NR 585NP Week 8 Dissemination Plan Example

Dissemination Plan: One Finding About Home Blood Pressure Monitoring, Written for Four Audiences at Three Lengths, With the Qualifier That Has to Survive at Every Length

Student Name

College of Nursing, Chamberlain University

NR 585NP: Research Methods and Evidence-Based Practice for Advanced Nursing Practice

Instructor Name

Month Day, Year

Dissemination Plan: One Finding About Home Blood Pressure Monitoring, Written for Four Audiences at Three Lengths, With the Qualifier That Has to Survive at Every Length

Audiences Before Formats

Four groups need to act on the finding, and each can decide something different.

Clinicians at both Cedar sites decide whether to refer patients to the pilot and whether to keep lending cuffs without a plan.

Registered nurses and medical assistants carry out the pilot: teaching cuff technique, measuring arms and acting on readings.

The medical director and practice owners decide on the protocol, the nurse time and whether to extend the program.

Patients with uncontrolled hypertension decide whether to take part and how to use a cuff they may already own.

The Claim at Three Lengths

Long (policy brief for the medical director and owners): "Trials in primary care show that when patients with uncontrolled hypertension measure at home and a clinician changes their medication in response, clinic systolic pressure ends up several points lower after six months to a year than with office-based care alone. Certainty is moderate. Handing out cuffs with nobody responding to the numbers achieves little. The evidence does not show an effect on strokes or heart attacks, and no trial has tested a nurse-led version in a practice like ours, which is why we recommend a six-month pilot."

Medium (poster in the staff room and clinician email): "Home readings lower blood pressure when someone acts on them. Randomized trials and two meta-analyses: systolic readings several points lower after six months to a year, moderate certainty. Cuffs alone: little effect. Our pilot tests a nurse-led version."

Short (90 seconds at the clinician huddle): "Home cuffs work only when someone uses the readings to change medication. That lowers pressure a few points. We're piloting nurse titration at Main Street; refer your uncontrolled patients."

The long version rests on the pooled individual patient analysis (Tucker et al., 2017) and on TASMINH4 (McManus et al., 2018), and the strength is the same at every length. None of the three says "home monitoring lowers blood pressure" without the clause about acting on readings.

Qualifiers That Have to Survive

Two qualifiers cannot be dropped at any length. The first is "when someone acts on the readings," because without it the claim turns back into the colleague's original idea, which the synthesis rejected. The other is "a few points," because staff who expect large drops may conclude the program has failed when it is working as the trials predict.

One qualifier can be dropped at the short length: the comparison to office-based care, because the huddle audience already knows what usual care is. Certainty in words ("moderate") is kept in the long and medium versions and left out of the huddle, where "a few points" carries the same caution.

Channels People Already Use

Clinicians: the Tuesday morning huddle at each site, which every clinician attends, and the weekly clinical email the medical director sends. Nobody reads the shared drive, so nothing goes there alone.

Nurses and medical assistants: a 20-minute session at the monthly staff meeting, with the poster in the staff room afterward.

Medical director and owners: a two-page brief sent before their monthly meeting, with 10 minutes on the agenda.

Patients: a one-page handout given at the cuff teaching visit, in plain English and Spanish that a sixth grader could follow: "Checking your blood pressure at home helps your nurse adjust your medicine. Your readings only help if you send them to us." The handout also tells patients who already own a cuff to bring it in to check its size and accuracy.

Timing and Who Tells It

The brief goes first, to the medical director and owners, on 10 November, because nothing else proceeds without their approval. The huddle and email follow on 18 November, given by the medical director rather than by me, because clinicians are more likely to change referrals when the request comes from their own lead. The staff session is on 25 November, given by me and the pilot nurse. Patient handouts start with the first enrollments in December.

Obstacles, Named

Clinicians may continue lending cuffs without a plan, because the cuff cupboard is easy. The huddle message asks them to refer instead, and the practice manager has agreed to move the loan cuffs to the pilot nurse's office.

Some staff heard the original claim that cuffs alone would work. The staff session addresses it directly: "We said this at the August meeting; the evidence says something more specific."

What Could Distort the Message

The likeliest distortion is in the hallway, where "the cuff study" becomes "cuffs work." The poster's first line therefore leads with the clause about acting on readings rather than with the cuff. A second risk is that the practice newsletter, which goes to patients, reprints the medium version without the handout's plain language; the medical director has agreed that nothing about the pilot goes to patients except the handout. A third is that early results from the first month, which will be noisy, are shared as if they were the answer. The plan shares no outcome numbers until the six-month review.

A Second Round at Six Months

When the pilot ends, the same four audiences will receive the result, using the same three lengths and the same rule that the qualifiers survive. If the pilot fails its prediction, that is disseminated as clearly as success would have been, so that clinicians do not go back to lending cuffs on the strength of the original claim.

Evidence That It Landed

For clinicians: referrals to the pilot in the first month, compared with the 268 eligible; and the number of cuffs lent outside the pilot, which should fall to near zero.

For nurses and medical assistants: arm measurements recorded at rooming for enrolled patients.

For the medical director and owners: a decision on the protocol by 1 December.

For patients: the share of enrolled patients sending readings in the second month.

Two weeks after the huddle, I will ask five clinicians at random what the pilot is testing. If more than one says "home cuffs lower blood pressure" without the clause about acting on readings, the short version has failed and will be rewritten. Brownson et al. (2018) note that dissemination is more effective when messages are designed for a specific audience and delivered through channels they already trust, and this check tests whether that happened.

References

Brownson, R. C., Eyler, A. A., Harris, J. K., Moore, J. B., & Tabak, R. G. (2018). Getting the word out: New approaches for disseminating public health science. Journal of Public Health Management and Practice, 24(2), 102-111. https://doi.org/10.1097/PHH.0000000000000673

McManus, R. J., Mant, J., Franssen, M., Nickless, A., Schwartz, C., Hodgkinson, J., Bradburn, P., Farmer, A., Grant, S., Greenfield, S. M., Heneghan, C., Jowett, S., Martin, U., Milner, S., Monahan, M., Mort, S., Ogburn, E., Perera-Salazar, R., Shah, S. A., ... Hobbs, F. D. R. (2018). Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): An unmasked randomised controlled trial. The Lancet, 391(10124), 949-959. https://doi.org/10.1016/S0140-6736(18)30309-X

Tucker, K. L., Sheppard, J. P., Stevens, R., Bosworth, H. B., Bove, A., Bray, E. P., Earle, K., George, J., Godwin, M., Green, B. B., Hebert, P., Hobbs, F. D. R., Kantola, I., Kerry, S. M., Leiva, A., Magid, D. J., Mant, J., Margolis, K. L., McKinstry, B., ... McManus, R. J. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLOS Medicine, 14(9), e1002389. https://doi.org/10.1371/journal.pmed.1002389