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From knowledge to action: Knowledge translation in the “real world” of clinical psychiatry Johnson, Joy; Malchy, Syd; Baines, Katie 2009-04

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FROM KNOWLEDGE TO ACTION: KNOWLEDGE TRANSLATION IN THE “REAL WORLD” OF COMMUNTY PSYCHIATRY Katie Baines MSc RN, Syd Malchy BA MSc & Joy Johnson PhD RN FCAHS The Problem … Knowledge translation is a messy and complicated business … KT theories describe the phases of the process; but give little guidance as to what to do “on the ground”. Presentation Overview … Knowledge translation: KTA process … Overview of the CACTUS project … Appreciative Inquiry … Motivational Interviewing Terms for “Knowledge to Practice” … Evidence into practice/translating scientific knowledge (N = 15) … Implementation (n = 12) … Evidence/research based (n = 8) … Knowledge/research/evidence utilization/uptake (n = 6) … Diffusion (n = 5) … Dissemination (n = 3) … Technology transfer (n = 3) … Knowledge exchange/mobilization (n = 2) … Organizational change (n = 2) … Assimilate (n = 1) … Behaviour change (n = 1) … Integrate (n = 1) … Change management (n = 1) … Scaling up (n = 1) … Improvement (n = 1) … Adoption (n = 1) (Graham & Tetroe, 2007)  The Cactus II Project … A knowledge to action project focused on addressing smoking cessation in community psychiatric settings … Six community case study locations … Design integrated clinical tobacco reduction interventions, determine effectiveness and evaluate uptake … PLAN, DO, STUDY, ACT *Funded by CIHR Principles of Appreciative Inquiry Inquiry into the social innovation potential of a social system (Cooperrider & Srivastva, 1987) … Change happens over conversations … Change can be transitional or transformational … Improvisation vs. Implementation … What do you want more of? Motivational Interviewing … Client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick, 2002) Guiding Principles (RULE) … Resisting the righting reflex … Understand your patients/organizations motivations … Listen to your patient/organization … Empower your patient/organization General Principles … Express Empathy (acceptance, reflective listening, ambivalence is normal) … Develop discrepancy (client/organization should voice the arguments for change) … Roll with Resistance (avoid arguing for change, resistance is not directly opposed, resistance is a signal to respond differently) … Support Self-efficacy (important motivator, client/organization responsible for the change, counsellor/researcher must believe in the change) Conclusion … Supplementary theories are required to supplement KT models … Reconsider deficit-based approaches; build on strengths (from push to pull) … MI principals are a helpful guide to meaningful knowledge to action engagement Questions


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