Doi:0.1097/01.nna.0000302384.91366.8f

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Respond to at least two of your colleagues by offering additional ideas to overcome the barriers to strategies suggested by your colleagues and/or by offering additional ideas to facilitate dissemination.
1) POST BY JEN AVI
Dissemination Strategies
Evidence-based practice should be at the core of every medical professional. One way to ensure others on the interprofessional team are all practicing evidence-based medicine is by knowledge sharing. Purtle and others (2020) explain that dissemination strategies are approaches to spreading information about evidence-based research findings to help focus on an intervention or process change. Choosing the most appropriate strategy to distribute information about evidence-based policy changes is essential and can vary from workplace to workplace.
Strategies to Use and Avoid
One of the dissemination strategies I would most likely use in my workplace is staff meetings and unit in-services, as suggested by Melnyk and Fineout-Overholt (2018). I would choose this because meeting in person allows people to be more active in the presentation and be able to ask questions in real-time. Melnyk and others (2011) suggest the idea of having EBP mentors to help spread knowledge. The second strategy I would be most likely to use. During technological system advances at my work, super-users were often more knowledgeable about the programs being implemented. This shows how EBP mentors could make staff more comfortable during practice changes.
The least likely dissemination strategies I would use are social media and fliers. Fliers do serve a purpose in spreading information. However, there are limited ways to ensure people read and comprehend the material presented. Although social media is a common strategy used in today’s world, in my work environment, the use of social media has been misconstrued at times. When using online dissemination strategies, one must know that things may be read differently or overlooked altogether. For this reason, if I were spreading evidence-based practice, I would choose to use in-person techniques.
Barriers and How to Overcome Them
It is crucial to anticipate barriers that can arise when implementing EBP changes. One barrier that may impact the staff meeting strategy is being unable to get all the staff together for meetings. A possible way to overcome this barrier is by offering multiple meeting times and even an option to call in securely. The second barrier that may impact the EBP mentor strategy is the selected staff not having time for the extra work. To overcome this barrier, an ample number of mentors would be needed to sustain at least one mentor per shift for the implementation phase. Additionally, as Melnyk and others (2011) suggested, to ensure all staff receives training, someone is designated to track down people who missed information to deliver education.
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.
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. https://doi.org/10.1097/01.naj.0000405063.97774.0e.
Purtle, J., Nelson, K. L., Bruns, E. J., & Hoagwood, K. E. (2011). Dissemination strategies to accelerate the policy impact of children’s mental health services research. Psychiatric Services, 71(11), 1170-1178. https://doi.org/10.1176/appi.ps.201900527.
2) POST BY EUCH IBE
Main Post
Introduction
The teaching of EBP can and should be accomplished with multiple strategies, including continuing education conferences with skills-building activities; interactive workshops; and dissemination of educational materials, such as journal articles, textbooks, and informational handouts. In this discussion, I will elaborate on the strategies with the barriers to disseminating my intervention from my PICOT question, “How will patients with mental illness benefit from peer support intervention versus non-peer support groups to improve general or mental health recovery and prevent frequent acute care readmission or emergency room visits.” According to the PICOT acronym for the elements of the clinical question: my patient population (P) are Patients with mental illness, intervention (I) is peer support, comparison intervention (C) is non-peer support, outcome(s) (O) is to improve general or mental health recovery and prevent frequent acute care readmission or emergency room visits, and time it takes for the intervention to achieve the outcome(s) (T) is excluded in this discussion (Melnyk & Fineout-Overholt, 2018).
The dissemination strategies
To begin with, one of the findings from my research in my previous assignments is that the deterioration of individuals with mental illness/disorders is partly attributable to poor healthcare and lifestyle habits. In addition, it largely results from taking psychoactive medications, disparities in the healthcare system, and other factors associated with clinicians (e.g., knowledge deficit with EBP and scarcity). However, peer support is one of the right interventions and evidence-based practices to support individuals with mental illness/disorders, especially the vulnerable (i.e., homeless, children, people from low socio-economic countries, women, Autism Spectrum Disorder, and Health Care Workers) to decrease the high rate of mental illness and improve general or mental health recovery, prevent frequent acute care readmission, and enhance life expectancy if adequately applied to create a better society (Muralidharan et al., 2021).
Before starting the dissemination process in my organization, I will begin with forming an EBP team while seeking administrative support to develop a protocol to roll out this evidence-based finding, together with many other considerations such as organizational readiness; clinician willingness; and weighing of all the costs, benefits, and outcomes prudently. After the team is formed, I will use the following strategies to disseminate my intervention (Peer support) (Melnyk et al., 2011).
First, the EBP team will schedule a series of in-service presentations using posters/handouts/emails, and webinars with attendee database tracking throughout my organization to introduce the new protocol/policy. We will rotate the days and times of this in-service to capture as many direct-care clinicians as possible.
Second, we will train and appoint a volunteer to deliver the presentation to any clinicians that missed EBP team presentations. However, this volunteer can be compensated with an award of a one-time monetary value or vacation or time off, or free meals. The voluntary process provided the time needed for these individuals to develop advanced EBP skills to prepare them to lead EBP initiatives at the unit, functional unit, and hospital levels.
