ENABLERS AND BARRIERS TO TRANSLATION
There are many hurdles to overcome when it comes to the translation of evidence into practice. As noted in White et al. (2024), of all the identified evidence, only about half of it is ever actually put into practice. Thus, being able to detect the potential enablers and barriers that you may encounter when implementing an EBP initiative is critical to your success. For this Discussion, you will draw on your professional experience in healthcare settings to consider specific enablers and barriers to evidence-based practice (EBP) quality improvement (QI) initiatives.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
· White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2024).
Translation of evidence into nursing and healthcare (4th ed.). Springer.
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· Chapter 13, “Teamwork for Translation” (pp. 257–270)
· Chapter 14, “Barriers and Facilitators to Translation” (pp. 270–280)
Note: Read one or more of the following exemplars based on the focus of your Discussion post:
· Chapter 18, “Acute Care Exemplars” (pp. 315–355)
· Chapter 19, “Primary Care Exemplars” (pp. 356–379)
· Chapter 20, “Certified Registered Nurse Anesthetists Exemplars” (pp. 391–417)
· Chapter 21, “Health Systems Exemplars” (pp.417–458)
· Chapter 22, “Team Projects Exemplars” (pp. 461–500)
· Cane, J., O’Connor, D., & Michie, S. (2012).
Validation of the theoretical domains framework for use in behaviour change and implementation scienceLinks to an external site..
Implementation Science.
To Prepare
· Review the Week 7 Learning Resources. Pay particular attention to the theories and best practice recommendations related to enablers and barriers to translating and applying evidence in support of practice or organization change initiatives.
· Select an organization and a practice or organization issue within that organization. Consider evidence-based practice (EBP) quality improvement (QI) initiatives to address the issue.
· Select
one evidence-based practice (EBP) quality improvement (QI) initiative on which to focus for this Discussion.
Note: You may reuse an initiative you selected earlier in this course or select a new one.
· Think about the kinds of
enablers you might encounter when translating and applying evidence for the evidence-based practice (EBP) quality improvement (QI) initiative you selected.
· Think about the kinds of
barriers you might encounter when translating and applying evidence for the evidence-based practice (EBP) quality improvement (QI) initiative you selected.
· Consider the ways in which you might address the barriers you identified.
By Day 3 Of Week 7
Post the following:
· Identify the organization you selected.
· Describe the practice or organization issue you selected.
· Describe the evidence-based practice (EBP) quality improvement (QI) initiative you selected to address the issue.
· Describe the types of
enablers that you might encounter when translating and applying evidence for the evidence-based practice (EBP) quality improvement (QI) initiative. Be specific and explain how enablers can benefit the project.
· Describe the types of
barriers that you might encounter when translating and applying evidence for the evidence-based practice (EBP) quality improvement (QI) initiative. Be specific and explain how barriers may challenge the project.
· Explain how, as a DNP-prepared nurse, you would address the barriers you identified. Be specific and describe specific approaches to address each barrier.
Note: Your posts should be substantial , supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful post but cannot stand alone as the entire post.
Read a selection of your colleagues’ posts.
By Day 6 of Week 7
Respond to at least
two of your colleagues, on different days, by suggesting additional approaches to address the barriers they identified. Be specific and cite sources to support your recommendations.
Note: Your responses to colleagues should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or adding a fresh viewpoint and be constructive, enhancing the learning experience for all students.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you have learned and/or any insights that you have gained because of your colleagues’ comments.
RESPOND TO THIS DISCUSSION POST
PRIN
Organization: Correctional Facility
Practice or Organization Issue:
The issue I have selected is the high prevalence of chronic disease management, particularly for
patients with diabetes. Inmates often have multiple health conditions, including diabetes, hypertension, and mental health issues, which are poorly managed due to inconsistent access to care, lack of patient education, and limited follow-up. This issue leads to frequent emergency department visits, complications, and poor quality of life for the inmates. The correctional healthcare system faces unique challenges in managing chronic diseases, such as limited resources, security concerns, and high patient turnover, making it even more difficult to effectively manage these conditions (Fazel & Luntamo, 2019; O’Donnell & Wicks, 2020).
