Case 12
See attached instructions
See attached instructions
In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry. I x page only no title page and include 2 to 3 References.
1. List two dissemination strategies you would be most inclined to use and explain why.
2.Explain which dissemination strategies you would be least inclined to use and explain why.
3. Identify at least two barriers you might encounter when using the dissemination strategies, you are most inclined to use. Be specific and provide examples.
4.Explain how you might overcome the barriers you identified.
Respond to the four colleagues
with preference to colleagues who selected different translation science frameworks or models from the one you chose. Recommend another framework/model they might consider and/or clarify their explanation of translation science. Cite sources to support your posts. PLEASE INCLUDE AT LEAST 2 REFERENCES OF EACH RESPONSE
1 . One of the prominent theories that has been very effective in the incorporation of learned information into action is the Knowledge to Action (KTA) model. Spooner et al. (2018) stated that this model is the conceptual layout recommended to help individuals perturbed by the process of knowledge implementation to evidence-based practice. Knowledge creation and action cycle are the two major parts of the KTA model used to translate the knowledge obtained into clinical settings and the barriers encountered during this process are based on the practice conditions. When the KTA model is utilized one can ascertain that the knowledge obtained is from reliable research with long-lasting outcomes (Spooner et al., 2018).
The ease of translation of knowledge to action is the reason the KTA model is more popular among clinicians. Working in the correctional facility as a Nurse Practitioner, allows me to see a variety of inmates from minor to more serious crimes. Most of these inmates suffer from different mental health disorders including Schizophrenia and Bipolar disorder and their manner of voicing their anger is significant. The complexity and interdisciplinary nature of correctional facilities necessitates a conceptual framework or model to help translate evidence-based information into action. Field et al. (2014) pointed out that the KTA framework was made to address the various complexities utilized in explaining the method of theory implementation into action. Achieving optimal health requires an increase in the quality of healthcare services and products delivered. Kastner and Straus (2012) opined that the information implementation process including synthesis, dispensing, interchange, and effective use is crucial in the advancement of healthcare
Relevancy To my practice
Due to the hierarchy in correctional facilities, working as a Nurse Practitioner in this space can be very demanding as the county sheriff is in charge of operations while the detention officers apply different rules in dealing with inmates with psychiatric illnesses. The “Use of Force” is the most likely used process by detention officers when managing violent and mental health patients and this unsafe practice can lead to injury on both parties. Moreover, utilizing force is dehumanizing, does not promote support, and is not a holistic approach. Although, assessing and stabilizing these types of patients can be tough for healthcare providers due to their presentation, abnormal vital signs, and violence against the care team. Relating the KTA model to my practice issue can be done by incorporating the two parts of the model the knowledge creation and the action cycle. For knowledge creation, pinpointing the “Use of force” as a limitation to the delivery of efficient care to inmates and the action part is the transformation model to dismiss the use of force. This action promotes social support in the setting and the change team consists of sergeants, nurses, nurse practitioners, and several mental health professionals. A specific example of the effective use of the KTA model was highlighted when a bipolar patient was accompanied to the clinic due to a psychotic episode. The patient had refused to respond to the officer's question during intake and was identified as a high risk for suicidal ideation/attempt. While the suicidal process was being implemented the patient became violent and aggressive. The change team took over the situation and incorporated the “action cycle” of the KTA model by leading the inmate to a quiet area and reassuring him of his safety. This deed by changing them caused the patient to become compliant with his admission and provided willingly all the needed information for the process. Horesh and brown (2020) emphasized that there is an imminent need to close the disparaging gaps in care delivery in major areas as the care team addresses the barriers and creates innovative ways to support individuals in need.
2 . The translation science framework/model I chose is the Iowa model for Evidence-based Practice framework because of the detailed algorithm. The Iowa Model algorithm is user-friendly and straightforward, guiding nurses to use research to improve care. The Iowa Model centers around complete organizational support for transitioning current practices with top priority triggers to current evidence-based practice. The model is designed as a pilot test instead of an instant practice change. The process begins with stating the trigger or purpose identified. The process then determines if it is a priority; once established as a priority, the next step is addressed. This step includes appraising and analyzing the evidence and determining if there is sufficient evidence. If the answer is yes to the sufficient evidence question, the design of the pilot is developed. Once the pilot is appropriate for a change in practice, the change is implemented.
An example of a trigger appropriate for the Iowa Model use is the change in practice for pressure ulcers. The organization accepts pressure ulcers as a top priority. The next step is evidence-based practice research and determining if the information is substantial. Once evidence is validated as appropriate, the design pilot integrating pressure ulcer preventative equipment is developed. Once approved, the pilot is evaluated again for appropriateness and implemented into practice. In conclusion, I chose this model because of the straightforward algorithm.