Further the line, we will emulate the ARCC Model for System-Wide Implementation and Sustainability of EBP ARCC (Advancing Research and Clinical Practice Through Close Collaboration) because it is the key strategy to sustain evidence-based care in the presence of an EBP mentor (a clinician with advanced knowledge of EBP, mentorship, and individual as well as organizational change) (Melnyk et al., 2011).
Finally, the least dissemination strategy I will use is in-service presentations using handouts and emails because some people do not pay attention to their emails. They either scroll down without reading or delete the mail, presuming that it is junk mail, or mark it as read to not see those highlights as “not read.” On the other hand, handouts can easily be left floating on the desks or shredded or thrown in garbage cans with no one interested in reading and understanding the pamphlets.
Barriers that might be encountered when using dissemination strategies.
Inadequate EBP knowledge and skills of clinicians.
Misperceptions that EBP takes too much time.
Organizational culture and politics.
Lack of support from nurse leaders and managers.
Inadequate resources and investment in EBP (Melnyk et al., 2017).
One key strategy for improving the quality of care is implementing evidence-based practice (EBP) to elaborate more on two of the above barriers. First, EBP does not take too much time, as perceived by some people; rather, it decreases hospital costs and improves patient outcomes if accepted and implemented well, as learned throughout our learning/research in this course (Melnyk et al., 2017).
On the other hand, nurses’ schedules needed to accommodate time away from clinical responsibilities for initial training and later to complete the EBP process. Nurses or other clinicians might find it difficult to attend the EBP team presentations due to time constraints with being involved in EBP presentations, patients care, and other responsibilities (Family). I have been in a webinar presentation in my organization, passing medications at the time and calling rapid response on one of my patients experiencing TIA (Transient Ischemic attack). However, I did not know or understand the topic, or anything presented in the webinar, but I was marked as an attendee. So, I received my award because I participated as assigned by logging in to the webinar.
Another example is Organizational culture, like the saying, “This is how we do it here, and it works,” with no evidence to suggest that it works. Some staff/nurses are always resistant to any change, and it does not matter if it is EBP. They want to keep to their old habits because they are very comfortable. No openness to new ideas/EBP. I have worked with a nurse that told me that the nurses on their unit do not give medications to the patient even when asked if they do not see any physical sign (grimacing or grunting) that the patient is in pain because most of their long-term patients are drug addicts and will do anything to take pain medications. So, she told me to stop giving them pain medications when they asked because they were not in pain. I tried to educate her on pain assessment tools and other evidence that people from different cultures experience pain differently. She became adamant and said, “this is how we do it here, and it is working.”
Overcoming the barriers as outlined above.
Effective communication and transdisciplinary teamwork.
Equipping clinicians with the knowledge/education and skills needed to attain the EBP competencies and consistently implement evidence-based care. Therefore, Evidence-based interventions also improve the standardization of care and decrease variation.
Improvement of systems design includes using checklists, decreasing interruptions, preventing fatigue, avoiding task saturation, reducing clinician stress, and improving environmental conditions.
Developing organizational cultures/administration, including leaders and managers who model important behaviors related to EBP that support evidence-based delivery where a clinician can question the evidence behind the care they provide and never settle for the status quo.
By supporting mentors skilled in EBP and HRHO (High-reliability health care organizations) concepts, clinicians with access to EBP mentors can play a key role in implementing EBP and care (Melnyk, 2012)
Conclusion
According to Melnyk et al. 2017, It is well known that evidence-based practice (EBP) improves healthcare quality, safety, and patient outcomes as well as promotes clinicians’ active engagement in their practices. Also, Nurses who use an evidence-based approach to care and practice in cultures that support EBP are more empowered as they can make a difference in the care of their patients. Finally, the presence of EBP mentors and champions administrative support Clinicians’ beliefs about the value of EBP and the ability to implement the EBP process as narrated above and outlined in the diagram below. As elaborated in the introductory part, Peer support is a well-supported intervention that will improve general or mental health recovery and prevent frequent acute care readmission or emergency room visits for vulnerable individuals suffering from mental health/disorders.
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. Doi: 10.1097/NAQ.0b013e318249fb6a.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
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. AJN, American Journal of Nursing, 111 (9), 57-60. doi: 10.1097/01.NAJ.0000405063.97774.0e.
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
Muralidharan, A., Peeples, A. D., Hack, S. M., Fortuna, K. L., Klingaman, E. A., Stahl, N. F., Phalen, P., Lucksted, A., & Goldberg, R. W. (2021). Peer and Non-Peer Co-Facilitation of a Health and Wellness Intervention for Adults with Serious Mental Illness. Psychiatric Quarterly, 92(2), 431–442. https://doi.org/10.1007/s11126-020-09818-2
Learning Resources
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 10, “The Role of Outcomes on Evidence-based Quality Improvement and enhancing and Evaluating Practice Changes” (pp. 293–312)
Chapter 12, “Leadership Strategies for Creating and Sustaining Evidence-based Practice Organizations” (pp. 328–343)
Chapter 14, “Models to Guide Implementation and Sustainability of Evidence-based Practice” (pp. 378–427)
Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. & Stillwell, S.B. (2011). Evidence-based practice step-by-step: Implementing an evidence-based practice change. American Journal of Nursing, 111(3), 54-60.
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), 552–557. doi:0.1097/01.NNA.0000302384.91366.8f
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
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
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

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