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Knowledge Dissemination: Case Study


A lack of patient awareness of the need to ensure the consistency of their treatment is a serious problem in healthcare. In the given case study, the Amish population is identified by Michelle as the target audience that needs education on reporting about their utilization of non-traditional medicine. Taking into account that ARNP-prepared nurses should ensure that patients clearly understand their conditions and the factors that affect their health, the paramount role of such education cannot be overestimated. This paper aims to discuss strategies to be applied by leaders at the micro (written instructions, face-to-face and online counseling), meso (formal education, oral presentation and informal role modeling), and macro (professional conferences, policy-related activity) levels.

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Ways to Disseminate Change Necessity

In order to convey the message of care quality improvement, the ARNP leader should consider the context of the problem. In particular, Amish are a Christian movement of Mennonite origin, which is distinguished by the unwillingness to accept some modern technologies and amenities, preferring manual labor and a simple rural life. According to Cates (2014), while visiting medical centers, they tend to pay cash, and if one of them needs a serious operation, the entire community provides money. This shows that the cultural and religious background is especially important for Amish, and their resistance to relying on evidence-based practices and open communication with caregivers may be explained by their traditions.

In this connection, the strategies should be linked to Amish worldview at all the levels. Face-to-face conversations can be supplemented by online counseling for those patients who use smartphones and have access to the Internet and written recommendations (Schipper, Bakker, De Wit, Ket, & Abma, 2015). The micro level would require providing formal education for staff and further oral presentation and informal role modeling to teach nurses on how to act in specific cases. A publication presented in professional conferences and policy-related activity can be used at the macro level.

Micro, Meso, and Macro Levels of Knowledge Dissemination

Micro Level

The interaction with a patient and his or her family is of paramount importance at the micro level. Starting with the primary assessment and the selection of treatment options and ending with follow-up, a nurse should be aware of all the aspects of the patient’s health. In the given case, it is noted that the unreported use of homeopathy, herbal teas, and other measures was used by Amish patients, and they showed resistance to disclosing it unless asked. In this connection, it seems appropriate for Michelle to offer face-to-face counseling and explain to them that such inconsistency is likely to negatively affect their health. Most importantly, a treatment plan designed especially to their needs may turn out to be unsuccessful. Considering that Amish do not usually visit traditional schools and have only eight-grade education, the provision of written instructions can be beneficial (Farrar, Kulig, & Sullivan-Wilson, 2018). Simple words and visuals should be used to demonstrate the positive role of becoming more open with their care providers.

If a patient does not understand the medical information, he or she would not be able to be fully and actively participate in the treatment process. The ongoing monitoring of the way Amish patients take their medication and other remedies is a promising strategy to reveal any unreported health-related information. During each of the meetings with Amish, it is critical to ask about their experience, any deterioration of symptoms, and improvements. Online counseling services compose another feasible way to reach those who use the Internet. It is important to avoid pressure on patients so that they can feel comfortable while sharing their thoughts and previous actions. Farrar et al. (2018) assume that attentiveness to details and responsiveness in answering their questions can play the key role in encouraging patients to begin new practices to their health. In fact, many representatives of minor groups can be afraid or hesitant to state that they utilize home remedies to prevent disapprobation from doctors and nurses (Weller, 2017). Therefore, it should be clarified that no one would heart or condemn them as well as force to quit non-traditional treatment.

Meso Level

The meso level is characterized by its orientation towards improving staff effectiveness in caring for patients from various perspectives, including relationship building, physical manipulations, evaluation, et cetera. To effectively communicate with medical personnel and patients, knowledge of human behavior and training in talking and listening is required. Many doctors and nurses tend to be primarily inclined to act and may even be intolerant of the patient’s desire to be heard as this puts them in a passive position (Williamson, Almaskari, Lester, & Maguire, 2015). They may want to convince the patient that they are in complete control of the situation since they know enough about his or her condition and illness. Formal education can be applied to reveal and address such unwanted behaviors of staff and promote a more positive approach to learning the given population’s background. For example, Michelle can design several educational sessions to discuss the most relevant topics, among which there can be the cultural specifics of Amish, ways to address their hesitance and resistance, and so on.

