Nku: dnp-program-2

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Module 7: In 600 words  

The instruction says it is related to module 2, so please see the attached Melnyk PowerPoint and the discussion question and the response the person that wrote module 2 for me provided. Please cover all questions appropriately and use in-text citations. All references used must have in-text citations.

Discussion Board Question:

1. The topic for this week is dissemination of research and evidence for practice. Often visualizing how you might share your work in the future may assist in giving you ideas about the planning and conducting of your project so you will have what you need when ready to share.  It may help you think ahead about your future audience. Share at least three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional and national level. (Related to MO2). I HAVE ATTACHED THE QUESTION AND WHAT YOU WROTE FOR ME IN THAT MODULE 2.

2.  When integrating and sustaining EBP Melnyk (2019) stated it is important to know about the current barriers and find ways to eliminate persistent barriers in the work environment. A. Find one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings; B. discuss ways to b1. create and b2. sustain an environment for EBP, and C. share the evaluative outcomes implemented by the authors. 

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 3

Finding Relevant Evidence to Answer Clinical Questions

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Answering Clinical Questions

  • Searching for evidence that has already been appraised for validity and reliability decreases the amount of time needed to determine whether the information is reliable
  • Pre-appraised literature can include:
  • Systematic reviews and meta-analyses
  • Meta-syntheses
  • Integrative reviews
  • Synopses/critiques of single studies

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Hierarchy of Information Resources

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Databases Useful for Finding Individual Research Reports

  • MEDLINE®
  • CINAHL
  • PsycINFO®

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Databases Useful for Finding

Pre-Appraised Evidence

  • Cochrane Database of Systematic Reviews
  • BMJ Clinical Evidence
  • Database of Reviews of Effects (DARE)
  • National Guideline Clearinghouse (NGC)
  • Physician’s Information and Education Resources (PIER)
  • American College of Physicians Journal Club (ACP)

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Question

Which of the following sources of evidence would be the best evidence to use to suggest a clinical practice change?

  • A well-designed randomized controlled trial (RCT)
  • A systematic review that encompasses multiple studies
  • Expert opinion of experienced and educated nurses
  • A case study that addresses a similar clinical situation

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Answer

b. A systematic review that encompasses multiple studies

Rationale: Systematic reviews are pre-appraised evidence, which are considered to be higher on the hierarchy of evidence than expert opinion, individual RCTs, or case studies.

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Licensed Databases Versus Web- Based Search Engines

  • Licensed databases such as PubMed® list the journals indexed, which allows users to know which journals they are searching
  • Internet search engines such as Google and Google Scholar search the Internet, but there is no transparency as to what information is included in the search
  • Internet search engines include the grey literature, which include unpublished drug trials, reports, or conference proceedings. Because there is no peer review of this evidence, it should be appraised to ensure that the information is reliable.
  • Combining a licensed database with an Internet search engine may yield the best search results

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Questions That Need to Be Asked About Databases Used for Searching Evidence

1. Is the evidence current?

2. Which search strategies are supported (e.g., are keywords, title searches, and subject heading searches all supported)?

3. How frequently is the database updated?

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Three Commonly Used Search Strategies

  • Keyword searching uses words generated from each component of the PICOT question
  • All appropriate keywords, including common terms, synonyms, acronyms, phrases, coined phrases, and brand names, need to be used
  • Major strengths: Provides a quick snapshot of how helpful a database will be in finding relevant evidence
  • Major weaknesses: May miss studies that do not exactly match the authors’ keyword choices; may find many studies irrelevant to the PICOT question

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Three Commonly Used Search Strategies—(cont.)

  • Subject headings searching uses a standardized set of preselected terms for the search
  • Also referred to as controlled vocabulary, subject terms, thesaurus, descriptors, or taxonomies
  • Major strengths: Searches can be broadened without considering every synonym for the chosen keyword; studies selected only if at least 25% relevant to the topic, thus decreasing the number of irrelevant hits
  • Major weaknesses: Newly developed technologies, phrases, and acronyms may not yet be linked in the database and thus be missed

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Question

Is the following statement true or false?

Subject headings searching (also known as controlled vocabulary searches) may yield fewer hits than a keyword search, but these hits are more likely to be relevant to the clinical question.

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Answer

True

Rationale: Controlled vocabulary systems exist to increase the relevance of search results while limiting the number of less relevant hits.

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Three Commonly Used Search Strategies—(cont.)

  • Title searching uses keywords generated from the “P,” “I,” and “O” components of the PICOT question to search article titles with the same keywords
  • As with the use of keyword searches, all appropriate common terms, synonyms, acronyms, phrases, coined phrases, and brand names need to be used
  • Major strengths: Increases the chance of the article found being relevant to the PICOT question and is highly effective in finding relevant articles
  • Major weaknesses: Misses studies that do not contain the keywords in the title

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Combining Searches

  • Placing several concepts from the PICOT question in one search allows a simultaneous search, but it cannot be determined which concept has the most available evidence
  • Running multiple single-word searches allows the number of “hits” to be seen for each. Then decisions can be made to possibly use Boolean operators.
  • Using the Boolean operator “AND” is useful when narrowing a search to combine two search results. BOTH terms need to be present or an article will not be included in the results.
  • Using “OR” will expand a search to include either one or both terms in the results

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Combining Searches—(cont.)

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Combining Searches—(cont.)

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Using Limits in Searches

  • Using the “limit” function pares down a large results list
  • Options for limiting the results vary by database
  • Limiting to RCTs or meta-analysis first can help determine the highest level of evidence that is available
  • Limiting the search may result in missing relevant evidence (e.g., limiting the search to “full-text only” eliminates all publications that the database does not subscribe to in full text)

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Using Reference Management Software Systems (RMS) in Searches

  • Often referred to as citation managers
  • Used to save, search, sort, share, and continuously add, delete, and organize promising citations
  • Web-based proprietary examples include RefWorks and Endnote®
  • Open-source options include Mendeley (
    http://www.mendeley.com) and Zotero (
    http://www.zotero.org)

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Examples of Evidence Databases

SH, subject heading; FT, full text; KW, keyword; KP, key phrase; TI, title.

Database Document and Resources Search Strategies
CINAHL + Journal article citation and abstract of primary studies, reviews, and synopses
+ FT (with FT subscription) 
KW, KP, TI
SH (i.e., CINAHL headings)
Cochrane Databases + CDSR—FT systematic review
+ CENTRAL—citation and abstract of clinical trials
Note: Only two of the five Cochrane databases are described here
KW,  
SH (i.e., MeSH if you know the heading)

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Examples of Evidence Databases—(cont.)

