeply embedded characteristics of practice cultures – characteristics that often inhibit effective person-centred practice to be realised.

title: Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders
abstract: boomer c.a.& mccormack b. (2010) Journal of Nursing Management 18, 633–644 
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders 
 
To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. 
 
The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. 
 
Programme evaluation methodology to determine the ‘worth’ of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. 
 
Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. 
 
Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. 
 
Implications for nursing management  Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators.

title: Transformative learning and research utilization in nursing practice: a missing link?
abstract: Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions.



The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice.



Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice.



(1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.

title: The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.
abstract: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system.



To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations.



A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2.



Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context.



Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.

title: Evidence Equals Excellence: The application of an evidence-based practice model in an academic medical center.
abstract: An evidence-based practice (EBP) program that is designed to develop mentors in both clinical and academic settings has the potential for transforming a health care organization. This article describes an innovative program, Evidence Equals Excellence, which consists of two components: a clinical practice component for health care clinicians and an academic program for baccalaureate and graduate nursing students. The development of EBP mentors creates a core group of clinicians who can assist fellow staff members apply evidence at the bedside. An academic program prepares new graduates to partner easily with clinical mentors to support and initiate successful practice changes.

title: A collaborative approach to building the capacity for research and evidence-based practice in community hospitals.
abstract: The use of best evidence to support nursing practice and the generation of new knowledge to use in practice are hallmarks of excellence. Nurses at the bedside, however, often lack the resources and knowledge necessary to change the traditional nursing culture to one in which the use of evidence is incorporated into daily care. This article describes the experience in two hospitals using a program designed to give nurses the skills needed to engage in evidence-based care.

title: An Advanced Educational Program Promoting Evidence-Based Practice
abstract: Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses’ organization. Program evaluations are extremely positive, and the long-term impact is described.

title: Professional differences in interprofessional working
abstract: UK government policy is encouraging healthcare staff to blur traditional roles, in the drive to increase joint working between practitioners. However, there is currently a lack of clarity regarding the impact that changes to traditional working practice might have on staff delivering the services, or on patient care. In this article, we report findings from three qualitative case studies examining interprofessional practice in stroke care, in which the influence of professional differences emerged as a significant theme. We draw on findings from individual semi-structured interviews, as well as fieldwork observations, to describe the influence of professional knowledge and skills, role and identity, and power and status considerations in interprofessional working. The insights that were gained contribute to the understanding of how professional differences impact on healthcare staff joint working, and suggest that the elements identified need to be fully considered in drives towards changed working practice.

title: The Nonspread of Innovations: the Mediating Role of Professionals
abstract: Two qualitative studies in the U.K. health care sector trace eight purposefully selected innovations. Complex, contested, and nonlinear innovation careers emerged. Developing the nonlinear perspective on innovation spread further, we theorize that multi-professionalization shapes "nonspread." Social and cognitive boundaries between different professions retard spread, as individual professionals operate within unidisciplinary communities of practice. This new theory helps explain barriers to the spread of innovation in multiprofessional organizations in both health care and other settings.

title: An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?
abstract: This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships.

title: Integration of health and social care: a case of learning and knowledge management.
abstract: This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies.

title: What fosters or prevents interprofessional teamworking in primary and community care? A literature review.
abstract: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved.



This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century.



A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods.



Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed.



These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.

title: Networks, Organizational Learning and Knowledge Management: NHS Cancer Networks
abstract: There has been increased interest in the UK in network-based modes of organizing in the public services, as opposed to markets or hierarchies. One supposed advantage of the network form is a greater capacity for the transfer of evidence-based or ‘best’ practices across the network and accelerated organizational learning. Such networks may have a knowledge management role and stimulate the formation of ‘communities of practice’. This article tests these arguments using data from a study of managed NHS cancer networks in London. The general pattern was for networks to concentrate on structural reconfiguration, while their knowledge management role remained marginal. Some alternative implications for future policy development are considered.

title: Knowledge for Theory and Practice
abstract: We examine three related ways in which the gap between theory and practice has been framed. One approach views it as a knowledge transfer problem, a second argues that theory and practice represent distinct kinds of knowledge, and a third incorporates a strategy of arbitrage--leading to the view that the gap is a knowledge production problem. We propose a method of engaged scholarship for addressing the knowledge production problem, arguing that engaged scholarship not only enhances the relevance of research for practice but also contributes significantly to advancing research knowledge in a given domain.

