DQ1 . Describe different strategies to deal with the management of any barriers, facilitators, and challenges.

NUR 699 Week 4 Discussion Consider a known or potential obstacle or barrier to your intervention implementation

DQ1 . Describe different strategies to deal with the management of any barriers, facilitators, and challenges.

For decades, evidence-based practice (EBP) has been an aspiration for health service providers. The World Health Organization (WHO) has stated that healthcare provision should be based on the best available evidence. Healthcare professionals are expected to engage with evidence and practice in line with it. Professional regulatory bodies such as the Nursing and Midwifery Council include the expectation that nurses deliver EBP in all settings (Brooke and Mallion, 2016; Mallion and Brooke, 2016). However, gaps still exist between research evidence, changes to practice and improved outcomes for patients (Wilson et al., 2010; Grimshaw et al., 2012).

Previous research, exploring nurses’ beliefs, skills and knowledge of EBP, has reported that nurses encounter various barriers to EBP implementation, resulting in a lack of engagement. Barriers frequently reported include lack of time, staff shortage, heavy patient caseload, family commitments, limited knowledge of EBP and negative beliefs toward it, and limited academic skills (Mallion and Brooke, 2016). Many publications however, fail to address why and how implementation processes have worked, or why attempts failed. This lack of concern with the process of change is another barrier to the application of best evidence in practice (Bryar and Bannigan, 2003). There have been calls by policy makers and researchers to use theory to explore these processes (Mcevoy et al., 2014).

The majority of nursing implementation science research has been conducted in acute hospital settings (Estabrooks et al., 2002; Lucero et al., 2009; Van Bogaert et al., 2009; Brooke and Mallion, 2016). Although care in the community has expanded globally, literature exploring implementation of EBP in this setting remains limited, including implementation strategies used by community nurses (Brooke and Mallion, 2016).

Describe different strategies to deal with the management of any barriers, facilitators, and challenges GCU NUR699

Lessons may be learnt from hospital and nursing home settings; however, community nursing is a unique setting that requires specific implementation strategies. Furthermore, it has been agreed that implementation studies in nursing are preoccupied with ‘education’ as a strategy including lectures and discussion sessions, feedback and reminders (van Achterberg, 2013); other potential strategies are seldom explored.

The aim of this review is to explore the use of implementation theory and identify the strategies required for, and the barriers and facilitators to, successful implementation within community nursing. The purpose is to add to the knowledge on effective implementation within this context.

In this paper, we use the term ‘implementation’ and ‘community nursing’. Internationally, community nursing is often referred to as ‘home care nursing’. In the United Kingdom, Australia and Sweden these nurses are referred to as ‘district nurses’. We define community nursing as the work of caring for people in their homes, rather than an institution. We define implementation as ‘[The] active and planned efforts to mainstream an innovation within an organization’ (Greenhalgh et al., 2004, p. 582). While dissemination is an important component in implementation science, this review is focused on the implementation only of innovations designed to enhance care.

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Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.