SH, subject heading; FT, full text; KW, keyword; KP, key phrase; TI, title.

Database Document and Resources Search Strategies
EMBASE + Journal article citation and abstract of primary studies, reviews, and synopses
+ conference coverage
KW, KP, TI,
SH
MEDLINE + Journal article citation and abstract of primary studies, reviews, and synopses
+ FT (varies on PubMed; other vendors with FT subscription)
KW, KP, TI,
SH, clinical queries

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Examples of Evidence Databases—(cont.)

SH, subject heading; FT, full text; KW, keyword; KP, key phrase; TI, title.

Database Document and Resources Search Strategies
National Guideline Clearinghouse +Clinical practice guidelines
+ syntheses of selected guidelines
+ FT
KW, category
PsycINFO ++ Journal article citation and abstract of primary studies, reviews, and synopses
+ FT (with FT subscription)
KW, KP, TI, SH

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Examples of Evidence Databases—(cont.)

SH, subject heading; FT, full text; KW, keyword; KP, key phrase; TI, title.

Database Document and Resources Search Strategies
Trip +Journal article citation and abstract of primary studies, reviews, and synopses
+ guidelines
+ linkout to FT when available
KW, KP, TI,
PICOT search builder, proximity

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Question

Which of the following online evidence sources is most likely to provide pre-appraised evidence?

  • CINAHL
  • MEDLINE
  • PubMed
  • The Cochrane Library

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Answer

d. The Cochrane Library

Rationale: The Cochrane Databases include the Cochrane Database of Systematic Reviews (CDSR), which is a collection of systematic reviews that synthesize RCTs from multiple peer-reviewed sources. CINAHL, MEDLINE, and PubMed may contain evidence at a synthesis level, but most of the sources are individual research articles that must be appraised by the user.

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PubMed®: A Unique Resource

PubMed®: Database produced and maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine

  • Contains >19 million citations from >5,600 journals of biomedical sciences, nursing, dentistry, and pharmacy
  • Free and committed to providing access to all evidence
  • Provides free online access to the MEDLINE® database
  • Includes automatic term mapping that uses the keywords entered to map them to appropriate MeSH® terms

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PubMed®: A Unique Resource—(cont.)

Search results appear in the order in which they were added to the database. To find the most recently published article, use the “Sort by Pub Date” option.

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PubMed®: A Unique Resource—(cont.)

Automatic term mapping uses a three-step process to search keywords entered in the search box and to map them to appropriate MeSH® terms:

  • Step 1—MeSH® term: Looks for a match between keywords entered and a list of MeSH® terms. If a match is found, MeSH® term plus the keyword is used to run the search.
  • Step 2—Journal title: If no MeSH® term match, keywords are compared with a list of journal titles. If a match is found, the journal title is used to run the search.

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PubMed®: A Unique Resource—(cont.)

  • Step 3—Author name: If no match is found in steps 1 and 2, words in the search box are then compared with a list of author names. If there is a match, author’s name is used to run the search.

If no match is found after step 3, search engine will drop the keyword farthest to the right in the search string and will repeat the three-step process

If a match is found, then automatic term mapping will use the match (MeSH® term, journal title, or author name) plus the keyword as part of the search and return to process the term that was previously dropped to begin a separate search

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PubMed®: A Unique Resource—(cont.)

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Final Tips to an Efficient Search

  • Begin with PICOT question to generate keywords
  • Use subject headings when available
  • If search results are sparse, expand it using the explode option (if not automatic)
  • Use available search engine mechanisms to focus the search so that the topic of interest is the main point of the article
  • Establish inclusion/exclusion criteria before searching so that the studies that answer the question are easily identifiable. Apply these criteria after search strategy is complete.

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Week 2

Discussion Board:

A. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.   

Refer back to last module’s discussion board item #4 in which you identified one or two potential problems that you are considering for your DNP Project.  As we move into the building blocks for evidence, try to think about what you want to improve through your DNP project.
A. State the problem that you are considering for your DNP project.
B. Find a peer-reviewed quantitative research article that addresses this problem.
C & D. State the type of research design and the associated level of evidence in the article.
E. What critical appraisal questions did you use to critique this article from Melnyk Chapter 5? Please list both the question and the answer to each question. (Use the questions that match the research design in the article).
F. How can you use this evidence from your chosen article to solve your clinical problem? 


RESPONSE TO QUESTIONS

1.
A. Share an example of evidence-based practice from your work setting.
B & C. Describe how qualitative and quantitative research results can be used to solve practice problems. This is known as translational research.   

For us as nurses, our delivery of safe, high-quality, patient-centered care is dependent upon our good understanding of evidence-based practice, and how to apply it successfully (Schmidt & Brown, 2022). Evidence-based practice examples from my work setting involves using the previous records in the hospital facility about hospitalization and conducting research where evidence about the issue is used for intervention for better health services to reduce hospitalization cases. Qualitative and quantitative research are critical in providing significant scientific evidence that is well-balanced and illuminated for the purpose of better findings that are unique in the process of supporting evidence-based care. Mixed research is more valuable because it makes it possible to get detailed information about the target research, like interviewing the participants using open-ended questions and structure some of the questions to serve a quantitative approach giving about the measurable outcome that influences a significant decision.

2A.
State the problem that you are considering for your DNP project.

The one problem that I consider significant in the DNP project is obtaining approval for the area of interest in the research, especially when targeting to source data from healthcare facilities and other sensitive areas that need a significant explanation and emphasis to get the opportunity. Healthcare facilities are keen on making sure that patients’ data are secured from possible exposure from a researcher that failed to follow the provided guideline. Due to the risks associated with the hospital, getting approvals is challenging for the research.

B.
Find a peer-reviewed quantitative research article that addresses this problem. According to Savander et al. (2021), patients might fail to secure their data during an interview or follow-up survey and might share sensitive data that the researcher might expose. The article explains the role that healthcare organizations play in ensuring that participants, including their families, are given consent to be aware of the research being conducted to protect the interest of both parties.

C&D. Research design used in the study is quantitative research and a quasi-experimental design (Savander et al. (2021). The ultimate goal of using a quasi-experimental quantitative research design, helps with attempting to establish a cause-effect relationship from one variable to another

E.
What does this research mean for clinical practice?

The research means that there is the need for all researchers to follow the protocol of getting approvals before any research to get a credible outcome and protect the participants for future involvement in other research activities.

