Evidence-Based Practice in Nursing

Evidence-Based Practice in Nursing

Evidence-Based Practice in Nursing

Evidence-Based Mental Health Counseling

Walden University

Nurs 6052: Essentials of Evidence-based Practice

Assignment: Evidence-based Project

Part 1

9/14/19

Clinical Issue of Interest

The clinical issue of interest is mental health counseling. A significant part of the population is suffering from mental illnesses and the counseling is critical to ensuring the best practices are involved in trying to care for individuals with mental issue. The field also focuses on ensuring the best interventions are adopted to ensure mental health issues are addressed efficiently.

Use of Keywords in Search for Articles

In searching for peer-reviewed articles in various libraries, it was critical to identify a keyword that could be used to search for related articles. The search was conducted using “mental health counseling” as the keyword. The use of a targeted keyword helped identify articles that were related to the topic.

Research Databases

The following research databases were used in the search using the identified keyword.

Sage Journals.

Science Direct.

Taylor and Francis Online.

Need for Research Databases in Search for Peer-Reviewed Articles

The search for peer-reviewed articles needs to be conducted using particular libraries that offer reputable articles. In trying to identify the best library to use, one has to focus on aspects such as the area of interest and the particular library databases that might provide the best articles.

References

Dieser, R., Christenson, J., & Davis-Gage, D. (2014). Integrating flow theory and the serious leisure perspective into mental health counseling. Counselling Psychology Quarterly, 28(1), 97-111. doi: 10.1080/09515070.2014.944883

Kim, E., Furlong, M., Dowdy, E., & Felix, E. (2014). Exploring the Relative Contributions of the Strength and Distress Components of Dual-Factor Complete Mental Health Screening. Canadian Journal Of School Psychology, 29(2), 127-140. doi: 10.1177/0829573514529567

Laux, J., Calmes, S., Moe, J., Dupuy, P., Cox, J., & Ventura, L. et al. (2018). The Clinical Mental Health Counseling Needs of Mothers in the Criminal Justice System. The Family Journal, 19(3), 291-298. doi: 10.1177/1066480711405823

Rückert, H. (2015). Students׳ mental health and psychological counselling in Europe. Mental Health & Prevention, 3(1-2), 34-40. doi: 10.1016/j.mhp.2015.04

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Part 4 A Critical Appraisal

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

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Levels of Evidence Table

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

* Evidence Levels:

· Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

· Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

· Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

· Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

· Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

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Outcomes Synthesis Table

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

References

Dieser, R., Christenson, J., & Davis-Gage, D. (2014). Integrating flow theory and the serious leisure perspective into mental health counseling. Counseling Psychology Quarterly, 28(1), 97-111. DOI: 10.1080/09515070.2014.944883

Kim, E., Furlong, M., Dowdy, E., & Felix, E. (2014). Exploring the Relative Contributions of the Strength and Distress Components of Dual-Factor Complete Mental Health Screening. Canadian Journal of School Psychology, 29(2), 127-140. DOI: 10.1177/0829573514529567

Laux, J., Calmes, S., Moe, J., Dupuy, P., Cox, J., & Ventura, L. et al. (2018). The Clinical Mental Health Counseling Needs of Mothers in the Criminal Justice System. The Family Journal, 19(3), 291-298. DOI: 10.1177/1066480711405823

Rückert, H. (2015). Students׳ mental health and psychological counseling in Europe. Mental Health & Prevention, 3(1-2), 34-40. DOI: 10.1016/j.mhp.2015.04.006

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Part-4B Critical Analysis in Research

Assignment: Evidence-Based Practice and the Quadruple Aim

Evidence-based practice (EBP) is defined as the integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care. Evidence-based practice strategies allow nurses and other health care providers to translate research findings into clinical practice. With efficient literature-searching skills and the application of formal rules of evidence in evaluating research findings, providers can apply existing scientific knowledge in their clinical practice for each individual patient.

The Institute for Healthcare Improvement stated they should target the triple aim in health care: improving the patient experience, improving population health outcomes and decreasing health care costs. Some years after the triple aim goal came out, a fourth aim was added, which was to improve the work life of clinicians and their well-being. Evidence-based practice is the secret that enables us to reach that quadruple aim.

Patient experience, population health, costs, and work life of healthcare providers are the four components and elements of the quadruple aim. Each component is extremely important and plays a unique role. As evidence-based practice has already been focused on patient outcomes, experience, population health and costs, the only component that has not been brought to light is the fourth and final component on the quadruple aim, the work life of health care providers.

Work life of the health care providers then came into play. The costs of burnout are widely under-recognized. Health professional burnout poses a significant threat to the clinical, financial and reputational success of an institution. But burnout can be prevented with intentional organizational initiatives. The return on investment for organizations that address burnout can be substantial. This is mainly why the fourth and final component of the quadruple aim was imperatively added and is now part of evidence-based practice.

