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Dissemination Strategies NURS 6052 Discussion: Developing a Culture of Evidence-Based Practice
To Prepare:
- Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.
- This may include: unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.
- Reflect on which type of dissemination strategy you might use to communicate EBP.
By Day 3 of Week 9
Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.
By Day 6 of Week 9
Respond to at least two of your colleagues on two different days by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.
Discussion – Week 9
Dissemination strategies for evidence-based practices deal with different strategies that can be used to get information out to others. Information that deals with evidence-based practices that can be used in the healthcare community that provides effective outcomes. There are a lot of facilities that use evidence-based practices to aid in patient care. But most facilities that don’t use evidence-based practices may not have been given the information on how it could positively affect the way they provide patient care. It is the responsibility of those in leadership positions to get information about the use of evidence-based practices and how it could improve patient care. Melnyk (2012) noted “Training and performance require intense focus, strong leadership, effective communication, teamwork, data-base practices, root-cause analysis of errors, a safety and continuous learning culture, improvement processes, and an outcomes evaluation” (pg. 127).
One dissemination strategy I would use would be giving a presentation on a podium. I would be able to give all the important information through a PowerPoint presentation. My audience would include everyone that is involved in patient care. I would also be able to include the audience’s input on different topics that they feel would be beneficial for them in interacting with patients. A second dissemination strategy I would use would be a poster presentation. I would be able to include the most important information. I would also include pamphlets to go alone with the poster. The barriers for these types of strategies would be that there is not enough information, or that the information is not important to them. To overcome my barriers, I would get the input of the people I am doing the presentation for ahead of time, that way I would know what things to cover and have the information necessary to convince them about the importance of implementing evidence-based practices. Gallagher-Ford et al. (2011) noted “When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved” (pg. 54). The strategy that I would least likely use is peer-reviewed or dated publication because the information is constantly changing. There are always some new developments that come about. There are always going to be changes, so clinicians and other healthcare leaders would need to keep an open mind (Zimmerman, 2017). Another method I would least likely use is unit-based such as huddles because of the timing it may occur. Most units are extremely busy so the information may not be retained.
References
Zimmerman, K. (2017). Essentials of Evidence Based Practice. International Journal of Childbirth Education, 32(2), 37-43
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 9
Thank you for such insights into dissemination of evidence to others. You are spot on regarding strengths and possible barriers when disseminating information. Barriers to understanding and acceptance may occur when information is shared with others. Melnyk et al., (2017) discusses potential barriers that impede evidence- based practice from becoming the standard of care. One such barrier is lack of support from nurse leaders. Lack of understanding as to what EBP can bring to nursing care, misinterpretation of time constraints with implementation, are other considerations voiced by some. More often than not, this may be a result of lack of knowledge related to EBP and the benefits from such. As graduate prepared nurses how do you propose we decrease the potential barriers in order to support a positive patient outcome?
Melnyk, B.M., Fineout-Overholt, E., Giggleman, M., Choy, K. (2017). A test of
the ARCC model improves the implement healthcare culture, and patient
outcomes. World Views of Evidence Based Nursing 14(1), 5-9.
7 months ago
Claudia Paz
RE: Discussion – Week 9
One disseminating strategy I would use is unit-level presentations. In one of the organizations, I used to work for, in order to move up the clinical ladder from clinical nurse I to clinical nurse II a unit project had to be presented. This is a great tool to provide the unit with the most up-to-date EBP guidelines. The more a nurse is aware of proven strategic guidelines, the better care the patient receives (Melnyk &Fineout-Overholt, 2019).
Another disseminating strategy to use is poster boards. A team member from the Cath lab once did a poster board on a cardiology topic and all the nurses would run to this poster board to follow the guidelines. A nurse who genuinely wants to impact the life of their patient in a positive way will always seek the best patient care for their patient. A hospital that follows EBP and guides their workers to perform the patient care that is proven to be more effective, together with a strong nursing leadership and available resources fosters an atmosphere of patient satisfaction and safety (Newhouse et al., 2007).
Reference
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Newhouse, R.P., Dearholt,S., Poe, S., Pugh, L.C., & White, K.M. (2007). Organizational change strategies for evidence-based practice. Journal of Nursing Administration, 37912), 552-557. doi:0.1097/01.NNA. 0000302384.91366.8f
7 months ago
Inderpreet Sandhar
RE: Discussion – Week 9
Great post Claudia,
I agree with you that unit-level presentation is a great tool to provide the unit with the most up to date guidelines and policies. Disseminating evidence-based practice information to patients, public, healthcare organizations, and healthcare professionals is essential in the improvement of patient and population health. It is important that while selecting a strategy to use in disseminating, its strategy must ensure that the dissemination goals are met, which may include increasing evidence reach and increasing ability and motivation among providers to integrate evidence use (Milner, 2021).
Using the unit-level dissemination ensures that the uncertainty risks are eradicated, a principal factor attaining the desired outcomes. In-unit presentation allows participants to voice concerns and feel a part of the change and value. It is important to understand the audience you will disseminate information to, meaning that you must assess their needs, readiness, and how best you think they will be informed.
References:
Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29.
Milner, K. (2021). Evidence-Based Practice and Dissemination Strategies.
7 months ago
Cory Legan
Main Discussion – Week 9
As health care provider, it is our responsibility to be aware of evidence-based practice, to ensure excellent patient care and positive outcomes (Walden University, LLC. (Producer), 2018). This level of awareness allows us to share our knowledge with others. In addition, it also promotes confidence in our clinical practice.