F.
How can you use this evidence from your chosen article to solve your clinical problem? The hospital ensures that the process of getting approval is long, and the researcher has to share the intention of conducting the study and also get an opportunity to understand the procedure and guidelines to follow on using the data and giving the consent to the participants. The researcher also has to share their plan for securing the data and give assurance that they understand the consequences of the violation.

References

Savander, E. È, Hintikka, J., Wuolio, M., & Peräkylä, A. (2021). The patients’ practises disclosing subjective experiences in the psychiatric intake interview.
 Frontiers in Psychiatry, 12, 605760. 
https://doi.org/10.3389/fpsyt.2021.605760

Schmidt, N. A., & Brown, J. M. (2022). 
Evidence-based practice for nurses (Fifth edition ed.). Jones & Bartlett Learning.

Siedlecki, S. (2020). Quasi-experimental research designs.
 Clinical Nurse Specialist, 34(5), 198-202. 
https://doi.org/10.1097/NUR.0000000000000540

Weekly Discussion Board Grading Criteria

DISCUSSION BOARD RUBRIC

Student Points

QUALITY

POINT RANGE

Demonstrates thorough preparation, synthesis and informed opinion; addresses topic thoroughly; comments/ asks questions that contribute to group learning. Brings appropriate outside materials into the discussion; always listens to and supports the work of others. Meets the deadlines for posting responses as outlined by course requirements. Includes citations in the body of the post as well as references at the end of the post using APA format.

5- 4.5

Demonstrates some preparation and generally addresses topic; comments/asks questions; brings outside materials to class but may lack appropriateness; usually listens to and supports the work of others. May be inconsistent in responses or delayed in response to others. APA formatting errors in citations and references.

4.4 -2.5

Demonstrates inadequate preparation, marginal or off-topic posts, lacks synthesis, and reaffirms existing information, minimal / no contribution to group learning. Posts only within the last 24 hours of the week; rarely supports the efforts, ideas, and work of others. Late or no response to others. Posting lacks citations and references.

2.4- 0

ASSESSMENT, REASONING, AND SYNTHESIS

POINT RANGE

Sound synthesis of material and data analysis from assigned readings and activities; Draws appropriate conclusions; facilitates/stimulates interaction and discussion with peers and instructor. Presents new ideas to the group.

5- 4.5

Faulty or incomplete synthesis and conclusions of data analysis, offers superficial opinion; Responses are limited and may not reflect assigned weekly reading or activities. Interactions and ideas are limited.

4.4 -2.5

Unsatisfactory synthesis of data analysis and conclusions; content not relevant; absence of informed opinion; absence of new ideas; responses are weak and disjointed.

2.4- 0

POINT TOTAL

/10

April 2018


NKU- DNP Peers’ Posts Needing Responses



Kayla Tackett

1.
Share at least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional, and national level. (Related to MO2)

Disseminating evidence is very important when caring for patients. It is important to share the information quickly and efficiently to provide greater patient care from providers (Melnyk et al., 2019). When disseminating for my DNP project, I would use a poster presentation at the local level. I would post the poster in an area where the population that needs to be reached will be able to view. At the regional level, I would disseminate the results through an oral presentation where I would create a PowerPoint presentation to discuss the results and answer questions as necessary. At a national level, I would share a manuscript where individuals could find the information when searching for it.

2A. Find 
one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings.

The article found was based on the Kotter and Cohen’s model of change. Baloh et al (2018) examined the change process by implementing team huddles in small rural hospitals. The authors followed eight hospitals that implemented the team huddles over a two-year time frame.

2B. Discuss 
ways to 
create and sustain 
an environment for EBP.

It is important in healthcare to create an environment of evidence-based practice. Unfortunately, creating the environment is one of the easier parts. Sustaining the EBP environment creates more of a challenge. While sustaining the EBP process is top priority, the first step is to find an EBP mentor. The EBP mentor can be any advanced clinician whether this is an APRN, RN, or another healthcare provider. This mentor will be highly knowledgeable in EBP and able to work constructively with a team to ensure the mentors are valued and knowledgeable as well (Melnyk et al., 2019). The mentor, facilitators, and champions of EBP share the new EBP, disseminate the information, and ensure the change is carried out. The mentor will ensure the change continues following the implementation. Not only does the mentor ensure the change is carried out, but he/she ensures the clinicians are competent in caring for patients utilizing EBP (Bianchi et al., 2018).

2C. Share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

The authors worked with the Kotter and Cohen’s model of change to implement the team huddles into the small rural hospitals. The list of outcomes is below (Baloh et al., 2018).

· Established a sense of urgency (problem areas)

· Created a guiding coalition

· Developed a vision and strategy

· Communicated the change vision

· Empowered broad-based action

· Generated short term wins

· Consolidated gains and produced more change

· Anchored new approaches in the culture

References

Baloh, J., Xi, Z. & Ward, M. (2018). Implementing team huddles in small rural hospitals: How does the Kotter model of change apply? 
Journal of Nursing Management, 26(5). 571-578. 

https://doi.org/10.1111/jonm.12584
Links to an external site.

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., Aleo, G., & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence-based practice. 
Journal of Nursing Management, 26(8). 918-932. 

https://doi.org/10.1111/jonm.12368
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. (4th ed). Philadelphia: Lippincott Williams & Wilkins



Raphaelle Molas

1.
The topic for this week is dissemination of research and evidence for practice. Often visualizing how you might share your work in the future may assist in giving you ideas about the planning and conducting of your project so you will have what you need when ready to share.  It may help you think ahead about your future audience. Shareat least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional and national level. (Related to MO2)

