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https://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide1/index.htm

The below are four students’ discussions postings. You need to offer to their individual postings substantive responses as a student not an instructor. Please note that you need to respond for each student on a half-page with one reference.

Student 1
Stakeholders can best contribute to health promotion initiatives by having the “motives to lead that include a desire for achievement, power or ability to influence others, and affiliation interpreted as interest in helping others” (Healey & Zimmerman, 2010, p. 243). Stakeholders not only need motivating factors to be successful but they should also possess leadership qualities to develop strong collaborative efforts among varying governmental agencies, businesses, and the effected community. The need for continuous quality improvement requires the utilization of The Model of Improvement. Stakeholders play a role in this PDSA method for “analyzing a process of change where an aim or goal to improve health care delivery has been established” (Healey & Zimmerman, 2010, p. 259). Stakeholders are imperative when setting aims, establishing measures, selecting changes, and testing changes which all occur after the problem or issue has been identified. While many stakeholders many not be aware of the best practices in a health promotion initiative they are often aware of how utilizing a best practice with help or possibly the hinder the community being addressed. Stakeholders hold the important position of communicating to the community the difference between living longer lives and living longer healthy lives (Healey & Zimmerman, 2010, p. 281).
References:
Healey, B., & Zimmerman, R. (2010). The new world of health promotion. New program development, implementation, and evaluation.Sudbury, MA: Jones and Bartlett Publishers.

Student 2
I feel that the first step in involving community stakeholders is to engage them. Once they are engaged, it is much easier to enhance the roles of leadership, initiative, and drive to build and promote a quality health initiative. When looking at leadership skills it is best to define roles and needs of those involved, so that parties involved have an understanding of their need and where they are most valuable. Community stakeholders can be neighbors, elected officials, physicians, nurses, local health agencies, etc.
The agency for research and quality published a guide book titled, Engaging Stakeholders to Improve the Quality of Children’s Health Care. I am posting a few excerpts from that article I found helpful and pertinent to our question. Stakeholders can contribute a first-hand prospective on what will and will not work. Often times the stakeholders can give a prospective otherwise not seen as well as providing an ability to influence.
Forsythe, Ellis, Edmundson, Sabharwal, Rein, Konopka & Ellis, L., (2016), noted in their research regarding stakeholder engagement, that respondents emphasized meaningful and continuous partnerships, shared leadership strategies, communication through multiple strategies that fit specific stakeholder partners, and adaptation to the practical needs of stakeholders to be important factors.
Engaging Stakeholders:
1. Defining the goals, scope, and institutional home of the engagement.
2. Deciding whom to engage.
3. Building the structure of the stakeholder group.
4. Convening the stakeholder group and disseminating products.
5. Assessing the quality and results of the engagement.
The Important Role of Stakeholders:

• Ensuring that your QI efforts represent a variety of perspectives.
• Increasing transparency of QI efforts.
• Securing buy-in or increasing support from key decision makers.
• Expanding your capacity for current and future QI efforts.
• Empowering community members to be involved in QI activities.
• Increasing public awareness.
• Improving coordination of QI efforts.
• Advancing policy changes at the State level.

Engaging Stakeholders to Improve the Quality of Children’s Health Care. (2014, July 14). Retrieved February 06, 2018, fromhttps://www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/implementation-guides/implementation-guide1/index.htm
Forsythe, L., Ellis, L., Edmundson, L., Sabharwal, R., Rein, A., Konopka, K., & Ellis, L. E. (2016). Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned. JGIM: Journal Of General Internal Medicine, 31(1), 13-21. doi:10.1007/s11606-015-3450-z

Student #3
PICOT Question
How do clinicians (p) attitudes (O) towards new technology (I) change over time (T)?
Article:
Carayon, P., Hundt, A. S., & Wetterneck, T. B. (2010). Nurses’ acceptance of smart IV pump technology. International Journal of Medical Informatics, 79, 401-411. https://doi.org/10.1016/j.ijmedinf.2010.02.001