A strategic approach to encourage evidence-based practice in our daily work is through leadership (Newhouse & et al., 2007). I believe in leading by example. This can be accomplished through personal mentorship (2007). I would be unlikely to participate in a committee to encourage evidence-based practice in the healthcare field. I feel that our workplace does not accommodate the time needed for a committee to be an effective way to disseminate information. However, if we model the use of evidence-based practice in our own practice, our colleagues are likely to share input as well. Another way to improve the use of evidence-based practice in a clinical environment is through policy (Melnyk & et al., 2011). Implementing evidence-based practice as a policy helps inform and educate healthcare providers of updated clinical interventions.
These disseminating approaches are not foul proof. There are still barriers to overcome, when concerning evidence-based practice. Some of these barriers include staff resistance. Some healthcare providers are hesitant to change. Another obstacle to overcome would be the lack of time to perform research and discover evidence-based practices. Some clinicians may have the mindset that it is just easier or faster to do something the way they’ve always done it.
To overcome these barriers, I would help educate others on why the following changes are necessary. The main goal of healthcare providers is to take care of patients to the best of our ability. Evidence based practice can help us further reach this goal, while improving patient outcomes.
References:
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Evidence-based
practice, step by step: Sustaining evidence-based practice through organizational
policies and an innovative model. American Journal of Nursing, 111(9), 57–60.
doi:10.1097/01.NAJ.0000405063.97774.0e
Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C., & White, K. M. (2007). Organizational change
strategies for evidence-based practice. Journal of Nursing Administration, 37(12), 552–
- doi:0.1097/01.NNA.0000302384.91366.8f
Walden University, LLC. (Producer). (2018). Evidence-based Decision Making [Video file].
Baltimore, MD: Author.
7 months ago
Tosin Addeh
RE: Main Discussion – Week 9
Good Day Cory,
Reading your post was informative, but it got me thinking of other possible strategies that could aid healthcare professionals in absorbing change when it comes to EBP. So, in your third paragraph, you said staff resistance is one of the barriers to EBP implementation. To counteract these effects, one strategy I would recommend is to perform a thorough assessment of their environment. This assessment should include issues that affect them the most at the workplace and what is their best form of assimilating information. Melnyk et al. (2017) described the Advancing Research and Clinical Practice Through Close Collaboration (ARCC) Model as a tool to use to make this assessment. This model will help observe those areas that would be most important to the nurses for a change.
When assessments are not done, the staff will likely lack interest and resist change because the wrong topic might have been picked for EBP that will not influence them. Mathieson et al. (2019) stated that effective adoption of evidence-based practice is only possible if the nurse themselves deem it useful and there is evidence that it could positively impact the patient and/or their primary care, which means that the second strategy to avoid staff resistance to EBP change is to make sure that the topic of the EBP chosen will have great benefit and improve their work ethics. There will be more cooperation and increased adoption of the disseminated EBP.
References
Mathieson, A., Grande, G., & Luker, K. (2019, January). Strategies, facilitators and barriers to implementation of evidence-based practice in Community Nursing: A systematic mixed-studies review and qualitative synthesis. Primary health care research & development. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476399/
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. doi:10.1111/wvn.12188
https://eds.s.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=7bbe46d3-28c9-4cb9-
8f48-d100ee55f9aa%40redis
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Main Discussion – Week 9
As you indicate, our biggest strength can also be our greatest weakness. Knowing how to maximize the strengths and minimize the dowwnside of a process allows for optimalization of any intervention. Thank you for callling that point forward.
Dr. B.
7 months ago
Shontrice Davis
RE: Discussion – Week 9
The two dissemination strategies that I would be most inclined to use is unit-level presentation and local dissemination (Harvey, Kitson, 2015). Unit-level dissemination is great at making sure that the issue the has been addressed improves the underlying problem. Various units of different settings have different assessments of the environment. That means the the operational environment needs to be taken into consideration when it comes to which evidence-based practice that will be applied. Therefore, making sure the engagement is well thought out, the implementation will be based on the specific unit (Brownson et al., 2018). Healthcare facilities’ goal is to implement things that will improve the performance of their units. Local dissemination is specific to signifiant participants. This aspect will help create a strong emphasis on institutional development (Hall, Roussel, 2016). However, it is important to be sure that the dissemination outcomes needs to be completed in an environment where resources and technology is available. The application of evidence-based practice should be centered around creating an environment that is ready for positive change. Therefore, training will play a big part in how facilities implement evidence-based practice (Brownson et al., 2018). I least inclined to poster presentations dissemination to implement evidence-based practice. Posters are not able to give full details and do not entail all of what needs to be implemented. One would also have to be sure that the posters are engaging. This is another difficulty that healthcare facilities may run into. I am also least likely to use podium presentations. Healthcare facilities would have to worry about marketing of the engagement. Poor marketing could lead to poor turnout of attendance.
A barrier of unit-level dissemination would be the lack of interest from staff members. For example, staff members could resist the new change due to the dislike of what is being implemented. However, staff involvement in the presentation may win the staff members over. For example, making a staff member a speaker at the presentation will make them feel involved in the implementation. Seeing fellow staff members speaking a the presentation will draw more interest into the implementation. A barrier for local dissemination would lack of access to resources such as peer-reviewed journals. For example, many journals require a subscription fee. This can be overcome by healthcare facilities providing free access to journals for staff members.
Resources
Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: translating science to practice. Oxford University Press.
Hall, H. R., & Roussel, L. A. (Eds.). (2016). Evidence-based practice. Jones & Bartlett Publishers.
Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
7 months ago
Crystal Anderson
RE: Discussion – Week 9
Disseminating is to widely spread information. Dissemination of health related information can include elements such as summaries and educational sessions with patients. Dissemination can be through brochures, videos, websites and so much more. Knowledge translations is the synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening healthcare providers, managers, policy makers, informal caregivers and patients (Chapman, et al., 2020). Evidence-Based practice is the integration of clinical expertise, knowledge, judgement and critical reasoning acquired through professional training and expertise. Evidenced-based practice is a critical tool in delivery high quality patient care.
Two strategies that I would use to spread information in a health care setting would be posters for the public and weekly huddle summaries for the units. I would place posters throughout the hospital in public common areas such as elevators, high traffic hallways and cafeteria. Posters should be visually stimulating and easy to follow. The most common example of posters that spread information throughout the hospital that I have seen used is the stroke warning sign posters that list the signs and symptoms of stroke and when to call; there are barriers to this form of spreading information which can be language barriers; solution to this information to this may be that there is a direct website with current information that offers information in another language. Weekly huddle summaries for particular unit allows information in the units to be spread easily from coworker to coworker. There may be a barrier to huddle forms if information not up to date with current information; ways to fix this issue is to ensure charge nurse or floor manager update information as much as possible. My least favorite way to spread information in health care to many people are brochures because often no one picks them up to read unless they are bored and also brochures are easy to loose and important information can be missed. Again there are many ways to spread information, especially with a lot of technology.
Reference
Chapman, E., Haby, M.,Toma, S., Carla de Bortoli., M., Illanes, E., Oliveros, M., & Maia Barreto, J. (2020). Knowledge translation strategies for dissemination with a focus on healthcare recipients: An overview of systematic reviews. Implantation Science, 15,14. Https://doi.org/10.1186/s13012-020-0974-3
7 months ago
Sharon Muchina
RE: Discussion – Week 9
Crystal, Interesting post.
As educators, we must incorporate various creative ways of sharing Evidence-Based (EB) information with healthcare workers and patients. Otherwise, disseminating information using one style carries a risk of some people missing it completely. As you mentioned, people read brochures when they are bored. Although many people pick them up, it doesn’t necessarily mean that they read them.
According to Gallagher-Ford et al. (2011), utilizing an in-service allows the participants to receive literature and brochures about the presentation on arrival. The participants can also engage in a face-to-face conversation throughout the training, demonstrations can be done, and participants can be broken into small groups to work together on a project. This learning process is time-consuming, but it provides learning options, and it is an effective way to determine if the disseminated information was understood.
Barriers to disseminating EB information can be overcome by effective communication and teamwork. Strong leadership is required to train and educate competent clinicians like nurse managers on the use and application of EB information to attain best practices in their departments that bring about the best patient outcomes (Melnyk,2012).
References
Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change. AJN, American Journal of Nursing, 111 (3), 54-60. doi: 10.1097/10.1097/01.NAJ.0000395243.14347.7e.
Melnyk, B. M. (2012). Achieving a High-Reliability Organization Through Implementation of the ARCC Model for Systemwide Sustainability of Evidence-Based Practice. Nursing Administration Quarterly, 36 (2), 127-135. doi: 10.1097/NAQ.0b013e318249fb6a.
7 months ago
Rona Adams
RE: Discussion – Week 9
Crystal,
Your discussion post was very informative. There are multiple ways to disseminate health care information to staff and patients. In my organization, one-way healthcare information is disseminated twice a month is when leadership invites guest speakers who are experts in their field to speak to the team during Huddle. These individuals range from specialized providers and hospice liaisons to Diabetic Educators. The information received is delivered via PowerPoint presentation, in-person meetings, and Teams virtual meetings. According to Broome & Marshall, 2021, “nursing leaders must communicate and execute a clear vision for EBP within their organization.” As a staff, we can incorporate relevant information into the clinical practice to provide more effective interventions to provide care to patients. I also agreed that brochures are a terrible way to spread and provide information. Often health care representatives send brochures and samples for new medications, etc. to the office to present to patients or providers. Although the information can be helpful to patients; most of the time the brochures are left behind or overlooked. Disseminating new evidence can effectively improve patient outcomes for practice (Melnyk & Fineout-Overholt, 2019).
Broome, M. E., & Marshall, E. (2021). Frameworks for becoming a transformational leader. In Transformational leadership in nursing (3rd ed.). https://doi.org/10.1891/9780826193995.0006
7 months ago
Sharon Muchina
RE: Discussion – Week 9
Developing a Culture of Evidence-Based Practice
Applying Evidence-Based (EB) knowledge to change clinical healthcare practices can be challenging in disseminating information effectively for implementation that can bring about the best patient outcomes. Therefore, the two strategies I would use to disseminate EB information effectively are in-services and mentorship programs.
To distribute EB information effectively, I would utilize in-service presentations. At an in-service, participants can come from various departments. They can be divided into smaller teams to work together. The presentation can be a PowerPoint, face-to-face training, and demonstrations, while packets containing the agenda and draft documents can be distributed (Gallagher-Ford et al.,2011).
Another effective way I would use to disseminate EB information is through training and mentorship programs. Each department would have a trained mentor who completes the initial training. The mentor would act as an expert and future mentor responsible for training and educating other employees. The mentor would monitor the outcomes of implementing and disseminating EB information in their department (Newhouse et al.,2011).
Strategies I would be least inclined to use are e-mails and electronic posters on healthcare monitors like computer screens to disseminate EP information. The reason is that there is no way of knowing if the information was received or read. The e-mail sent might go to junk mail or not be opened on time. Furthermore, nurses might need to invest extra time out of their busy schedules to read and understand the poster presentation to benefit from the EB information. The nurse might ignore or scan over the poster and not bother reading it in detail.