                My scholarly project will focus on evaluating whether malignancy screening in kidney transplant recipients (KTRs) ages 40-75 years is routinely conducted at the Cincinnati VA Medical Center. Understanding and implementing the current recommended clinical practice guidelines for routine cancer screening among KTRs will ensure early detection and treatment to improve health outcomes. My aim for this scholarly project is to also compare compliance of screening among KTRs versus their age and gender matched general population counterparts at the Cincinnati VA Medical Center. Prior to working in Nephrology, I worked in Primary Care- also at the Cincinnati VA. Quality metrics that primary care focused heavily on were the HEDIS measures which comprised of a set of standardized performance measures to compare the Cincinnati VA to other VA’s and the country. Preventive care has also been a cornerstone in primary care. Routine cancer screening has been included among the HEDIS measures that we are “graded” on. With this in mind, I wanted to use this platform to educate primary care providers on the importance of close malignancy screening among KTRs, especially for certain cancers that are oncogenic viral mediated due to chronic immunosuppression (such as in HPV causing cervical cancer). One of the ways I can educate primary care providers, which are essentially the central hub of a patient’s care, is by reaching out to their service chief, and requesting a virtual meeting via Microsoft Teams – a very common virtual platform that the VA utilizes on a daily basis. Because our primary care clinics are spread out throughout the Cincinnati/Kentucky/Indiana region, it is best to share my presentation via Power Point on a virtual platform. Coming from primary care myself, I will be able to identify some of the barriers (including time and limited knowledge on the care of transplant recipients) that they may face especially when having that conversation with the patient about routine cancer screening. Involving the PACT (patient aligned care team) in this discussion is also crucial to facilitate engaging discussions on ways this can be put into practice. I plan on presenting the current recommended guidelines for routine cancer screening, and extrapolate data from previous research studies regarding the prevalence of malignancy among KTRs. From there I would also present current research on the epidemiology of certain cancers in relation to KTRs. Reviewing the current data on prevalence, morbidity and cancer related mortality rate, against the current compliance rate of screening, will hopefully shed light on the importance of ensuring adherence to current clinical guidelines in the efforts to improve patient outcomes.

            The second way I plan on disseminating my findings is through panel presentations among nephrology clinicians within the Cincinnati VA, other VA transplant centers, as well as at the University of Cincinnati and Christ Hospital – facilities I have worked closely with in providing transplant care for veterans at the Cincinnati VA Medical Center. As the transplant coordinator at the Cincinnati VA, I have many renal transplant connections throughout the area and within the VA system. I find that this would be especially helpful in sharing and discussing current evidence and best practice among each of the transplant centers. I would serve as the panel discussion moderator presenting and disseminating my findings, and requesting panel discussion among nephrologists and transplant nephrologists about screening guidelines among KTRs.

            Lastly, I would like to disseminate my findings through poster presentations. The Cincinnati VA Medical Center has resources such as medical media that provide us with means to promote educational advocacies for veterans. With my service chief’s permission, I can request medical media to assist in putting together colorful and creative posters to promote routine cancer screening among KTRs. There are multiple opportunities throughout the year that these posters can be showcased. The Cincinnati VA always has some event that they promote each month for health awareness. For example, February is National Cancer Prevention Month, and March is National Kidney Month – two months that can be used to promote cancer screening among KTRs through medical media such as posters, or even power point slides on the TVs throughout the halls or waiting rooms at the VA. Additionally, public opportunities such as the VA APRN Conference in September hosted by the Cincinnati VA Medical Center, would be a great opportunity to disseminate current evidence and importance of routine malignancy screening among KTRs to fellow APRNs.  

2.
When integrating and sustaining EBP Melnyk (2019) stated it is important to know about the current barriers and find ways to eliminate persistent barriers in the work environment.
Find one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings;

3.
discussways to b1. 
create and b2.
 sustain an environment for EBP, and
C. 
share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

A study by Gordon, et al. (2019) conducted a cross sectional survey, informed by Roger’s Diffusion of Innovations theory, among U.S.- based transplant surgeons, transplant nephrologists and general nephrologists who were members of the American Society of Transplant Surgeons on their attitudes, behavioral intentions and practices of Apolipopotein L1 (APOL1) genetic testing of African American (AA) potential living donors (LDs). According to the study, AAs have a disproportionately higher prevalence of chronic kidney disease (CKD) and end stage renal disease (ESRD) than other racial/ethnic groups (Gordon, et al., 2019). They state that there may be a genetic link between APOL1 gene risk variants and incidence of CKD and ESRD in individuals of African ancestry, but not other populations. Evidence suggests that the APOL1 risk variants to donor outcomes comes from deceased donors (DD), and that these risk variants in AA DDs cause significant higher incidence of graft failure among kidney transplant recipients. There have been some ethical concerns and uncertainties among the transplant community on whether to use genetic testing to protect donor safety, improve donor informed consent and reduce disparities. The American Society of Transplantation recommended against routine APOL1 testing, while the kidney disease: Improving Global Outcomes (KDIGO) recommended considering APOL1 genotyping AA donors.

Roger’s Theory of Innovation guided survey question development. They used Roger’s theory to explain how a new behavior (in this study- APOL1 testing) spreads through a social system (the field of transplant nephrology) and gets adopted into practice. According to Melnyk & Fineout- Overholt, (2019), in Roger’s Diffusion of Innovations Theory, early innovators comprise of the first 2.5% on the innovative curve, followed by subsequent early adopters comprising of about 13.5% of the curve, then the early majority consisting of approximately 34% of the curve, followed by the late majority comprising of another 34%, and lastly the remaining 16% are the laggards, those who are set in their ways and most resistance to change. In this particular study, they found the 3% of the respondents as the innovators, and 14% as early adopters, who according to Roger’s theory are most apt to adopt the change. According to Melnyk & Fineout -Overholt, the top 3% are those who are out of the box thinkers and recognize the advantages of the innovations (2019). In the study, physicians are more likely to adopt routine APOL1 testing if they perceive it as advantageous, while others still had reservations about incorporating this into routine clinical practice due to various barriers such as the absence of professional guidelines, and strong evidence such as in prospective data and randomized control trials on APOL1 in AA donors. There were also some ethical concerns that routine APOL1 would reduce the number of potential donors.

There can be many potential barriers to the implementation of evidence-based practice. When something new is introduced, there can be some degree of skepticism about the change (Melnyk & Fineout-Overholt, 2019). Allowing the clinicians to express their skepticisms, apprehensions and fears, as well as clarifying any misperceptions that they may have about the practice change. The study noted that that the limitation in the study is perhaps some physicians’ lack of familiarity with and/or use of APOL1 genetic testing. Perhaps allowing the clinicians a platform to express their apprehension and provide clarification as to what the change would entail could help reduce skepticism and misperceptions about the change. Providing a framework addressing the ethical concerns the physicians may have about routine testing and providing more education about APOL1 testing itself may also demystify this new proposed practice change. Additionally, professional guidelines and clinical decision support may help physicians evaluate AA donors to clarify the proper use of routine APOL1 genetic testing among potential donors.

