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From knowledge to action: Knowledge translation in the “real world” of clinical psychiatry Johnson, Joy; Malchy, Syd; Baines, Katie 2009-04-30

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FROM KNOWLEDGE TO ACTION: KNOWLEDGE TRANSLATION IN THE “REAL WORLD” OF COMMUNTY PSYCHIATRYKatie Baines MSc RN, Syd Malchy BA MSc & Joy Johnson PhD RN FCAHSThe 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 InterviewingTerms 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 CIHRPrinciples of Appreciative InquiryInquiry 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/organizationGeneral 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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