The oral presentation and the subsequent informal role modeling are two more strategies that equip nurses with tools to work with Amish. The presentation can be prepared by the leader to emphasize the key points that should be taken into account while offering services. This will help the staff to better understand their responsibilities, which should be clarified in the course of role modeling. Several mini case studies are likely to demonstrate how exactly nurses should behave and communicate with the Amish population. Care providers should become authorities for patients, due to whose assistance patients feel calm, safe, and confident in a positive outcome of the treatment (Williamson et al., 2015). It should be transparently stated that the medical team and the patient have a common responsibility in the treatment and the expectation of high efficiency of the process. As a result, one may anticipate that patients would become highly motivated to collaborate with the staff because it concerns their own health. In case of Amish, patience and stoicism can also be expected as additional beneficial points contributing to successful recovery and trustful relationships between them and care providers.

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Macro Level

At the macro level, Michelle should disseminate knowledge regarding the change for her clinic administrators. The latter have little awareness of the Amish population as the main manager has to control 35 centers. The presentation of information necessary to induce change at this level should start with the collection of data on the topic of interest. As the key change and care quality improvement advocate, Michelle would need to understand whether there any scholarly works on the identified problem (Oelke, Lima, & Acosta, 2015). Upon the completion of this task, she can focus on policy-related activity that may consist of designing a specific policy as well as cultural perspectives. The proposed policy should specify the obligatory asking patients about their non-traditional treatment and encouraging them to practice transparency during their visits to the clinic.

The publication of research in academic journals and presentation of findings at conferences is another strategy of knowledge dissemination. Michelle can be recommended to explore the mentioned health concern in detail and report about the needs to the wider populations (Edwards, 2015). She may also adopt and transform experiences of other minority groups that encountered similar problems. The main administrator’s attention to the health concern is likely to increase if the ARNP-prepared leader would offer some evidence-based strategies and the ways to accomplish them. In other words, the macro level is associated with advocating for policy change along with the greater attention from the key care coordinators.


To conclude, a supportive organizational environment should be created to resolve the problem of inconsistent treatment and avoidance in reporting about home remedies. The Amish population places great importance in their families, and nurses should respect it while explaining to them the role of open communication. Face-to-face counseling and written instructions were identified as useful to promote openness and willingness of these patients to report on the use of home remedies. To prepare the staff for their new responsibility, Michelle can initiate education and role modeling strategies, while she also has the opportunity to impact policy change by reaching the clinic administrators and publishing her study on the given problem in scholarly journals to attract wider attention of society.


Cates, J. A. (2014). Serving the Amish: A cultural guide for professionals. Baltimore, MD: JHU Press.

Edwards, D. J. (2015). Dissemination of research results: On the path to practice change. The Canadian Journal of Hospital Pharmacy, 68(6), 465-469.

Farrar, H. M., Kulig, J., & Sullivan-Wilson, J. (2018). Older adult caregiving in an Amish community. Research in Gerontological Nursing, 11(1), 29-38.

Oelke, N. D., Lima, M. A. D. D. S., & Acosta, A. M. (2015). Knowledge translation: Translating research into policy and practice. Revista Gaucha De Enfermagem, 36(3), 113-117.

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Schipper, K., Bakker, M., De Wit, M., Ket, J. C. F., & Abma, T. A. (2015). Strategies for disseminating recommendations or guidelines to patients: A systematic review. Implementation Science, 11(1), 82-99.

Weller, G. E. (2017). Caring for the Amish: What every anesthesiologist should know. Anesthesia & Analgesia, 124(5), 1520-1528.

Williamson, K. M., Almaskari, M., Lester, Z., & Maguire, D. (2015). Utilization of evidence-based practice knowledge, attitude, and skill of clinical nurses in the planning of professional development programming. Journal for Nurses in Professional Development, 31(2), 73-80.

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