Reference:
Gordon, E.J., Wicklund, C., Lee, J., Sharp, R.R., Friedewald, J. (2019). A National Survey of Transplant Surgeons and Nephrologists on Implementing Apolipoprotein LI (APOLI) Genetic Testing Into Clinical Practice. 
Progress in Transplantation. (29)1. 26-35. 

https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1177/152692481881704
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). 
Evidence-based practice in nursing & healthcare. A guide to best practice. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. 


NKU- DNP Peers’ Posts Needing Responses



Kayla Tackett

1.
Share at least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional, and national level. (Related to MO2)

Disseminating evidence is very important when caring for patients. It is important to share the information quickly and efficiently to provide greater patient care from providers (Melnyk et al., 2019). When disseminating for my DNP project, I would use a poster presentation at the local level. I would post the poster in an area where the population that needs to be reached will be able to view. At the regional level, I would disseminate the results through an oral presentation where I would create a PowerPoint presentation to discuss the results and answer questions as necessary. At a national level, I would share a manuscript where individuals could find the information when searching for it.

2A. Find 
one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings.

The article found was based on the Kotter and Cohen’s model of change. Baloh et al (2018) examined the change process by implementing team huddles in small rural hospitals. The authors followed eight hospitals that implemented the team huddles over a two-year time frame.

2B. Discuss 
ways to 
create and sustain 
an environment for EBP.

It is important in healthcare to create an environment of evidence-based practice. Unfortunately, creating the environment is one of the easier parts. Sustaining the EBP environment creates more of a challenge. While sustaining the EBP process is top priority, the first step is to find an EBP mentor. The EBP mentor can be any advanced clinician whether this is an APRN, RN, or another healthcare provider. This mentor will be highly knowledgeable in EBP and able to work constructively with a team to ensure the mentors are valued and knowledgeable as well (Melnyk et al., 2019). The mentor, facilitators, and champions of EBP share the new EBP, disseminate the information, and ensure the change is carried out. The mentor will ensure the change continues following the implementation. Not only does the mentor ensure the change is carried out, but he/she ensures the clinicians are competent in caring for patients utilizing EBP (Bianchi et al., 2018).

2C. Share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

The authors worked with the Kotter and Cohen’s model of change to implement the team huddles into the small rural hospitals. The list of outcomes is below (Baloh et al., 2018).

· Established a sense of urgency (problem areas)

· Created a guiding coalition

· Developed a vision and strategy

· Communicated the change vision

· Empowered broad-based action

· Generated short term wins

· Consolidated gains and produced more change

· Anchored new approaches in the culture

References

Baloh, J., Xi, Z. & Ward, M. (2018). Implementing team huddles in small rural hospitals: How does the Kotter model of change apply? 
Journal of Nursing Management, 26(5). 571-578. 

https://doi.org/10.1111/jonm.12584
Links to an external site.

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., Aleo, G., & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence-based practice. 
Journal of Nursing Management, 26(8). 918-932. 

https://doi.org/10.1111/jonm.12368
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. (4th ed). Philadelphia: Lippincott Williams & Wilkins



Raphaelle Molas

1.
The topic for this week is dissemination of research and evidence for practice. Often visualizing how you might share your work in the future may assist in giving you ideas about the planning and conducting of your project so you will have what you need when ready to share.  It may help you think ahead about your future audience. Shareat least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional and national level. (Related to MO2)

                My scholarly project will focus on evaluating whether malignancy screening in kidney transplant recipients (KTRs) ages 40-75 years is routinely conducted at the Cincinnati VA Medical Center. Understanding and implementing the current recommended clinical practice guidelines for routine cancer screening among KTRs will ensure early detection and treatment to improve health outcomes. My aim for this scholarly project is to also compare compliance of screening among KTRs versus their age and gender matched general population counterparts at the Cincinnati VA Medical Center. Prior to working in Nephrology, I worked in Primary Care- also at the Cincinnati VA. Quality metrics that primary care focused heavily on were the HEDIS measures which comprised of a set of standardized performance measures to compare the Cincinnati VA to other VA’s and the country. Preventive care has also been a cornerstone in primary care. Routine cancer screening has been included among the HEDIS measures that we are “graded” on. With this in mind, I wanted to use this platform to educate primary care providers on the importance of close malignancy screening among KTRs, especially for certain cancers that are oncogenic viral mediated due to chronic immunosuppression (such as in HPV causing cervical cancer). One of the ways I can educate primary care providers, which are essentially the central hub of a patient’s care, is by reaching out to their service chief, and requesting a virtual meeting via Microsoft Teams – a very common virtual platform that the VA utilizes on a daily basis. Because our primary care clinics are spread out throughout the Cincinnati/Kentucky/Indiana region, it is best to share my presentation via Power Point on a virtual platform. Coming from primary care myself, I will be able to identify some of the barriers (including time and limited knowledge on the care of transplant recipients) that they may face especially when having that conversation with the patient about routine cancer screening. Involving the PACT (patient aligned care team) in this discussion is also crucial to facilitate engaging discussions on ways this can be put into practice. I plan on presenting the current recommended guidelines for routine cancer screening, and extrapolate data from previous research studies regarding the prevalence of malignancy among KTRs. From there I would also present current research on the epidemiology of certain cancers in relation to KTRs. Reviewing the current data on prevalence, morbidity and cancer related mortality rate, against the current compliance rate of screening, will hopefully shed light on the importance of ensuring adherence to current clinical guidelines in the efforts to improve patient outcomes.

            The second way I plan on disseminating my findings is through panel presentations among nephrology clinicians within the Cincinnati VA, other VA transplant centers, as well as at the University of Cincinnati and Christ Hospital – facilities I have worked closely with in providing transplant care for veterans at the Cincinnati VA Medical Center. As the transplant coordinator at the Cincinnati VA, I have many renal transplant connections throughout the area and within the VA system. I find that this would be especially helpful in sharing and discussing current evidence and best practice among each of the transplant centers. I would serve as the panel discussion moderator presenting and disseminating my findings, and requesting panel discussion among nephrologists and transplant nephrologists about screening guidelines among KTRs.

            Lastly, I would like to disseminate my findings through poster presentations. The Cincinnati VA Medical Center has resources such as medical media that provide us with means to promote educational advocacies for veterans. With my service chief’s permission, I can request medical media to assist in putting together colorful and creative posters to promote routine cancer screening among KTRs. There are multiple opportunities throughout the year that these posters can be showcased. The Cincinnati VA always has some event that they promote each month for health awareness. For example, February is National Cancer Prevention Month, and March is National Kidney Month – two months that can be used to promote cancer screening among KTRs through medical media such as posters, or even power point slides on the TVs throughout the halls or waiting rooms at the VA. Additionally, public opportunities such as the VA APRN Conference in September hosted by the Cincinnati VA Medical Center, would be a great opportunity to disseminate current evidence and importance of routine malignancy screening among KTRs to fellow APRNs.  