Making a successful in-service is time-consuming and expensive; it requires effective communication and willing participants for the presentation to be successful. The mentorship and training program might face challenges in identifying a mentor willing to take responsibility for teaching and educating other employees and monitoring the outcomes of implementing EBP in their department.
To have a successful in-service, I would inform the participants how their support in establishing the EB outcomes, when implemented, would benefit them as clinicians to improve work conditions, better their work performance, reduce medical errors, and improve patient outcomes (Melnyk,2012). To overcome the mentorship barrier, I would find support from human resources and other leaders like nurse managers to identify a mentor in their department who could get compensated for their role in establishing EBP training and education in their department.
References
Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change. AJN, American Journal of Nursing, 111 (3), 54-60. doi: 10.1097/10.1097/01.NAJ.0000395243.14347.7e.
Melnyk, B. M. (2012). Achieving a High-Reliability Organization Through Implementation of the ARCC Model for Systemwide Sustainability of Evidence-Based Practice. Nursing Administration Quarterly, 36 (2), 127-135. doi: 10.1097/NAQ.0b013e318249fb6a.
Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C. & White, K. M. (2007). Organizational Change Strategies for Evidence-Based Practice. JONA: The Journal of Nursing Administration, 37 (12), 552-557. DOI: 10.1097/01.NNA.0000302384.91366.8f.
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 9
7 months ago
Sharon Muchina
RE: Discussion – Week 9
7 months ago
Inderpreet Sandhar
RE: Discussion – Week 9
7 months ago
April Williams
RE: Discussion – Week 9
Initial Discussion Post: Two dissemination strategies
According to Melnyk, (2012), each year over 200,000 unintended medical death occur from mistakes. Most individuals want to do a good job, but mistake do occasionally happen. By implementing the five concepts of a high reliability organization, healthcare organization have an opportunity to build a culture of patient safety where care is patient centered (Melnyk, 2012). Using the bases of a High Reliability Organization (HRO) two dissemination strategies that can be used to communicate Evidence Based Practice (EPB) are offer opportunities for a standardized processes to conduct performance improvement projects that begins with establishing a clinical question to address in a standardized PICOT format. ( Melnyk, 2012). The PICOT format ensure there is common knowledge of subject matter and search criteria can be justified by all practitioners (Eriksen et al., 2018). Once the evidence based research is completed and performance improvement project is completed, the project should include plan to develop a campaign to promote the improvement project.
In a performance improvement project for Pressure Injury Prevention (PIP), a campaign can be developed to disseminate the roll out new education and policies for pressure injury prevention (PIP), The campaign could include two key items, an elevator speech and education brochure. The elevator speech can be similar to the (PIP) “SKINCARE” bundle of PIP intervention (Tayyib, 2021). Using a campaign to rollout EBP allows the user to be able to connect with the clinicians in a positive way and is a quick way to gain support (Gallagher-Ford, 2011).
The dissemination strategies I would be least inclined to use is email and electronic training. These are generally items that large groups of people do not frequently or thoroughly read carefully and it can takes time to verify their dissemination.
The main barrier to using the campaign is the risk that once the campaign is over, the project may not be remembered and staff may go back to their old ways. It is also important to make sure all key contributors are given credit and recognition for their contributions as it could create negativity while others are promoting the project.
In overcoming these barriers, an SBAR communication can be used to announce the project and provide a list of the team members and a timeline can be provided all the activities that will be included in in the implementation plan. These steps will ensure the projects continues to be highlighted and staff has a better understanding of the goals and outcomes of the project.
References
Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature
search quality: a systematic review. Journal of the Medical Library Association : JMLA, 106(4), 420–431.
https://doi.org/10.5195/jmla.2018.345
Gallagher-Ford, L. , Fineout-Overholt, E. , Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Implementing an
Evidence-Based Practice Change. AJN, American Journal of Nursing, 111 (3), 54-60. doi:
10.1097/10.1097/01.NAJ.0000395243.14347.7e.
Melnyk, B. M. (2012). Achieving a High-Reliability Organization Through Implementation of the ARCC Model for Systemwide Sustainability of
Evidence-Based Practice. Nursing Administration Quarterly, 36 (2), 127-135. doi: 10.1097/NAQ.0b013e318249fb6a.
Tayyib, N. , Asiri, M. , Danic, S. , Sahi, S. , Lasafin, J. , Generale, L. , Malubay, A. , Viloria, P. , Palmere, M. , Parbo, A. , Aguilar, K. , Licuanan, P.
& Reyes, M. (2021). The Effectivenessof the SKINCARE Bundle in Preventing Medical-Device Related Pressure Injuries in
Critical Care Units: A Clinical Trial. Advances in Skin & Wound Care, 34 (2), 75-80. doi: 0.1097/01.ASW.0000725184.13678.80.
7 months ago
Chaquita Nichols
RE: Discussion – Week 9
Great post April
Pico(t) is an acronym used by clinicians and researchers for direction to form the bases for a clinical question and better outcome. P-Population, I-Intervention, C-Comparison, O-Outcome, and T-Time. It is said to be the number start of an Evidence-based practice clinical question (Gallagher & Melnyk, 2018). Forming a PICOT question is a great start to begin implementing evidence-based practices. You have your area of focus and a period to get it completed. Once all the research is completed regarding the PICOT question, it can then be implemented into the area of focus. Then the outcomes can be evaluated and if effective it can be applied to other facilities, and if it was not effective, further research can be done. I did not think about that one.
