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Action-Oriented Study Circles Facilitate Efforts in Nursing Homes to “Go from Feeding to Serving”: Conceptual Perspectives on Knowledge Translation and Workplace Learning

DOI: 10.1155/2012/627371

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Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs’ knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants’ (working in nursing homes) experiences from study circles ( ?? = 5 9 2 , 71 AOSC) and for comparisons between AOSC participants ( ?? = 7 4 ) and nonparticipants ( ?? = 1 1 5 ). Finally, a focus group interview was conducted with AOSC participants (in total ?? = 1 2 ). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC. 1. Background Promoting nutritional health equity among at risk older populations in nursing homes is of importance. Effective interventions that reduce the risk of undernutrition can help to ensure that people stay healthier in old age. Findings from a couple of studies indicate inequity between the nutritional care provided to patients in hospitals and elderly people in nursing homes. Two surveys conducted in 2007 indicate that patients in hospitals and at risk of undernutrition are more likely to get oral supplements (43–54%) [1] than elderly persons at risk of undernutrition in nursing homes (14–19%) [2]. It is plausible that appropriate nutritional care for older people in nursing homes requires educational interventions. This study is a part of a larger project that has shown, in a before–during–after controlled trial, that by implementing action oriented study circles (AOSC) for the staff in nursing homes, knowledge translation (KT) regarding eating and nutrition was achieved in terms of


