NURS 836 Week 7 Discussion Board Forum 7 on Equity in Dissemination and Implementation Example

Discussion Board Forum 7: Equity Starts With What We Measure

NURS 836 Translational Research in Health Care, Discussion Board Forum 7

Thread by [Student Name]

The hospital and the classmates replied to are composites written for a model discussion; the textbook and studies cited are real.

Last week a recovery room nurse called me to look at the sacrum of a patient with dark skin after a five-hour hip revision. "I can't tell if that's redness," she said. Neither could I. The skin felt warmer and firmer than the surrounding area, and the patient winced when we touched it, but our documentation asks only whether there is nonblanchable erythema. That moment exposed a flaw in my dressing project. Its primary outcome, stage 1 injury, is detected mainly by color, and color is the least reliable sign in richly pigmented skin.

This week's chapters argue that equity has to be designed into dissemination and implementation, not checked afterward (Brownson et al., 2018). In my project, inequity could enter in two places. In implementation, if staff believe injuries are rarer in dark skin because they see fewer, they may be less careful to apply the dressing. In evaluation, if injuries in dark skin go undetected, our results will undercount harm in exactly the patients at greatest risk of missed diagnosis.

The evidence offers alternatives. A 2026 scoping review of ten studies on detecting pressure injuries in adults with dark skin tones grouped strategies into thermographic imaging, subepidermal moisture sensors, image processing and colorimetry, and enhanced assessment and lighting, and noted that routine bedside visual and tactile assessment was underrepresented in the research (Mbuzi et al., 2026). One hospital team developed a nontechnological practice enabler that assesses four features in every skin tone: tone, temperature, texture and twinge, meaning pain (Neu et al., 2026). In a perioperative trial in prone-position surgery, subepidermal moisture measurements detected more damage than visual assessment, and patients who received preoperative silicone foam dressings had fewer moisture-defined injuries regardless of skin tone (Bates-Jensen et al., 2024). An outcome we cannot see in some patients is an outcome we will quietly fail to prevent in them.

So I am changing the plan, and telling the operating room staff why, because the change only works if they understand what it is for. Every postoperative skin check, at one, two and three days, will use the four-part enabler, staff training will include images across skin tones, and we will report injury rates by skin tone category so that a difference cannot hide inside an average. I will also ask our wound care team whether the hospital's subepidermal moisture scanner, now used only on two medical units, could be borrowed for a sample of cases in the first month, to check how many injuries visual and tactile assessment alone would have missed. If the gap is large, that finding belongs in the dissemination plan too, because other operating rooms are probably missing the same injuries.

Reply to Simone

Simone, your dissemination plan for the new sepsis screening tool targets nurses, physicians and leaders, but not patients or families, and its materials are only in English. If a third of your emergency patients prefer Spanish, as you mentioned, families may be the first to notice a patient deteriorating at home after discharge. Brownson et al. (2018) treat audience selection as a core decision in dissemination planning. And the scoping review I cited found that methods tested across diverse patients were largely technological, with routine bedside methods underrepresented (Mbuzi et al., 2026), a reminder that what is studied shapes who benefits. Could your discharge instructions include sepsis warning signs in Spanish?

Reply to Marcus

Marcus, your RE-AIM evaluation for the fall prevention bundle reports reach and effectiveness for the whole unit. I wonder whether you could also report them for groups at different risk, such as patients with limited English or cognitive impairment, who may be less able to use the call light the bundle relies on. RE-AIM's reach and adoption dimensions ask about representativeness, who is and is not included, and not only about totals (Glasgow et al., 2019). An average improvement could hide a group for whom falls did not decline. Which subgroup would you be most worried about missing?

References

Bates-Jensen, B. M., Crocker, J., Nguyen, V., Robertson, L., Nourmand, D., Chirila, E., Laayouni, M., Offendel, O., Peng, K., Romero, S. A., Fulgentes, G., & McCreath, H. E. (2024). Decreasing intraoperative skin damage in prone-position surgeries. Advances in Skin & Wound Care, 37(8), 413-421. https://doi.org/10.1097/ASW.0000000000000186

Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2018). Dissemination and implementation research in health: Translating science to practice (2nd ed.). Oxford University Press.

Glasgow, R. E., Harden, S. M., Gaglio, B., Rabin, B., Smith, M. L., Porter, G. C., Ory, M. G., & Estabrooks, P. A. (2019). RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Frontiers in Public Health, 7, Article 64. https://doi.org/10.3389/fpubh.2019.00064

Mbuzi, V. B., Morgan, S., Stratton-Maher, D., Tulleners, T., & East, L. (2026). Skin assessment strategies for identification of pressure injuries in dark-skin-tone patients: A scoping review. Healthcare, 14(16), Article 2655. https://doi.org/10.3390/healthcare14162655

Neu, C., Furtado, S., Dyck, R., Sheikh, F., Tremain, L., & Johnson, D. (2026). Early identification of pressure injury: An equity-informed initiative. Advances in Skin & Wound Care, 39(6), 288-293. https://doi.org/10.1097/ASW.0000000000000475