3 : The integration of evidenced-based strategies into practice can be challenging, especially in behavioral health. Knowledge translation frameworks provide a systematic approach for translating knowledge into practice, which promotes and sustains practice change (White et al., 2019). The knowledge-to-action (KTA) framework is one of the most popular conceptual frameworks used in healthcare settings to support the implementation of evidence-based practice (White et al., 2019). The framework incorporates existing change theories from health, social sciences, education, and management fields to provide user-friendly action phases to consider during the knowledge translation process.
The KTA framework comprises two components: knowledge creation and action. Knowledge creation is the production of knowledge and consists of three phases: knowledge inquiry, knowledge synthesis, and creation of knowledge for best practice (Davison et al., 2015). The Action component guides the implementation process for change and sustainability consisting of the following phases: identify the problem; adapt knowledge to the local context; assess barriers to knowledge use; select, tailor, and implement interventions; monitor knowledge use; evaluate outcomes; and sustain knowledge use (Davison et al., 2015).
The practice problem that I am looking to address issues facing mental healthcare that negatively affect access to mental health services (Andrade et al., 2014). Inequalities in health and social circumstances perpetuate social and economic exclusion that leads to unequal access to health and its determinants (Marmot et al., 2008). The utilization of the KTA model allows us to critically examine and support the move towards health equity by addressing the causes of health inequities in addition to acknowledging the gap between knowledge and action to improve health equity.
4.The Knowledge to Action (KTA) framework is a prominent concept that emphasizes translating research findings into practical therapeutic applications. The primary objective of this strategy is to prioritize evidence-based interventions, particularly in contexts where the effective dissemination of knowledge is of utmost importance (Spooner et al., 2018). The KTA framework is primarily centered around two fundamental processes: generating and disseminating knowledge, followed by its practical implementation. The applicability of this paradigm is contingent upon the specific characteristics of the context. Nevertheless, its primary objective is establishing long-term treatments grounded in rigorous research (Spooner et al., 2018).
Within the domain of critical care nursing, the interplay between generating knowledge and implementing practical insights holds immense value. Critical care units manage many situations, encompassing life-threatening disorders and post-operative care. The intricate and interdisciplinary character of critical care environments necessitates the development of a systematic framework that integrates evidence-based ideas into tangible interventions. Field et al. (2014) acknowledge that the KTA framework is appropriately structured to manage the complexities associated with knowledge translation effectively. To improve patient outcomes and the healthcare system, engaging in successful knowledge translation is crucial, which involves the ethical sharing and application of research findings (Kastner & Straus, 2012).
Application In My Practice
Managing the difficulties encountered in a critical care environment is inherently arduous. In this context, the potential consequences are significant, and the implementation of therapies based on timely and evidence-based practices can determine the outcome between survival and mortality. For example, the selection of ventilation systems, sepsis management approaches, and hemodynamic monitoring techniques necessitates a foundation in empirical research while also considering the unique requirements of each patient.
The KTA model, comprising the elements of “Learning Paths” and “Action Cycle,” provides a framework for implementing evidence-based practice in the critical care setting. During the initial stage of learning, it is imperative to find optimal methods or standards tailored to specific medical diseases such as acute respiratory distress syndrome (ARDS) or septic shock. In contrast, the “action” step involves the customization and execution of these optimal methodologies by individual patient circumstances.
Let us contemplate a hypothetical situation when a patient afflicted with septic shock exhibits an inadequate response to the initial administration of fluids for resuscitation purposes. By employing the Knowledge-to-Action (KTA) paradigm, a critical care nurse can effectively incorporate current research about initiating vasopressors. This approach allows for the adjustment of interventions based on empirical evidence while also considering the specific circumstances of the individual patient. The need for knowledge translation is heightened in healthcare teams as they confront increasing difficulties, particularly in high-pressure settings such as critical care units, where adherence to evidence-based treatment is crucial (Horesh & Brown, 2020).
It is challenging to engage in meaningful discussions with patients when moral and ethical dilemmas present themselves.
How we engage with our patients can have a profound impact on the care they receive and the decisions they make.
The following exercise will present you with moral and ethical dilemmas common to many clinical practices. The moral and ethical challenges here are often ones the practitioner will have strong, personal feelings about.