2.
When integrating and sustaining EBP Melnyk (2019) stated it is important to know about the current barriers and find ways to eliminate persistent barriers in the work environment.
Find one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings;

3.
discussways to b1. 
create and b2.
 sustain an environment for EBP, and
C. 
share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

A study by Gordon, et al. (2019) conducted a cross sectional survey, informed by Roger’s Diffusion of Innovations theory, among U.S.- based transplant surgeons, transplant nephrologists and general nephrologists who were members of the American Society of Transplant Surgeons on their attitudes, behavioral intentions and practices of Apolipopotein L1 (APOL1) genetic testing of African American (AA) potential living donors (LDs). According to the study, AAs have a disproportionately higher prevalence of chronic kidney disease (CKD) and end stage renal disease (ESRD) than other racial/ethnic groups (Gordon, et al., 2019). They state that there may be a genetic link between APOL1 gene risk variants and incidence of CKD and ESRD in individuals of African ancestry, but not other populations. Evidence suggests that the APOL1 risk variants to donor outcomes comes from deceased donors (DD), and that these risk variants in AA DDs cause significant higher incidence of graft failure among kidney transplant recipients. There have been some ethical concerns and uncertainties among the transplant community on whether to use genetic testing to protect donor safety, improve donor informed consent and reduce disparities. The American Society of Transplantation recommended against routine APOL1 testing, while the kidney disease: Improving Global Outcomes (KDIGO) recommended considering APOL1 genotyping AA donors.

Roger’s Theory of Innovation guided survey question development. They used Roger’s theory to explain how a new behavior (in this study- APOL1 testing) spreads through a social system (the field of transplant nephrology) and gets adopted into practice. According to Melnyk & Fineout- Overholt, (2019), in Roger’s Diffusion of Innovations Theory, early innovators comprise of the first 2.5% on the innovative curve, followed by subsequent early adopters comprising of about 13.5% of the curve, then the early majority consisting of approximately 34% of the curve, followed by the late majority comprising of another 34%, and lastly the remaining 16% are the laggards, those who are set in their ways and most resistance to change. In this particular study, they found the 3% of the respondents as the innovators, and 14% as early adopters, who according to Roger’s theory are most apt to adopt the change. According to Melnyk & Fineout -Overholt, the top 3% are those who are out of the box thinkers and recognize the advantages of the innovations (2019). In the study, physicians are more likely to adopt routine APOL1 testing if they perceive it as advantageous, while others still had reservations about incorporating this into routine clinical practice due to various barriers such as the absence of professional guidelines, and strong evidence such as in prospective data and randomized control trials on APOL1 in AA donors. There were also some ethical concerns that routine APOL1 would reduce the number of potential donors.

There can be many potential barriers to the implementation of evidence-based practice. When something new is introduced, there can be some degree of skepticism about the change (Melnyk & Fineout-Overholt, 2019). Allowing the clinicians to express their skepticisms, apprehensions and fears, as well as clarifying any misperceptions that they may have about the practice change. The study noted that that the limitation in the study is perhaps some physicians’ lack of familiarity with and/or use of APOL1 genetic testing. Perhaps allowing the clinicians a platform to express their apprehension and provide clarification as to what the change would entail could help reduce skepticism and misperceptions about the change. Providing a framework addressing the ethical concerns the physicians may have about routine testing and providing more education about APOL1 testing itself may also demystify this new proposed practice change. Additionally, professional guidelines and clinical decision support may help physicians evaluate AA donors to clarify the proper use of routine APOL1 genetic testing among potential donors.

Reference:
Gordon, E.J., Wicklund, C., Lee, J., Sharp, R.R., Friedewald, J. (2019). A National Survey of Transplant Surgeons and Nephrologists on Implementing Apolipoprotein LI (APOLI) Genetic Testing Into Clinical Practice. 
Progress in Transplantation. (29)1. 26-35. 

https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1177/152692481881704
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). 
Evidence-based practice in nursing & healthcare. A guide to best practice. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. 


NKU- DNP Peers’ Posts Needing Responses



Kayla Tackett

1.
Share at least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional, and national level. (Related to MO2)

Disseminating evidence is very important when caring for patients. It is important to share the information quickly and efficiently to provide greater patient care from providers (Melnyk et al., 2019). When disseminating for my DNP project, I would use a poster presentation at the local level. I would post the poster in an area where the population that needs to be reached will be able to view. At the regional level, I would disseminate the results through an oral presentation where I would create a PowerPoint presentation to discuss the results and answer questions as necessary. At a national level, I would share a manuscript where individuals could find the information when searching for it.

2A. Find 
one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings.

The article found was based on the Kotter and Cohen’s model of change. Baloh et al (2018) examined the change process by implementing team huddles in small rural hospitals. The authors followed eight hospitals that implemented the team huddles over a two-year time frame.

2B. Discuss 
ways to 
create and sustain 
an environment for EBP.

It is important in healthcare to create an environment of evidence-based practice. Unfortunately, creating the environment is one of the easier parts. Sustaining the EBP environment creates more of a challenge. While sustaining the EBP process is top priority, the first step is to find an EBP mentor. The EBP mentor can be any advanced clinician whether this is an APRN, RN, or another healthcare provider. This mentor will be highly knowledgeable in EBP and able to work constructively with a team to ensure the mentors are valued and knowledgeable as well (Melnyk et al., 2019). The mentor, facilitators, and champions of EBP share the new EBP, disseminate the information, and ensure the change is carried out. The mentor will ensure the change continues following the implementation. Not only does the mentor ensure the change is carried out, but he/she ensures the clinicians are competent in caring for patients utilizing EBP (Bianchi et al., 2018).

2C. Share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

The authors worked with the Kotter and Cohen’s model of change to implement the team huddles into the small rural hospitals. The list of outcomes is below (Baloh et al., 2018).

· Established a sense of urgency (problem areas)

· Created a guiding coalition

· Developed a vision and strategy

· Communicated the change vision

· Empowered broad-based action

· Generated short term wins

· Consolidated gains and produced more change

· Anchored new approaches in the culture

References

Baloh, J., Xi, Z. & Ward, M. (2018). Implementing team huddles in small rural hospitals: How does the Kotter model of change apply? 
Journal of Nursing Management, 26(5). 571-578. 

https://doi.org/10.1111/jonm.12584
Links to an external site.

