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.

1.            The first step in the dissemination process is identifying stakeholders. Once stakeholders have been identified, you must build a rapport before presenting your information (Gllagher-Ford et al., 2011). You then need to plan how you are going to engage stakeholders and how you will deliver the information to them.

            Dissemination strategies require clearly defined goals, sources, and audiences (Crable et al., 2023). Strategies that best suit me are a mixture of traditional and social media. For traditional, I would like to create a PowerPoint to present to stakeholders. For social media, I could create a social media platform to raise awareness on the topic being discussed. I chose PowerPoint because they are typically easy for everyone to follow, and it can be printed so stakeholders can take notes during the presentation if they would like. I chose a social media platform because social media allows information to be delivered rapidly to a large group of people (Bhatt et al., 2021).

            Barriers that may be encountered while using PowerPoint to disseminate evidence-based practice are having a computer and a projector to show the information, and depending on where you are presenting, this may not be available. To overcome this barrier, I would go to the site before the presentation and scope out the resources that I may need to bring with me to the presentation. Despite being widely used, stakeholders may have differing opinions on using social media to spread information about their organization.  I would talk with stakeholders beforehand and learn their opinions on the use of social media. It may be that they are okay with using social media, just that there are certain things they do not want to be shared about their organization. Talking with them beforehand would allow me to use social media and respect their opinions.

Bhatt, N. R., Czarniecki, S. W., Borgmann, H., van Oort, I. M.,Esperto, F., Pradere, B., van Gurp, M., Bloemberg, J., Darraugh, J., Roupret, M., Loeb, S., N’Dow, J., Ribal, M. J., & Giannarini, G. (2021). A Systematic Review of the Use of Social Media for Dissemination of Clinical Practice Guidelines. European Urology Focus, 7(5), 1195–1204. https://doi.org/10.1016/j.euf.2020.10.008

Erika L. Crable, Colleen M. Grogan, Jonathan Purtle, Scott C. Roesch, & Gregory A. Aarons. (2023). Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implementation Science Communications, 4(1), 1–14. https://doi.org/10.1186/s43058-023-00396-5

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. &  Stillwell, S.B. (2011). Evidence-based practice step-by-step:  Implementing an evidence-based practice changeLinks to an external site.. American Journal of Nursing, 111(3), 54-60

2. To disseminate EBP, I would be most likely to use posters and social media. Posters are versatile and can help merge the strengths of oral presentations and published works (White et al., 2021, p. 257) Depending on where information is disseminated, presenters can verbally present information while having a visual aid for passersby. One barrier to poster use would be choosing what information to present with limited space. There are certain standards for research posters, but with an EBP project, the presenter may have control over fonts and colors to make it visually appealing. Posters also give presenters the option to interact with interested parties. They can add anecdotes and personality to the poster. While listeners may not remember all the information on the poster, they are much more likely to remember a funny story or a smiling face.  My second choice of dissemination would be social media. There are several nuances to using social media and navigating and not being in control of how information is received and redistributed can be a barrier, but it is undoubtedly the most timely and cost-effective way to reach vast and diverse audiences. Posts/tweets, online newsletters, and blogs are all possibilities for distributing information. It may not be the best way to present lots of statistics and technical information, but it can be used to start discussions and help people engage with research (Lord et al., 2019). It also allows the public to be aware of new advancements. Social media can be used to divulge high points and digestible information and offer to link full studies for those interested. Social media is also immediate making it a timelier option. The method I would be least inclined to use is journal publications. Every journal has specific formats for the articles they publish. If my goal is to get published, my reporting and organization methods would need to reflect those standards. Manuscripts are permanent once published. They can be updated or debunked but, like social media, there will always be proof of it. The biggest barrier to manuscripts is the length of time it takes from the study to publication. As we see, healthcare moves fast, and best practices are constantly changing. It may take years to research, complete the study/project, and make all revisions necessary to get published. By then, the research may be obsolete. This is a universal problem but as a DNP, the focus is improving the practice of nursing. That is not possible to do with outdated information. While it is important that research reaches wide audiences, it is my philosophy to personally connect with nurses working directly with patients to improve nursing practice at the patient-facing level. It’s imperative that those nurses be included in quality improvement efforts to ensure that new protocols are feasible and create better workflows (Siedlecki, 2023). 

References 

Lord, S. E., Seavey, K. M., Oren, S. D., Budney, A. J., & Marsch, L. A. (2019). Digital presence of a research center as a research dissemination platform: Reach and resources. JMIR Mental Health, 6(4), e11686. https://doi.org/10.2196/11686 

Siedlecki, S. L. (2023). Translational science. Clinical Nurse Specialist, 37(2), 54–57. https://doi.org/10.1097/nur.0000000000000728 

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2021). Translation of evidence into nursing and healthcare (3rd ed., pp. 255–268). Springer Publishing Company. 

THE ASSIGNMENT: 5 PAGES

Examine 
Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

· Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1 (1 page)

· Which decision did you select?

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

· Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).

· Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

· Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Decision Point One

Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

·
 Client returns to clinic in four weeks

·
 Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection

·
 Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)

·
 Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned

Decision Point Two

Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety

RESULTS OF DECISION POINT TWO

·
 Client returns to clinic in four weeks

·
 Mrs. Perez reports that when she first received the Valium, it helped her tremendously. She states “I was like a new person. This is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her Valium early

·
 She is asking today for an increase the Valium dose or frequency

Decision Point Three

Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At that point, you would need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

The purpose of this assignment is to create a poster that will present the visual and graphic presentation of the capstone project. Poster presentation should clearly articulate what you did, how you did it, why you did it, and what it contributes to your field and the larger field of human knowledge. This assignment is due in week seven and must be presented by the student.

Create your poster per guidance and approval from your capstone course faculty (template provided above). Follow the poster template as outlined and review the recommended resources in creating your poster.

What goals should you keep in mind to construct a poster?

• Clarity of content. Decide on a small number of key points that you want your viewers to take away from your presentation, and articulate those ideas clearly and concisely.
• Visual interest and accessibility. The viewers should notice and take interest in your poster so that they will pause to learn more about your project, and you will need the poster’s design to present your research in a way that is easy for those viewers to make easy sense of it.

From the capstone project, students will create an effective poster with the following information:

Title: ( the influence of nursing leadership on nurse retention ) 

Authors: Your name, faculty advisor’s name

Background/Significance

Purpose or Aims of the Study

Methods/Design

Expected Results/Outcomes

Anticipated Conclusions

Potential Implications to Practice

Acknowledgements

Contact person: include email address

Expectations

• Length: One page
• Format: Poster Presentation
• Research: At least one peer reviewed reference within the last 5 years

 

This Soap Note Case Study it shoudl be in  (iron deficiency anemia diseases)

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.