Evidence-Based Practice (EBP) Quality Improvement (QI) Initiative:
The EBP quality improvement initiative I would focus on is implementing a structured diabetes management program that incorporates patient education, regular monitoring, and telemedicine follow-up where feasible. This initiative would aim to improve diabetes management within the facility by increasing inmate knowledge of diabetes self-management techniques, improving adherence to medication regimens, and enhancing communication between inmates and healthcare providers through telemedicine, if available. The goal is to reduce the complications associated with diabetes, such as diabetic neuropathy, retinopathy, and cardiovascular disease, as well as to decrease emergency room visits and improve overall inmate health outcomes (Miller et al., 2018). Research shows that structured diabetes management programs that emphasize self-care, education, and continuous monitoring can significantly improve glycemic control and reduce complications for patients, even in correctional settings. Integrating telemedicine would allow for better monitoring of inmates’ health while overcoming some logistical challenges inherent in a correctional facility, such as transportation barriers or security concerns that may limit access to in-person follow-up care (Alper et al., 2019; Guo et al., 2020).
Types of Enablers:
1.
Institutional Support: A key enabler for the implementation of the diabetes management program is the support of facility leadership and correctional administrators. If the facility’s leadership understands the long-term cost savings and health improvements associated with better chronic disease management, they may be more willing to allocate resources for the program. For example, they may allow funding for training, secure telemedicine systems, and diabetes management tools, such as glucometers and insulin pumps (Reed et al., 2020).
2.
Multidisciplinary Team Collaboration: The involvement of a multidisciplinary team including physicians, nurses, dietitians, and mental health professionals would also facilitate the success of this initiative. Inmates often have complex needs that require coordinated care. A collaborative team approach can enhance communication and create a comprehensive care plan that addresses not only the physical aspects of diabetes but also any underlying mental health conditions or substance use disorders that may be complicating diabetes management (Tait & Yapa, 2021).
3.
Telemedicine Infrastructure: The availability of telemedicine technology can be a powerful enabler. In many correctional facilities, video conferencing systems, and other communication technologies are already in use for legal proceedings, which could be adapted for healthcare purposes. Telemedicine would allow healthcare providers to offer virtual consultations, discuss treatment plans, and monitor blood glucose levels remotely, reducing the need for inmates to be transported to outside facilities (Gupta et al., 2020).
Types of Barriers:
1.
Limited Resources and Budget Constraints: A major barrier in correctional facilities is the lack of financial resources to support such initiatives. Implementing a diabetes management program would require funding for patient education materials, medical equipment, technology infrastructure for telemedicine, and possibly additional staff or training. Correctional healthcare budgets are often tight, and there may be competition for limited resources (Fazel & Luntamo, 2019).
2.
Inmate Non-Compliance: Non-compliance with medical regimens is a common issue in correctional facilities. Inmates may be unwilling to follow through with prescribed treatments, medication regimens, or lifestyle changes due to a variety of factors, such as a lack of understanding, mental health conditions, or distrust of healthcare providers. Additionally, some inmates may not prioritize their health the way they would if they were living in the community (Alper et al., 2019).
3.
Security and Logistical Challenges: Correctional facilities have strict security protocols that may create logistical barriers to implementing a quality improvement initiative. For example, allowing inmates to have access to telemedicine equipment or to participate in a structured program may require additional staff time for supervision or may raise concerns regarding security and confidentiality. Ensuring that the program fits within the security and logistical constraints of the facility is crucial (Reed et al., 2020).
4.
Staff Resistance to Change: Resistance from staff members who are already overburdened with their existing duties can be another barrier. Some healthcare workers may be hesitant to adopt new processes or workflows, especially if they perceive the new program as an additional burden. This could delay the implementation of the initiative or impact its overall effectiveness (Miller et al., 2018).