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., Aleo, G., & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence-based practice. 
Journal of Nursing Management, 26(8). 918-932. 

https://doi.org/10.1111/jonm.12368
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. (4th ed). Philadelphia: Lippincott Williams & Wilkins



Raphaelle Molas

1.
The topic for this week is dissemination of research and evidence for practice. Often visualizing how you might share your work in the future may assist in giving you ideas about the planning and conducting of your project so you will have what you need when ready to share.  It may help you think ahead about your future audience. Shareat least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional and national level. (Related to MO2)

                My scholarly project will focus on evaluating whether malignancy screening in kidney transplant recipients (KTRs) ages 40-75 years is routinely conducted at the Cincinnati VA Medical Center. Understanding and implementing the current recommended clinical practice guidelines for routine cancer screening among KTRs will ensure early detection and treatment to improve health outcomes. My aim for this scholarly project is to also compare compliance of screening among KTRs versus their age and gender matched general population counterparts at the Cincinnati VA Medical Center. Prior to working in Nephrology, I worked in Primary Care- also at the Cincinnati VA. Quality metrics that primary care focused heavily on were the HEDIS measures which comprised of a set of standardized performance measures to compare the Cincinnati VA to other VA’s and the country. Preventive care has also been a cornerstone in primary care. Routine cancer screening has been included among the HEDIS measures that we are “graded” on. With this in mind, I wanted to use this platform to educate primary care providers on the importance of close malignancy screening among KTRs, especially for certain cancers that are oncogenic viral mediated due to chronic immunosuppression (such as in HPV causing cervical cancer). One of the ways I can educate primary care providers, which are essentially the central hub of a patient’s care, is by reaching out to their service chief, and requesting a virtual meeting via Microsoft Teams – a very common virtual platform that the VA utilizes on a daily basis. Because our primary care clinics are spread out throughout the Cincinnati/Kentucky/Indiana region, it is best to share my presentation via Power Point on a virtual platform. Coming from primary care myself, I will be able to identify some of the barriers (including time and limited knowledge on the care of transplant recipients) that they may face especially when having that conversation with the patient about routine cancer screening. Involving the PACT (patient aligned care team) in this discussion is also crucial to facilitate engaging discussions on ways this can be put into practice. I plan on presenting the current recommended guidelines for routine cancer screening, and extrapolate data from previous research studies regarding the prevalence of malignancy among KTRs. From there I would also present current research on the epidemiology of certain cancers in relation to KTRs. Reviewing the current data on prevalence, morbidity and cancer related mortality rate, against the current compliance rate of screening, will hopefully shed light on the importance of ensuring adherence to current clinical guidelines in the efforts to improve patient outcomes.

            The second way I plan on disseminating my findings is through panel presentations among nephrology clinicians within the Cincinnati VA, other VA transplant centers, as well as at the University of Cincinnati and Christ Hospital – facilities I have worked closely with in providing transplant care for veterans at the Cincinnati VA Medical Center. As the transplant coordinator at the Cincinnati VA, I have many renal transplant connections throughout the area and within the VA system. I find that this would be especially helpful in sharing and discussing current evidence and best practice among each of the transplant centers. I would serve as the panel discussion moderator presenting and disseminating my findings, and requesting panel discussion among nephrologists and transplant nephrologists about screening guidelines among KTRs.

            Lastly, I would like to disseminate my findings through poster presentations. The Cincinnati VA Medical Center has resources such as medical media that provide us with means to promote educational advocacies for veterans. With my service chief’s permission, I can request medical media to assist in putting together colorful and creative posters to promote routine cancer screening among KTRs. There are multiple opportunities throughout the year that these posters can be showcased. The Cincinnati VA always has some event that they promote each month for health awareness. For example, February is National Cancer Prevention Month, and March is National Kidney Month – two months that can be used to promote cancer screening among KTRs through medical media such as posters, or even power point slides on the TVs throughout the halls or waiting rooms at the VA. Additionally, public opportunities such as the VA APRN Conference in September hosted by the Cincinnati VA Medical Center, would be a great opportunity to disseminate current evidence and importance of routine malignancy screening among KTRs to fellow APRNs.  

2.
When integrating and sustaining EBP Melnyk (2019) stated it is important to know about the current barriers and find ways to eliminate persistent barriers in the work environment.
Find one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings;

3.
discussways to b1. 
create and b2.
 sustain an environment for EBP, and
C. 
share the evaluative outcomes implemented by the authors.  (Related to MO1,2,3)

A study by Gordon, et al. (2019) conducted a cross sectional survey, informed by Roger’s Diffusion of Innovations theory, among U.S.- based transplant surgeons, transplant nephrologists and general nephrologists who were members of the American Society of Transplant Surgeons on their attitudes, behavioral intentions and practices of Apolipopotein L1 (APOL1) genetic testing of African American (AA) potential living donors (LDs). According to the study, AAs have a disproportionately higher prevalence of chronic kidney disease (CKD) and end stage renal disease (ESRD) than other racial/ethnic groups (Gordon, et al., 2019). They state that there may be a genetic link between APOL1 gene risk variants and incidence of CKD and ESRD in individuals of African ancestry, but not other populations. Evidence suggests that the APOL1 risk variants to donor outcomes comes from deceased donors (DD), and that these risk variants in AA DDs cause significant higher incidence of graft failure among kidney transplant recipients. There have been some ethical concerns and uncertainties among the transplant community on whether to use genetic testing to protect donor safety, improve donor informed consent and reduce disparities. The American Society of Transplantation recommended against routine APOL1 testing, while the kidney disease: Improving Global Outcomes (KDIGO) recommended considering APOL1 genotyping AA donors.