Your task in this exercise is to serve as the practitioner advocate for the patient by engaging in dialog that does not project personal bias or prejudice while also providing the patient with the medical information needed to make an informed, personal decision. As you choose your responses, try to use one of the ethical decision-making models we’ve explored to systematically evaluate each dilemma and choose the best way to engage the patient in dialog.
https://webapps.srm-app.net/CanvasContent/SF/WCU_NURS_521_DE_TEMPLATE/Case_Study/Conducting%20Moral%20and%20Ethical%20Dialog%20in%20Clinical%20Practice/story_html5.html
The following questions refer to your experience in this week’s exercise, Conducting Moral and Ethical Dialog in Clinical Practice. Describe your overall experience with the moral and ethical dialog exercise, and address at least three (3) of the following:
For this assessment, use the context of the organization where you conducted your interview to develop a viable plan for an interdisciplinary team to address the issue you identified. Define a specific patient or organizational outcome or objective based on the information gathered in your interview.
The goal of this assessment is to clearly lay out the improvement objective for your planned interdisciplinary intervention of the issue you identified. Additionally, be sure to further build on the leadership, change, and collaboration research you completed in the previous assessment. Look for specific, real-world ways in which those strategies and best practices could be applied to encourage buy-in for the plan or facilitate the implementation of the plan for the best possible outcome.
Using the Interdisciplinary Plan Proposal Template [DOCX] Download Interdisciplinary Plan Proposal Template [DOCX]will help you stay organized and concise. As you complete each section of the template, make sure you apply APA format to in-text citations for the evidence and best practices that inform your plan, as well as the reference list at the end.
Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.
Discussion
Purpose
Discuss barriers to practice as an APN in one’s state from both a state and national perspective. Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups.
Preparing the Discussion
Using the readings from this week as well as reliable outside resources to:
1. Identify and describe practice barriers for all four APNs' roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
2. Identify forms of competition on the state and national level that interfere with APNs' ability to practice independently.
3. Identify the specific lawmakers by name at the state level (i.e., key members of the state's legislative branch and executive branch of government)
4. Discuss interest groups that exist at the state and national levels that influence APN policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
6. A scholarly resource must be used for EACH discussion question each week.
In APA format and at least three pages, answer the following questions:
What do you feel are the greatest influences on clinical judgment? Is it experience, knowledge, or a combination of those things?
In your opinion, what part does intuition play in clinical judgment? How do you think you'll be able to develop nursing intuition?
please see attached
Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post
——You don't have to post this in APA format necessarily, it's just giving feedback to the student .
Here, in the state of Florida, one of the main barriers was the clause that nurse practitioners must work on the sponsorship of a physician or within close proximity of a physician. That has been relaxed by legislation that says only nurse can work in most sectors of healthcare, without oversight of a physician, this allows APRNs autonomy in a medspa, primary care clinics and/or even telemedicine when working independently and as an entrepreneur.
Since June of 2020, Florida operates under “Full practice”policy, which allows nurses that have proof of at least 3000 clinical hours of experience and graduate level pharmacology and differential diagnosis courses, the privilege to operate autonomously in primary care, med spas and even telemedicine under this regulation. This is considered to be the gold standard as APRNs are now able to register as an Autonomous Advanced Practice Registered Nurse and practice to the full extent of their role (Fla. BON, 2023)
With just just three short years ago, APRNs had to work under the supervision or sponsorship of a physician that was either either working in the practice or had a vested interest in a clinic where the APRN is practicing. Some states may also hold a prescriptive regulation or the APRN whereas they can only order certain schedules and medications. In some instances there may be pushback from physicians who do not co-sign the concept of nurse practitioners and or having the privileges that they are allowed believing that they are not trained like physicians. In some communities nurse practitioners may not be a choice of patients to be examined by and may just prefer their doctor instead.
For midwives in Florida, some of the barriers include the need to have a supervisory agreement with a Florida licensed physician for post graduate supervisory hours A lack of recognition as primary care providers on Medicaid and Medicare and private insurance company provider panels and other restrictions. (Hastings, et al, 2018)
CRNAs have barriers such a lack of fair reimbursement by third-party, payers, stating that they are not trained on the same skill level as physicians and failure of some of the other surgical groups or colleagues to recognize CRNAs as board certified to administer anesthesia. (Toney, 2023)
Rep. Cary Pigman (R-Sebring) and Sen. Jeff Brandes (R-St. Petersburg) joined members of the interest groups for APRNs the Florida Association of Nurse Anesthetists (https://www.fana.org/)and the Florida Nurse Practitioner Network (https://fnpn.enpnetwork.com/) in making new legislation that forwards, the causes nurse practitioners and pushes for more independence for them as well.
References
Toney-Butler TJ, Martin RL. Florida Nurse Practice Act Laws and Rules. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Hastings-Tolsma M, Foster SW, Brucker MC, Nodine P, Burpo R, Camune B, Griggs J, Callahan TJ. Nature and scope of certified nurse-midwifery practice: A workforce study. J Clin Nurs. 2018 Nov;27(21-22):4000-4017. doi: 10.1111/jocn.14489. Epub 2018 Jun 20. PMID: 29679403; PMCID: PMC7992184.