I agree that the campaign strategy is also an effective way to get evidence-based practice information out to others. That would also fall in the poster and oral strategy category because most campaigns have signs and posters to point out some main facts about evidence-based practice information. I do agree with the barrier of people forgetting about the information once the campaign is over, so it is up to the healthcare leaders to keep the information relevant. Melnyk & Fineout-Overholt (2019) noted “Creating a vision, mission, and goals for the organization to include EBP into role expectations and job performance requirements will result in positive outcomes to the organization and patients” (pg. 341).
References
Gallagher, F., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process. Worldviews on Evidence-Based Nursing, 16(6), 422-423. https://doi.org/10.1111/wvn.12408
Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing Practice and Healthcare (4th ed.). Wolters Kluwer.
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 9
You match your presentation to the audience you will be addressing. That is so important. If someone has five minutes, offering an hour presentation will prevent them from attending.
Identifying the content is also very important. Some information presented can be offered in bullet points, while other information needs more explanation. The more abstract the information, the greater the chance that one need more detailed the presentation.
Thanks much for bringing this point forth.
7 months ago
Shontrice Davis
RE: Discussion – Week 9
Hello, April. I enjoyed reading your discussion this week. There are many unintended medical injuries that occur in healthcare facilities. I agree with your idea of implementing a program to help decrease the number of theses occurrences. To add to your strategies, I would use unit-level dissemination. Unit-level is great at making sure that the issue that is being addressed improves the underlying problem (Harvey, Kitson, 2015). However, healthcare facilities would need to put effort into obtaining the interest of staff members. This way they will bet less likely to resist the change. Also, the implementation of evidence-based practice should be specific to each unit (Brownson et al., 2018). Your discussion contained many great strategies that think would be very useful to healthcare facilities.
References
Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: translating science to practice. Oxford University Press
Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.
7 months ago
Adetokunbo Oluwatuyi
RE: Discussion – Week 9
Dissemination Strategies
Evidence-based practice involves the use of research findings in clinical practices and decision-making to improve quality healthcare (Wilson & Austria, 2021). Some strategies that could be used would include using the hospital board and presentations during conferences (Joseph, 2019).
Least Inclined and Problems with Althea Other
I would be least inclined to use the hospital boards because it is less broad and is very limited to a specific set of people. It does not effectively spread information properly compared to the conference presentations. There could be possible problems with getting time to present at a presentation and being able to find a conference where your content would be related to what the conference is about (Lowe, 2022). If you are not the one organizing the conference you could make the organizer aware so you would be able to get time to present your findings. Relating your content to the topic should be easier, as long as the conference is related to healthcare it would not be a problem to relate.
References
Joseph, M. (2019, May 27). Dissemination of evidence based practice project results in nursing. The Nursing Ace. Retrieved April 27, 2022, from https://thenursingace.com/dissemination-of-evidence-based-practice-project-results-in-nursing/
Lowe, J. (2022, February 9). Council post: How to present effectively at conferences. Forbes. Retrieved April 27, 2022, from https://www.forbes.com/sites/forbescoachescouncil/2022/02/09/how-to-present-effectively-at-conferences/?sh=1dda589b152c
Wilson, B., & Austria, M.-J. (2021, February 26). What is Evidence-Based Practice? Retrieved April 27, 2022, from https://accelerate.uofuhealth.utah.edu/improvement/what-is-evidence-based-practice
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 9
7 months ago
Rona Adams
RE: Discussion – Week 9
Main Post–Disseminating Strategies for EBP
Evidence-based practice (EBP) allows credible research to support clinical decisions to better clinical practice outcomes. According to (Melnyk et al., 2016), healthcare professionals who incorporate EBP into their practice can genuinely make a difference and impact their care delivery for patients. Sometimes, it takes many years for the research findings to be translated for the health care setting to positively affect patient care (Melyk et al., 2016). The research information cannot be further investigated unless disseminated; strategic implementation can accomplish this task.
One way to disseminate information can be through grand rounds. It is a significant forum for an evidence-based presentation involving departments or academic settings where practitioners can engage their colleagues on many board topics (Melnyk & Fineholt-Overholt, 2019). The health care professionals can gather to share research and schedule ongoing intervals to discuss in a large audience where feedback is given. The oral presentation given is usually formal through visual slides or video. It was reported that grand rounds are an effective way for health care professionals to interact to address patient care issues by reviewing clinical evidence, discussing patient experiences, and receiving input from experts (Gardener et al., 2010). The barrier that can affect grand rounds is poor attendance from clinicians due to time constraints or a busy work schedule. A solution to engage practitioners and improve attendance is offering internet grand rounds that can be viewed remotely. This will allow the health care professional the opportunity to send emails providing feedback, be a part of the participation in real-time, or review the rounds at a time that best meets their needs (Melnyk & Fineholt-Overholt, 2019). During Covid 19 pandemic, clinicians had limited interactions, and virtual meetings became a new form of communication for conducting meetings or engaging with colleagues.
Another way of disseminating information is by publishing papers either in journals or creating posters; these efforts can be quite time-consuming due to submitting the journal and then awaiting approval for publishing. The published author can reduce the barrier of time constrain by developing a timeline. The benefits of a timeline allow the individual to have a structure to keep them on task to accomplish the goal (Gallagher-Ford et al., 2011). For example, graduate research students must create a timeline to work toward completing their graduate paper; if not, the student could lose valuable time. “Publishing experience can be gained by taking on less ambitious paper projects” (Melnyk & Fineholt-Overholt, 2019). It is essential that the individual publishing the evidence-based paper be an expert in the topic of interest and have relevant information.
The least disseminating strategy I would use is grand rounds because it takes clinicians away from the clinical setting. It takes a lot of time to organize and over the years more healthcare professionals are less interested in attending. Implementing small ground rounds can be more accommodating especially with the increase in health care worker shortage.