Addressing the Barriers as a DNP-Prepared Nurse:
1.
Addressing Limited Resources and Budget Constraints: As a DNP-prepared nurse, I would work closely with facility leadership to present a well-researched proposal that highlights the long-term benefits of managing chronic diseases like diabetes, including reduced emergency room visits and improved health outcomes. I would explore funding options, such as grants for correctional health programs or collaborations with public health agencies, to support the initiative. Additionally, I would look for cost-effective ways to implement the program, such as using existing telemedicine equipment or leveraging community partnerships for supplies (Gupta et al., 2020).
2.
Improving Inmate Compliance: To address non-compliance, I would implement patient-centered education that considers the unique needs and challenges faced by inmates. I would utilize a culturally sensitive approach, emphasizing the importance of diabetes management not just for their current health but also for their long-term well-being after release. Incorporating incentives, such as rewards for meeting health goals, may also improve compliance. Additionally, I would integrate mental health support into the program to address any psychological barriers to adherence, such as depression or substance use, which are common among incarcerated individuals (Tait & Yapa, 2021).
3.
Overcoming Security and Logistical Challenges: To overcome security challenges, I would collaborate with the correctional facility’s security and administration to design a workflow that ensures inmate safety and confidentiality while still delivering effective healthcare. For example, I would work with security personnel to schedule telemedicine appointments at specific times, ensuring that all necessary safety protocols are followed. I would also ensure that technology is secure, adhering to HIPAA regulations and maintaining privacy for the inmate and the healthcare provider (Reed et al., 2020).
4.
Addressing Staff Resistance: To address staff resistance, I would foster a participatory approach by involving staff in the planning and decision-making processes. Providing staff with training that demonstrates the positive outcomes associated with better chronic disease management both for the health of the inmates and for the operational efficiency of the facility would help alleviate concerns. Continuous support and feedback throughout the implementation process would help staff feel more confident and supported (Miller et al., 2018).
Conclusion:
The successful implementation of a structured diabetes management program within a correctional facility requires careful consideration of enablers and barriers. By leveraging institutional support, collaborating with multidisciplinary teams, and utilizing telemedicine technology, the initiative can improve health outcomes for inmates with diabetes. At the same time, addressing barriers such as limited resources, inmate non-compliance, security concerns, and staff resistance is crucial. As a DNP-prepared nurse, I would address these challenges by advocating for resources, fostering collaboration, and ensuring that the program is tailored to the unique needs of the correctional setting, ultimately improving chronic disease management and overall inmate health.
References
Alper, H., Lang, M., & Dey, A. (2019). Managing chronic disease in a correctional facility: Telehealth as a potential solution.
Journal of Correctional Health Care, 25(1), 25-32.
to an external site.
Fazel, S., & Luntamo, M. (2019). Addressing healthcare disparities in correctional settings: Challenges and strategies for improvement.
International Journal of Prisoner Health, 15(3), 159-168.
to an external site.
Guo, Y., King, J., & Jacobs, K. (2020). Telemedicine in correctional healthcare: Improving access and outcomes.
Journal of Telemedicine and Telecare, 26(4), 234-240.
to an external site.
Miller, D. R., McGinnis, P., & Burke, R. (2018). Diabetes management in correctional healthcare settings: Evidence-based strategies for improvement.
Journal of Correctional Nursing, 29(2), 72-79.
to an external site.
Reed, C., Smith, J., & Malouff, M. (2020). Implementing evidence-based practices in correctional settings: Overcoming barriers to change.
Journal of Correctional Health Care, 26(4), 305-312.
to an external site.
Tait, J., & Yapa, H. (2021). Overcoming barriers to chronic disease management in correctional facilities: The role of healthcare teams.
Journal of Correctional Nursing, 34(3), 165-172.
to an external site.
