PORTFOLIO OF ACTIVITIES

PORTFOLIO OF ACTIVITIES Topic Barriers and facilitators: Impact on clinical practice change In this activity you are required to conduct an analysis of barriers and facilitators which impact on clinical practice change. Reference should be made to peer reviewed literature to support your argument. Your audit proposal should be used as an example (My audit proposal is pressure ulcer), with reference to audit processes and potential outcomes. The analysis should address the following aspects: •    Discussion of common barriers and facilitators which impact on practice change, why these occur and strategies that can be employed in relation to these. (define barrier and define facilitators) •    Identification of key players that might be involved in practice change processes and why. •    The current elements of practice that could assist or hinder your project. •    Identification of assistance that might be needed by staff involved in order for practice change to be achieved (e.g. development of new skills/knowledge, system or process redesign). •    Discussion of strategies to sustain the changes in practice. Note: •    discuss each question for 200 words •    All references should be from articles less than 10 years old. Marking Guide – Portfolio Structure and Presentation 20% Structure (15%) •    Each section of the portfolio is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the portfolio) •    Where appropriate introduces/outlines/situates the activity/discussion •    Where appropriate each section of the portfolio ends with a cogent, defendable conclusion that summarises the discussion within the body of the paper Writing Style (5%) •    The portfolio is written with clear sentence structure and the spelling and grammar are correct Content 70% •    Demonstrates an understanding of the activities/discussions chosen by identifying the main components/issues/focus of the topic area •    Provides evidence of support from contemporary literature to support argument/points of view •    Where appropriate for the activity demonstrates critical thought •    Has completed all activities/discussion points Referencing  10% •    The referencing style used throughout the summary paper is congruent with the School Academic Manual •    The reference list is accurate (i.e. no missing page numbers, volumes, correct title etc.), complete (i.e. no references in the body of the paper are missing from the reference list) and consistent with the School Academic Manual •    The references cited are contemporary (i.e. less than 10 years old unless seminal papers) •    Primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source) •    There is evidence in the summary paper that the student has searched widely for information related to the topic/issue •    The student has acknowledged all sources of information •    Direct quotations are only used to make crucial points or to support the discussion/argument Faculty of Medicine, Department of Family Medicine and Emergency Medicine; Tier 2, Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Universit e Laval, Quebec, QC, Canada 2 Knowledge Transfer and Health Technology Assessment Research Group of the CHUQ Research Centre (CRCHUQ), Quebec, QC, Canada Key learning points Barriers and facilitators to knowledge use are among the most important elements to be considered by those interested in knowl- edge implementation. A number of taxonomies = frameworks and instruments for assessing barriers and facilitators have been developed and should be used when developing a knowledge-to-action project. There is a need for a consensus on existing taxonomies = frameworks and instruments to support valid comparison between diverse contexts. Knowledge Translation in Health Care: Moving from Evidence to Practice , Second Edition. Sharon E. Straus, Jacqueline Tetroe and Ian D. Graham. Ó 2013 by John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. 121 Introduction The need for the effective knowledge translation in clinical practice is essen- tial if we want to address the following challenges: (a) increased availability of health information [1]; (b) the expanded role of patients in clinical deci- sion making [2]; (c) management of expectations regarding new treatments and technologies [3]; and (d) enhanced patient safety [4].To date, there is consensus in the implementation research community that efforts to trans- late knowledge at the clinical level have met with little success [5]. Although each phase of the knowledge-to-action cycle is important for ensuring the effective translation of knowledge, the aim of this chapter is to highlight the specific challenges associated with the assessment of barriers and facilitators to knowledge use. The observations in this chapter are based on a search of the Knowledge Translation Resource Clearinghouse of the Keenan Research Centre, a joint program of St. Michael’s Hospital and the University of Toronto ’ s Faculty of Medicine ( http:// k tclearinghouse.c a / tools/ s c i e nce , accessed September 2012). The first section of this chapter addresses the importance of barriers and facilitators to knowledge use in health care. The second section briefly pres- ents the evolution of a few models in this field in order to highlight the relevance of using conceptual models to assess barriers and facilitators. The next section reviews relevant instruments for measuring barriers and facili- tators, and the last section of the chapter summarizes the lessons learned from the various research initiatives cited and identifies areas in need of further research. Why are barriers and facilitators to knowledge use important? A search in PUBMED up to August 7, 2012 using the search terms “barriers” and “barriers AND implementation” produced 57,665 and 4359 hits, respectively. The literature often refers to barriers and facilitators to knowledge use in the context of “beliefs about capabilities,” of which they are key determinants. “Beliefs about capabilities” includes the concept of perceived behavioral control, a determinant of behavior proposed by the theory of planned behavior (discussed in Chapter 4.2) [6]. In a review of 78 studies using social cognitive theories (theories where individual cognitions = thoughts are viewed as processes intervening between observ- able stimuli and responses in real wor ld situations) to identify factors influencing health professionals’ behaviors, the authors found that the cog- nitive factors most consistently asso ciated with predicting health care 122 Knowledge translation in health care