References
Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B., & Stillwell, S. (2011). Evidence-based practice, step by step: Implementing an evidence-based practice change. AJN, American Journal of Nursing, 111(3), 54–60. https://doi.org/10.1097/10.1097/01.naj.0000395243.14347.7e
Glenn Gardner, Kaylene Woollett, Naomi Daly, Bronwyn Richardson, Leanne M Aitken,
Innovation in clinical learning for the acute hospital environment: Nursing grand rounds,
Nurse Education Today, Volume 30, Issue 8, 2010, Pages 737-741, https://doi.org/10.1016/j.nedt.2010.01.015.
Li S, Cao M, Zhu X. Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine (Baltimore). 2019 Sep;98(39):e17209. doi: 10.1097/MD.0000000000017209. PMID: 31574830; PMCID: PMC6775415.
Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (Fourth, International ed.). Lippincott Williams and Wilkins.
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. https://doi.org/10.1111/wvn.12188
7 months ago
Britny Ray
RE: Discussion – Week 9
Hey Rona,
I enjoyed reading your post! Evidence based practice has truly helped sculpt the way healthcare is delivered to many patients. When it is supported and delivered correctly, the highest quality of care and best patient outcomes can be achieved (gallagher-ford et.al, 2011). I think the grand rounds strategy would be more successful and effective over th journal. I believe if the grand rounds occurred than you wold know people arelistenng and recieving the information. It is not certain if a journal is published if everyone reads the journal on their time. Also, At best, it usually takes several years to translate research findings into health care settings to improve patent care (melnyk, 2012).
References
Melnyk, B. M. (2012). Achieving a High-Reliability Organization Through Implementation of the ARCC Model for Systemwide Sustainability of Evidence-Based Practice. Nursing Administration Quarterly, 36 (2), 127-135.
Gallagher-Ford, L. , Fineout-Overholt, E. , Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change. AJN, American Journal of Nursing, 111 (3), 54-60.
7 months ago
Rona Adams
RE: Discussion – Week 9
Good evening,
Thank you for your response. In my organization, many grand rounds are conducted online and in person since Covid 19. Yes, the grand rounds provides updated medical information that can be very beneficial to the clinical practice.
Rona
7 months ago
Christina Fisher
RE: Discussion – Week 9
Rona,
The idea of smaller or virtual grand rounds is excellent. You mention that this would allow for attendance remotely; I also think it would allow for the recording of the rounds for others to view; while this would not allow for further questions, it would open the information to more people. Duback (2019) states that attendance “can be increased by leveraging technology and offering education and contact hours via independent study online” (p.108). Opening this up can be used as an educational opportunity for many departments, not just nursing.
Both grand and smaller rounds require additional time and commitment from those sitting on the committee and those in attendance. Peer-reviewed publications, as you mentioned, would be very time-consuming and would lead to a particular audience since once it is published, it must be sought out to be seen by individuals; thus, if the topic is not frequently discussed, it may not be seen by many. Matamoros and Cook (2017) mention that “In addition, multidisciplinary grand rounds serve to recognize the expertise of staff, mentor and support professional development, and provide a collaborative environment across all clinical disciplines and support services” (p.353). The implementation of these rounds can have educational benefits of disseminating EBP and serve as a morale booster for an entire unit.
References:
Duback, K. (2019). Making Pediatric Nursing Grand Rounds More Accessible to Staff Nurses. Journal of Pediatric Nursing, 49, 108. https://doi.org/10.1016/j.pedn.2019.09.010
Matamoros, L., & Cook, M. (2017). A Nurse-Led Innovation in Education: Implementing a Collaborative Multidisciplinary Grand Rounds. JOURNAL OF CONTINUING EDUCATION IN NURSING, 48(8), 353–357. https://doi.org/10.3928/00220124-20170712-06
7 months ago
Britny Ray
RE: Discussion – Week 9
Evidence based practice improves healthcare quality, patient safety, and outcomes, nurses are more empowered to make a difference in their patients care when evidence based practice is utilized (melnyk, 2017). Even
though evidence based practice is very benficial many barriers effect evidence based practice from being it’s best. Many healthcare organizations have implemented to sustain an evidence based practice culture environment
in their organization by using strategies to enforce it (Melnyk, 2017). Evidence based practice improves healthcare quality, patient safety, and outcomes, nurses are more empowered to make a difference in their patients care
when evidence based practice is utilized (melnyk, 2017). Even though evidence based practice is very benficial many barriers effect evidence based practice from being it’s best.
The two strategies I would be most inclined to use is a power point presentation or group meeting. The use of a PowerPoint presentation is beneficial because it allows for the use of different medias in the presentation, can
be exported to many formats for those who wish to have a paper copy, and additionally allows individuals to work together from just about anywhere (Rusu, 2021). The use of a group meeting would allow for one on one
questions and promotes the discussion of the topic amongst the attendees. Barriers that I may encounter using the strategies of PowerPoint presentation and meetings include lack of attendance and possible technical
difficulties. Possible ways to mitigate poor attendance include timing the meeting when most people are available (i.e., right before or right after a shift), setting up in a convenient location, and offering incentive for those that
attend (Berman, 2019). To avoid the possible barrier of a technology malfunction, it would be beneficial to have several paper copies of the presentation so that attendees could still follow along.
The two strategies I would be least likely to use would be email or pamphlets hung in busy areas. Emails are often deleted if the recipient is not specifically looking for the email. Emails are also difficult because they do not
convey the nonverbal cues that would be given in a face-to-face interaction (Vdovin, 2020). Using a pamphlet has several disadvantages including costly printing fees and limited space in which to share information (London,
2019).