title: Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.
abstract: The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.

title: Health Promotion Practice and the Road Ahead: Addressing Enduring Gaps and Encouraging Greater Practice-to-Research Translation
abstract: A decade ago, Lancaster and Roe described four critical gaps (i.e., communications, accessibility, credibility, and expectations) between research and practice in health education and health promotion that formed the framework for this department. Despite considerable attention and some progress, these gaps persist and are barriers to interaction and translation between health promotion and health education research and practice. Looking to the next several years as the new Associate Editors for this department, we renew the department’s commitment toward addressing these enduring gaps around which we frame new questions and invite continued dialogue.

title: The art and science of clinical knowledge: evidence beyond measures and numbers
abstract: Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction-factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organisation, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science.

title: Sources of information used by nurses to inform practice: An integrative review.
abstract: We present an integrative review of the literature about sources of information nurses use to inform practice. The demand for access to more and better information has been fueled by the evidence-based healthcare movement. Although the expectations for evidence-based practice have never been higher, the demands on care environments have never been greater. The goals of professional nursing are served by using the best available information to inform practice. To influence such activity, we must understand what sources of information nurses rely on for guidance.



We examined studies of any research design published between 1985 and 2006, as well as research dissertations in the same time frame. Databases searched included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, the Educational Resources Information Center, the Library and Information Science Abstracts and the Library Literature and Information Science databases.



The review question: what information sources do registered nurses turn to, to support direct patient care? Analysis included an overview of study design and practice setting, and an examination of sources accessed most frequently by nurses to guide practice.



We present, in ranked order, the sources nurses accessed in order to guide practice. We note the high reliance on informal, interactive sources. An unexpected finding of high reliance on journals is explored in greater detail and found to be equivocal at best. We conclude with a critical discussion of what we see as embedded assumptions and expectations about how information-seeking supports nursing practice.



Expectations embedded in the scope and context of nursing practice have influenced knowledge development in the area of information-seeking to support practice. It is important that future research in this area takes into account the expectations and information needs arising in emerging roles for nurses within evolving healthcare systems.

title: The use of tacit and explicit knowledge in public health: a qualitative study
abstract: BackgroundPlanning a public health initiative is both a science and an art. Public health practitioners work in a complex, often time-constrained environment, where formal research literature can be unavailable or uncertain. Consequently, public health practitioners often draw upon other forms of knowledge.MethodsThrough use of one-on-one interviews and focus groups, we aimed to gain a better understanding of how tacit knowledge is used to inform program initiatives in public health. This study was designed as a narrative inquiry, which is based on the assumption that we make sense of the world by telling stories. Four public health units were purposively selected for maximum variation, based on geography and academic affiliation.ResultsAnalysis revealed different ways in which tacit knowledge was used to plan the public health program or initiative, including discovering the opportunity, bringing a team together, and working out program details (such as partnering, funding).ConclusionsThe findings of this study demonstrate that tacit knowledge is drawn upon, and embedded within, various stages of the process of program planning in public health. The results will be useful in guiding the development of future knowledge translation strategies for public health organizations and decision makers.

title: Reflection and reflective practice in health professions education: a systematic review
abstract: The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.

title: Values-based health and social care : beyond evidence-based practice
abstract: Jill McCarthy and Pat Rose The Emergence of Evidence-based Practice - Mike Thomas, Mike Burt and Joy Parkes Evidence-based Practice within Values-based Care - Pat Rose and Jan Gidman Caring: Values and Evidence - Pat Rose and Sue Phillips Values of Reductionism and Values of Holism - Tom Mason, Pete Hinman, Ruth Sadik, Doreen Collyer, Neil Hosker and Adam Keen Valuing Professional Judgement - Jill McCarthy, Pauline Alexander, Moyra Baldwin and Jan Woodhouse The Value and Values of Service Users - Annette McIntosh, Julie Dulson and Julie Bailey-McHale, Vignettes by Joanne Greenwood A Values-based Era in Professional Caring - Jill McCarthy and Sue Grumley