This study was aimed at nursing staff prior to, 6-weeks after and 1-year post implementation of new intravenous (IV) smart pumps. The authors provide a detailed background of the research currently available on the topic. No bias is noted, the survey was supplied to all nursing staff at the point of pre-implementation, and then via email post implementation using email addresses supplied by the human resource department. There is a detailed description of how the tool was designed, and the areas to be studied within the tool. It is noted by the authors that this tool used questions adapted from previously used questionnaires. The results of the study were provided through data that was analyzed with SPSS 14.0. The variables surveyed (implementation, performance of pump, and usability of pump), were found to be statistically significant (p<.001), with the end result being that nurses’ perception of using the pump were more positive after 1 year than at the 6-week mark and pre-implementation. Areas that remain negative were the implementation process and training materials, and after using the pump for a year speed, reliability and noise were also negative. These results provide information that will assist me in my practice, understanding how nurses perceive the implementation process and how this process affects their attitudes towards the technology allows me to redesign implementation education. Understanding why nurses would bypass certain safety features within the technology and what they like or dislike about the technology also enables me to review these workflows and to ensure the next time technology is purchased these concerns are met e.g. alarm sounds etc.
Thank you

Student # 4
Children and adults diagnosed with autism spectrum disorder (ASD) suffer socio-emotional impairments. Some of the individuals with ASD have limitations that may affect their skeletal health (Calarge & Schlechte, 2017). The following quantitative study was developed to determine if there is a difference in bone mass between ASD and non-ASD risperidone-treated male patients ages 5 to 17 years old (Calarge & Schlechte, 2017).
PICOT Question
Are male children and adolescents diagnosed with ASD (P) who have been prescribed Risperidone (I) compared to non-ASD male children and adolescents (C) at increased risk for skeletal problems (O)?
Are the Results Valid?
The test results have some validity, although limitations remain and further studies need to be done. Data was taken from 4 studies so that a large sample could be utilized. A best-estimate diagnosis was made based on the use of review of psychiatric records, interview of the parent, the child behavior checklist, and a clinical interview with a child psychologist. In comparison to a study by Neumeyer et al. (2015) found that there is a higher odds ratio for hip fractures in children and young adults diagnosed with ASD. It was necessary for additional studies to be performed to prove the connection between skeletal health and ASD diagnosis. Participants were excluded from the study if they were on more than one antipsychotic drug, taking medications that effect bone health, diagnosed with chronic medical or neurological disorders, or were on gluten-free diets. State of the art technology, including peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) was used to assess trabecular bone mass.
Bias and Limitations
Bias, however, is included in this study. The study only includes boys and only on a specific medication. Females were left out of the study. Diagnosis of ASD was lacking the use of standardized methods.
What are the Results?
The trabecular areas that were found to have lower mass included the ultradistal radius, lower second metacarpal bone cortical thickness, and a lower bone strength index. Participants with ASD were found to have lower bone mass as compared to psychiatric controls. The results of this study provide necessary information for researchers to find interventions because of the higher risk of fractures in ASD children and adolescents. The lumbar spine was not found to have a significantly lower bone mass in participants with ASD.
Reliability of Study and Instruments
Multivariate linear regression analysis was used to differentiate the bone mass between ASD and non-ASD participants. The differences between study participants with and without ASD were were compared using the Wilcoxon rank-sum test for continuous variables and Fishers Exact test for categorical information (Calarge & Schlechte, 2017). Bone strength index (BSI) was measured. State of the art technology was used to measure BSI. Reproducibility rates were given, along with calculations of inter-rater reliability.
Will the Results Help Me in Caring for My Patients?
More studies are needed to find interventions to help improve bone mass in ASD patients. This study does not find the answers to fix the problem, but helps to understand how to treat patients with ASD on Risperidone when there are fractures or any other skeletal injuries. The patient will need to be assessed fully due to the increased risk of low bone mass. Medications can be provided to help patients’ bones become stronger.
References
Calarge, C. A., & Schlechte, J. A. (2017). Bone mass in boys with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(6), 1749-1755. https://dx.doi.org/10.1007/s10803-017-3097-1
Neumeyer, A., O’Rourke, J. A., Massa, A., Lee, H., Lawson, E. A., McDougle, C. J., & Misra, M. (2015). Brief report: Bone fractures in children and adults with Autism Spectrum Disorders. Journal of Autism & Developmental Disorders, 45(3), 881-887. https://dx.doi.org/10.1007/s10803-014-2228-1

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