References
Berman, J. (2019, September 20). 14 ways to improve attendee turnout. Smart Meetings. Retrieved April 28, 2022, from https://www.smartmeetings.com/tips-tools/how-to/98310/14-ways-improve-attendee-turnout
Rusu, C. (2021, March 24). What are the advantages and disadvatages of PowerPoint. VisualHackers. Retrieved April 28, 2022, from https://visualhackers.com/blog/what-are-the-advantages-and-disadvatages-of-powerpoint/
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. https://doi.org/10.1111/wvn.12188
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 9
You match your presentation to the audience you will be addressing. That is so important. If someone has five minutes, offering an hour presentation will prevent them from attending.
Identifying the content is also very important. Some information presented can be offered in bullet points, while other information needs more explanation. The more abstract the information, the greater the chance that one need more detailed the presentation.
Thanks much for bringing this point forth.
Dr. B.
7 months ago
Memory Rinomhota
RE: Discussion – Week 9
Hi Britny
Thank you for your engaging post. I agree that evidence-based practice is critical in the improvement of patient quality of care, outcomes, and safety (Melnky et al., 2017). One-on-one meetings with people like elected officials can be very effective and have a lasting effect but preparation is important. The challenge is that you have limited time to present your ideas. I agree that meeting during shift change is what many organizations utilize (Brownson et al., 2018). In my facility participation is poor people because staff who work the night shift will be rushing to take kids to school in the morning. People participate more when meetings are scheduled during their days off and paid overtime. It is a true email may end up in junk mail or scam email
References
Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Getting the Word Out: New Approaches for Disseminating Public Health Science. Journal of Public Health Management and Practice: JPHMP, 24(2), 102–111. https://doi.org/10.1097/PHH.0000000000000673
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. https://doi.org/10.1111/wvn.12188
7 months ago
Chaquita Nichols
RE: Discussion – Week 9
I enjoyed reading your post Britny
“Best practice only occurs when staff continually ask questions about treatment and care, have the resources and skills necessary to search for and appraise research evidence, implement the evidence in practice, and evaluate its effectiveness” (Crabtree, E., Brennan, E., Davis, A., & Coyle, A., 2016). I agree that emails and pamphlets are the least effective strategies to use when spreading information about evidence-based practice. Many people lose or throw away pamphlets and many people do not check their emails. I feel that group meetings and presentations can be effective because information discussed in the groups can also be shared with other groups. Melnyk & Fineout-Overholt (2018) noted that sharing information within and outside the organization through presentations and publications supports the growth of EBP, increases nursing knowledge, and encourages change in other organizations” (pg. 395).
References
Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing Practice and Healthcare (4th ed.). Wolters Kluwer.
7 months ago
Christina Fisher
RE: Discussion – Week 9
Britny,
You make some excellent points about the dissemination of EBP. By using the two strategies you chose, you eliminate the concerns of Melnyk et al. (2017) of misunderstanding and consider EBP as time-consuming (p. 5). The PowerPoint presentations and group meetings both offer the ability for clarification in real-time. As you said, handouts can be used to refer to, take notes on, and even be kept by those in attendance for future reference. The use of email and pamphlets doe have their disadvantages, as you mentioned. However, they do provide the ability for the intended audience to access the information at any given time. Talbot et al. (2017) mention that communication, such as email, leads to a disconnect in the information being sent and the understanding of the audience, leading to partial messages that may be misunderstood, which are not conducive to best practice and quality patient care (1302). As nurses, best practices and quality patient care are the most vital in all that we do as nurses.
Thank you,
Christina
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. https://doi.org/10.1111/wvn.12188
Talbott, C., Watson, L., Tariman, J., & Sorenson, M. (2017). “Clinical Chatter”: every nurse informed. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 26(9–10), 1301–1312. https://doi.org/10.1111/jocn.13620
7 months ago
Shirley Harleston
RE: Discussion – Week 9
Evidenced-Based Practice has been described as a problem-solving approach to the delivery of health care. When it’s delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. (Melnyk, et al, 2011).
All facets of the EBP must be included in order for it to be successful. The 3 components that must be present include best practice, clinical expertise, and patient preference and values (Walden, 2018).
Dissemination of EBP is the last step in which outcomes are shared. This could be done through grand rounds, poster presentations, or a published manuscript. (Milner, K.,2021)
Two mechanisms of dissemination of Evidenced-Based Practice (EBP) Material that I would utilize would be ground round presentation and Poster Presentation. The presentation will include a description of the project, objective, data analysis, outcomes, and lessons learned. (Humbles, et al 2019) I would use the ground rounds because it provides a forum to share our best practice and other topics of interest. The event will be planned in advance so that Staff and administration will attend. I would be able to present the information to all involved at the same time and they will hear the same information at the same time. Also, this method is visual and there will be time for questions and answers.
My second preference will be the poster presentation. This is also visual. I believe it would be remembered. Lastly, copies of the posters can be replicated and posted in strategic locations for everyone to see. Both methods are interactive.
A barrier I would encounter with grand rounds is that it requires an event center and one has to be in-person to get the full benefit. To overcome the barrier you can have a zoom grand round. However, the experience will not be the same. A second barrier will be the cost of presenting and preparing the material. I would also need to have others involved to participate in the presentation or at least approve it which might involve a lot of time.
References:
Gallagher-Ford, L. , Fineout-Overholt, E. , Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step by Step: Implementing an Evidence-Based Practice Change. AJN, American Journal of Nursing, 111 (3), 54-60. doi: 10.1097/10.1097/01.NAJ.0000395243.14347.7e.