Roger’s Theory of Innovation guided survey question development. They used Roger’s theory to explain how a new behavior (in this study- APOL1 testing) spreads through a social system (the field of transplant nephrology) and gets adopted into practice. According to Melnyk & Fineout- Overholt, (2019), in Roger’s Diffusion of Innovations Theory, early innovators comprise of the first 2.5% on the innovative curve, followed by subsequent early adopters comprising of about 13.5% of the curve, then the early majority consisting of approximately 34% of the curve, followed by the late majority comprising of another 34%, and lastly the remaining 16% are the laggards, those who are set in their ways and most resistance to change. In this particular study, they found the 3% of the respondents as the innovators, and 14% as early adopters, who according to Roger’s theory are most apt to adopt the change. According to Melnyk & Fineout -Overholt, the top 3% are those who are out of the box thinkers and recognize the advantages of the innovations (2019). In the study, physicians are more likely to adopt routine APOL1 testing if they perceive it as advantageous, while others still had reservations about incorporating this into routine clinical practice due to various barriers such as the absence of professional guidelines, and strong evidence such as in prospective data and randomized control trials on APOL1 in AA donors. There were also some ethical concerns that routine APOL1 would reduce the number of potential donors.

There can be many potential barriers to the implementation of evidence-based practice. When something new is introduced, there can be some degree of skepticism about the change (Melnyk & Fineout-Overholt, 2019). Allowing the clinicians to express their skepticisms, apprehensions and fears, as well as clarifying any misperceptions that they may have about the practice change. The study noted that that the limitation in the study is perhaps some physicians’ lack of familiarity with and/or use of APOL1 genetic testing. Perhaps allowing the clinicians a platform to express their apprehension and provide clarification as to what the change would entail could help reduce skepticism and misperceptions about the change. Providing a framework addressing the ethical concerns the physicians may have about routine testing and providing more education about APOL1 testing itself may also demystify this new proposed practice change. Additionally, professional guidelines and clinical decision support may help physicians evaluate AA donors to clarify the proper use of routine APOL1 genetic testing among potential donors.

Reference:
Gordon, E.J., Wicklund, C., Lee, J., Sharp, R.R., Friedewald, J. (2019). A National Survey of Transplant Surgeons and Nephrologists on Implementing Apolipoprotein LI (APOLI) Genetic Testing Into Clinical Practice. 
Progress in Transplantation. (29)1. 26-35. 

https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1177/152692481881704
Links to an external site.

Melnyk, B. M. & Fineout-Overholt, E. (2019). 
Evidence-based practice in nursing & healthcare. A guide to best practice. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. 


MODULE 7

Discussion Board Question:

1. The topic for this week is dissemination of research and evidence for practice. Often visualizing how you might share your work in the future may assist in giving you ideas about the planning and conducting of your project so you will have what you need when ready to share.  It may help you think ahead about your future audience. 
Share at least 
three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional and national level. (Related to MO2)

2.  When integrating and sustaining EBP Melnyk (2019) stated it is important to know about the current barriers and find ways to eliminate persistent barriers in the work environment.
A. 
Find one peer review article which discusses one of the four models of organizational change discussed in your Melnyk chapter readings;
B. 
discuss ways to b1. 
create and b2.
 sustain an environment for EBP, and
C. 
share the evaluative outcomes implemented by the authors. 


ANSWER

Question 1: Share at least three of the ways you may consider disseminating your findings when your DNP project is completed on a local, regional, and national level

There are many ways that I can use to disseminate the findings from my project at all levels including local level, state and federal levels. They include:

·
Presenting program results to local community groups and other local stakeholders

Sharing the findings of research with communities makes it easier for such groups to have accessibility to the data that their involvement in research studies helped to produce. Societies may take advantage of these results by using this information to fulfill their regional growth objectives and safeguard their rights. I can prepare a PowerPoint presentation of my findings, and organize for a periodic program to disseminate my findings to the local community. To ensure that they can understand my results would be sure to use simple language that most people can understand. Since physical presentation may be challenging, I would additionally print out posters and handouts and place them in one place that may community members are likely to access, for instant, in a grocery store

·
Making presentations at national conferences and association gatherings

Delivering clinical or operational studies at a professional gathering gives the potential to communicate study results fast, because the lag time involving conducting the investigation and delivering at a meeting might be brief. Additionally, meetings are generally hosted by professionals in the area, that are more inclined to be initial integrators of studies into action. The poster presentation style also has the added benefit of allowing for direct communication between academics and industry professionals (Edwards, 2015). Researchers may discuss their study in depth and obtain input that may be beneficial for subsequent investigations. Studies of participants at professional events demonstrate informants’ perception that information transmission is better when researchers are present to clarify and share their study results during a scientific conference.

·
Issuing a press release.

The dissemination of one’s research to the public may be facilitated via press releases. A large portion of the general public becomes aware of recent developments in medical studies via the dissemination of these reports and the publications and newscast items that are based on them. There are many audiences outside the media who may benefit from the information provided in press releases. Putting out a press release will raise my story’s visibility and provide me a platform from which to discuss my study’s implications. This will help me to reach all the people, at local, state and national level in a short time and more effectively.

Question 2

a.

Melnyk, B. M., Fineout‐Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© model improves implementation of evidence‐based practice, healthcare culture, and patient outcomes. 
Worldviews on Evidence‐Based Nursing
14(1), 5-9.

(b). Discuss
ways to b1. create 
and

Organizational leadership must make sure the necessary resources are in place to advance the EBP strategy. The infrastructure of an organization includes its people, its tools, and its adaptive culture. The chief healthcare executive and other members of the executive team need to be actively engaged in developing and implementing an EBP culture to ensure its success. In order to facilitate the operation, they should recognize possible obstacles to adoption, devise a strategy to lessen or eliminate those obstacles, and provide full backing to the project managers and change advocates.

b2. Sustain
an environment for EBP

The plan necessitates a commitment of sufficient human, monetary, educational, and training resources to the EBP endeavor. Integrating EBP into the operations of the whole company is a major strategic objective. Leaders must monitor the organization’s progress while the project is implemented and be ready to make adjustments to the plan if things change. Ensuring Committed Organizational Leadership is another strategy for maintaining a healthy EBP setting.

Share
the evaluative outcomes implemented by the authors

Execution of the ARCC Model in healthcare settings may boost clinicians’ views and adoption of evidence-based care, promote clinical experiences, and transform institutional attitude toward EBP. Results demonstrated substantial gains in clinicians’ EBP views and EBP execution combined with good development within an institutional EBP environment. Study results also demonstrated major benefits in some patient results.

References

Melnyk, B. M., Fineout‐Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© model improves implementation of evidence‐based practice, healthcare culture, and patient outcomes. 
Worldviews on Evidence‐Based Nursing
14(1), 5-9.

Edwards D. J. (2015). Dissemination of Research Results: On the Path to Practice Change. 
The Canadian journal of hospital pharmacy
68(6), 465–469.
https://doi.org/10.4212/cjhp.v68i6.1503

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