[1]  A. Westergren, C. Wann-Hansson, E. B. B?rgdal et al., “Malnutrition prevalence and precision in nutritional care differed in relation to hospital volume ? A cross-sectional survey,” Nutrition Journal, vol. 8, no. 1, article 20, 2009.
[2]  A. Westergren, C. Axelsson, P. Lilja-Andersson, C. Lindholm, K. Petersson, and K. Ulander, “Study circles improve the precision in nutritional care in special accommodations,” Food and Nutrition Research, vol. 53, no. 1, pp. 1–8, 2009.
[3]  A. Westergren and G. Hedin, “Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations?” Food and Nutrition Research, vol. 54, no. 1, 2010.
[4]  C. A. Estabrooks, L. Wallin, and M. Milner, “Measuring knowledge utilization in health care,” International Journal of Policy Evaluation & Management, vol. 1, no. 3, pp. 3–36, 2003.
[5]  I. D. Graham, J. Logan, M. B. Harrison et al., “Lost in knowledge translation: time for a map?” The Journal of Continuing Education in the Health Professions, vol. 26, no. 1, pp. 13–24, 2006.
[6]  C. A. Estabrooks, “Prologue: a program of research in knowledge translation,” Nursing Research, vol. 56, no. 4, supplement, pp. S4–S6, 2007.
[7]  L. Wallin, “Knowledge translation and implementation research in nursing,” International Journal of Nursing Studies, vol. 46, no. 4, pp. 576–587, 2009.
[8]  M. Eccles, J. Grimshaw, A. Walker, M. Johnston, and N. Pitts, “Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings,” Journal of Clinical Epidemiology, vol. 58, no. 2, pp. 107–112, 2005.
[9]  I. D. Graham and J. Logan, “Innovations in knowledge transfer and continuity of care,” Canadian Journal of Nursing Research, vol. 36, no. 2, pp. 89–103, 2004.
[10]  I. D. Graham and J. Tetroe, “Whither knowledge translation: an international research agenda,” Nursing Research, vol. 56, no. 4, supplement, pp. S86–S88, 2007.
[11]  R. P. T. M. Grol, M. C. Bosch, M. E. J. L. Hulscher, M. P. Eccles, and M. Wensing, “Planning and studying improvement in patient care: the use of theoretical perspectives,” Milbank Quarterly, vol. 85, no. 1, pp. 93–138, 2007.
[12]  A. L. Kitson, J. Rycroft-Malone, G. Harvey, B. McCormack, K. Seers, and A. Titchen, “Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges,” Implementation Science, vol. 3, no. 1, article 1, 2008.
[13]  G. Harvey, A. Loftus-Hills, J. Rycroft-Malone et al., “Getting evidence into practice: the role and function of facilitation,” Journal of Advanced Nursing, vol. 37, no. 6, pp. 577–588, 2002.
[14]  T. J. Schultz and A. L. Kitson, “Measuring the context of care in an Australian acute care hospital: a nurse survey,” Implementation Science, vol. 5, no. 1, article 60, 2010.
[15]  P. Gougoulakis, The Study Circle: Lifelong Learning-in Swedish, Stockholm Institute of Education , HLS f?rl, Stockholm, Sweden, 2001.
[16]  H. Daniels, An Introduction to Vygotsky, Routledge, London, UK, 1996.
[17]  R. DeVries, “Piaget's social theory,” Educational Researcher, vol. 26, no. 2, pp. 4–17, 1997.
[18]  L. O. Dahle, J. Brynhildsen, M. B. Fallsberg, I. Rundquist, and M. Hammar, “Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Link?ping, Sweden,” Medical Teacher, vol. 24, no. 3, pp. 280–285, 2002.
[19]  S. Toohey, Society for Research into Higher Education: Designing Courses for Higher Education, Open University Press, Buckingham, UK, 1999.
[20]  R. Strombeck, “The Swedish study circle—possibilities for application to health education in the United States,” Health Education Research, vol. 6, no. 1, pp. 7–17, 1991.
[21]  I. Dahn, “Let health education become adult education,” Landstingsv?rlden, vol. 3, pp. 16–17, 1987.
[22]  A.-M. Landtblom, C. Lang, and G. Flensner, “The study circle as a tool in multiple sclerosis patient education in Sweden,” Patient Preference and Adherence Patient Preference and Adherence, vol. 2, pp. 225–232, 2008.
[23]  V?rdalinstitutet, The Swedish Institute for Health Sciences, 2010,
[24]  E. S?nnerberg, L. Edgren, and L. Welin, “The Patient role in a changing world. Follow-up of a study circle for diabetes patients,” V?rd i Norden, vol. 4, pp. 38–41, 2001 (Swedish).
[25]  A. Sarkadi and U. Rosenqvist, “Study circles at the pharmacy—a new model for diabetes education in groups,” Patient Education and Counseling, vol. 37, no. 1, pp. 89–96, 1999.
[26]  W. Jansson, B. Almberg, M. Grafstrom, and B. Winblad, “The Circle Model—support for relatives of people with dementia,” International Journal of Geriatric Psychiatry, vol. 13, no. 10, pp. 674–681, 1998.
[27]  K. A. Forsberg, T. Bj?rkman, P. O. Sandman, and M. Sandlund, “Physical health—a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff,” Nordic Journal of Psychiatry, vol. 62, no. 6, pp. 486–495, 2008.
[28]  K. Wikby, A. C. Ek, and L. Christensson, “Implementation of a nutritional programme in elderly people admitted to resident homes,” Scandinavian Journal of Caring Sciences, vol. 23, no. 3, pp. 421–430, 2009.
[29]  A. Westergren, C. Lindholm, C. Axelsson, and K. Ulander, “Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations,” Journal of Nutrition, Health and Aging, vol. 12, no. 1, pp. 39–43, 2008.
[30]  V?rdalinstitutet, Study Plan for Study Circles with Focus on Nutrition and Eating, 2005.
[31]  M. G. Titler, “Methods in translation science.,” Worldviews on Evidence-Based Nursing, vol. 1, no. 1, pp. 38–48, 2004.
[32]  B. Karlstr?m and M. Andersen, Food and Nutritional Treatment for Elderly People: Problems and Possibilities, Statens Livsmedelsverk, Uppsala, Sweden, 1998.
[33]  U. Nilsson-Balkn?s and M. Andersen, Food and Nutrition for Sick People in Care and Service, Statens Livsmedelsverk, Uppsala, Sweden, 2003.
[34]  B. Berg, Qualitative Research Methods for Social Sciences, 2001.
[35]  U. H. Graneheim and B. Lundman, “Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness,” Nurse Education Today, vol. 24, no. 2, pp. 105–112, 2004.
[36]  H. F. Hsieh and S. E. Shannon, “Three approaches to qualitative content analysis,” Qualitative Health Research, vol. 15, no. 9, pp. 1277–1288, 2005.
[37]  SFS, The Act Concerning the Ethical Review of Research Involving Humans on the website of the Central Ethical Review Boards, 2003.
[38]  R. Robertson and K. Jochelson, Interventions that Change Clinician Behaviour: Mapping the Literature, The National Institute for Health and Clinical Excellence, London, UK, 2006.
[39]  R. Wiechula, A. Kitson, D. Marcoionni, T. Page, K. Zeitz, and H. Silverston, “Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit,” International Journal of Evidence-Based Healthcare, vol. 7, no. 4, pp. 283–295, 2009.
[40]  K. Zeitz, A. Kitson, H. Gibb et al., “Working together to improve the care of older people: a new framework for collaboration,” Journal of Advanced Nursing, vol. 67, no. 1, pp. 43–55, 2011.


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