Humbles, Patricia,PhD., R.N., & Jones, Sylvia, MSN/Ed,R.N., P.H.N. (2019). Faculty and students find a niche in scholarship: Teaching strategies to disseminate scholarly evidence-based practice projects. ABNF Journal, 30(4), 109-112. Retrieved from https://www.proquest.com/scholarly-journals/faculty-students-find-niche-scholarship-teaching/docview/2336263321/se-2?accountid=14872
Milner, K. (2021). Evidence-Based Practice and Dissemination Strategies. Role Development for the Nurse Practitioner, 33.
Walden University, LLC. (Producer). (2018). Evidence-based Decision Making [Video file]. Baltimore, MD: Author.
7 months ago
Kehinde Tade
RE: Discussion -Response 2 Week 9
Hi Shirley,
Thanks for your post,
According to Melnyk and Fineout-Overholt (2018), presentations stimulate the progress of sharing and learning to enhance clinical expertise relating to EBP while reaching a larger audience at one time. The cost of implementing EBP is a critical barrier to the sustainment of EBP (Roundfield & Lang, 2017). However, research on strategies to disseminate and enforce EBP suggests that long-term sustainment rates of EBP are relatively low (Roundfield & Lang, 2017). EBP protocols implemented in healthcare facilities resulting from evidence-based research empower clinicians to deliver high-quality care and eliminate unnecessary spending.
A suggestion to overcome the cost barrier is to develop less complicated EBPs that are simpler to implement and require less training and consultation time (Roundfield & Lang, 2017). Roundfield and Lang (2017) support that a public health approach to improve the quality of care requires balancing the worth of EBPs with the costs needed to implement and sustain. Overall, I enjoyed reading your discussion post.
References
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Roundfield, K. D., & Lang, J. M. (2017). Costs to Community Mental Health Agencies to Sustain an Evidence-Based Practice. Psychiatric services (Washington, D.C.), 68(9), 876–882. https://doi.org/10.1176/appi.ps.201600193
7 months ago
Shirley Harleston
RE: Discussion -Response 2 Week 9
Thank you.
7 months ago
Christina Fisher
RE: Discussion – Week 9
The two dissemination strategies that I would be most inclined to use are unit-level poster presentations and organizational–level presentations. I would use the unit-level posters to reach people on a personal level. While they seem impersonal unit-level information is mainly given to bedside staff. I feel like easy to understand, concise information with the option quickly and easily access further information will attract those who are working long hours. According to Zając and Bała, most EBP is distributed with challenging verbiage and specific jargon not easily understood by those who have not studied the subject (2019). This can be done by adding a statement that grabs their attention and even speaking to them personally. Then provide introductory information that is quick and easy to read. Then provide a QR to access further information about the topic; this will give the staff a quick way to access information further if they so choose; if not, the basic information was conveyed. The placement of these posters is critical. While it seems comical, employee bathrooms are a great place to put information that must be distributed due to the lack of distractions and breakrooms and any other high-traffic areas.
In contrast, I would use organizational presentations to reach a broader range. By addressing an organization, there are many departments present that can interpret the information presented in different ways and implement the information in various practices. A presentation on an organizational level would not be uncommon since those who represent an organization are accustomed to attending presentations and meetings, unlike those working on units. Therefore, they will be better able to attend a presentation without time constraints or the pull to return to patient care.
While these two strategies seem to be the most effective, there are still barriers, such as the misconception that EBP is time-consuming and confusing and the lack of support from the organization’s leaders (Melnyk et al., 2017, p. 5). I could overcome these barriers by making the information clear and easily accessible, getting the organization’s leaders behind the cause, and implementing EBP in their organization’s culture.
I would be least inclined to use podium presentations on any level and publications in peer-reviewed journals. I would not use these dissemination strategies because I feel they are too impersonal and would not lead people to be interested. They would not inspire them to do their research on the topic to further their knowledge. Dean (2021) states that EBP terminology and approach often lead to misunderstanding for those involved in the process (p. 4). Often EBP is portrayed as complex and made for researchers, not nurses. However, if this information is made readily available, it can be better understood and thus implanted and sustained.
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. https://doi.org/10.1111/wvn.12188
Dean, J., Gallagher, F. L., & Connor, L. (2021). Evidence‐Based Practice: A New Dissemination Guide. Worldviews on Evidence-Based Nursing, 18(1), 4–7. https://doi.org/10.1111/wvn.12489
Zając, J. F. & Bała, M. M. (2019). Public media is a tool for the dissemination of evidence-based information. International Journal of Evidence-Based Healthcare, 17 , S32-S33. doi: 10.1097/XEB.0000000000000191.
7 months ago
Tosin Addeh
RE: Discussion – Week 9
Second Student Response
Hello Christina,
Your post was educative and informative to read. I admire your choice of words in expressing your post. In your third paragraph, you said there is a misconception that EBP wastes time. Truthfully, I don’t think that is a misconception because organizational change absorbed staff time and energy, distracting the nurses from their routine (Mathieson et al., 2019). However, this should not stop the growth of the organization. Since such barriers to EBP is a time constraint, a proper avenue should be created to address those areas so that the organization can benefit from EBP implementation. To manage time constraints as an issue with EBP implementation, the organization must understand these, create a supportive culture and leadership, and ensure they are consistent support (Duff et al., 2020).
References
Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020, October 6). Determinants of an evidence-based practice environment: An interpretive description. Implementation
science communications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542098/
Mathieson, A., Grande, G., & Luker, K. (2019, January). Strategies, facilitators and barriers to implementation of evidence-based practice in Community Nursing: A systematic
mixed-studies review and qualitative synthesis. Primary health care research & development. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476399/
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