References

Flanagan, N. (2018). The Quadruple Aim: Improving Working Conditions for Health Care Providers. Caring for the Ages, 19(1), 10–11. doi: 10.1016/j.carage.2017.12.010

Rathert, C., Williams, E. S., & Linhart, H. (2018). Evidence for the Quadruple Aim. Medical Care, 56(12), 976–984. doi: 10.1097/mlr.0000000000000999

(2019). What is Evidence-Based Practice? doi: 10.4135/9781526492289

ESSENTIALS OF EVIDENCE BASED PRACTICE

Nursing research and evidence based practice with picot question

Discussion: Nursing Research and Evidence-Based Practice

In your practice as a nurse, you may use procedures and methods that did not necessarily originate in evidence, but instead were derived from informal and unwritten conventions, traditions, and observations. While these techniques may have merit, practices are constantly being updated and contradicted by information from scholarly research studies and professional guidelines. This new information serves as “evidence” for revising practices to improve outcomes across health care.

Based on this evidence, you can formulate a question. In this Discussion, you consider the use of evidence-based practice in your own organization and formulate a question that you will need to answer for your portfolio project. This is called a PICOT question. You will also investigate strategies for overcoming barriers to implementing evidence-based practice (EBP).

To prepare:                                                         

• Consider a recent clinical experience in which you were providing care for a patient.
• Determine the extent to which the care that you provided was based on evidence and research findings or supported only by your organization’s standard procedures. How do you know if the tasks were based on research?
• What questions have you thought about in a particular area of care such as a procedure or policy?
• Review Chapter 2, pages 31–34 on “Asking Well worded Clinical Questions” in Polit & Beck and consult the resource from the Walden Student Center for Success: Clinical Question Anatomy & examples of PICOT questions (found in this week’s Learning Resources). Formulate your background questions and PICOT question.
• Reflect on the barriers that might inhibit the implementation of evidence-based practice in your clinical environment.
• Review the article “Adopting Evidence-Based Practice in Clinical Decision Making” in this week’s Learning Resources. Select one of the barriers described that is evident in your organization and formulate a plan for overcoming this barrier.

By Day 3

Post an evaluation of the use, or lack thereof, of EBP in a recent clinical experience. Identify which aspects of the care delivered, if any, were based on evidence and provide your rationale. List your background questions and PICOT question about this nursing topic. Critique how the policies, procedures, and culture in your organization may hinder or support the adoption of evidence-based practices. Identify the barrier you selected from the article and explain how this barrier could be overcome within your organization.

Course Project: Part 1—Identifying a Researchable Problem

One of the most challenging aspects of EBP is to actually identify the answerable question.

—Karen Sue Davies

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.

To prepare:

• Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
• Review the section beginning on page 75 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
• Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
• Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
• Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

• Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.

To complete:

Write a 3- to 4-page paper that includes the following:

• A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
• The 5 questions you have generated and a description of how you analyzed them for feasibility
• Your preliminary PICOT question and a description of each PICOT variable relevant to your question
• At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections

By Day 7

Submit your Project. It will also be a component of your Portfolio Assignment for this course, which is due by Day 7 of Week 10.

Reference:

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144

2^nd part

Course Project: Part 2—Literature Review

This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

To prepare:

• Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
• Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
• Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week’s Learning Resources.
• Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Write a 3- to 4-page literature review that includes the following:

• A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
  • Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
• Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
• Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

By Day 7 of Week 5

This part of the Course Project is due. It will also be a component in your Portfolio Assignment in this course, which is due by Day 7 of Week 10.

3^rd part

Course Project: Part 3—Translating Evidence Into Practice

In Part 3 of the Course Project, you consider how the evidence you gathered during Part 2 can be translated into nursing practice.

Now that you have located available research on your PICOT question, you will examine what the research indicates about nursing practices. Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about. This final component of the Course Project asks you to translate the evidence and data from your literature review into authentic practices that can be adopted to improve health care outcomes. In addition, you will also consider possible methods and strategies for disseminating evidence-based practices to your colleagues and to the broader health care field.

To prepare:

• Consider Parts 1 and 2 of your Course Project. How does the research address your PICOT question?
• With your PICOT question in mind, identify at least one nursing practice that is supported by the evidence in two or more of the articles from your literature review. Consider what the evidence indicates about how this practice contributes to better outcomes.
• Explore possible consequences of failing to adopt the evidence-based practice that you identified.
• Consider how you would disseminate information about this evidence-based practice throughout your organization or practice setting. How would you communicate the importance of the practice?

To complete:

In a 3- to 4-page paper:

• Restate your PICOT question and its significance to nursing practice.
• Summarize the findings from the articles you selected for your literature review. Describe at least one nursing practice that is supported by the evidence in the articles. Justify your response with specific references to at least 2 of the articles.
• Explain how the evidence-based practice that you identified contributes to better outcomes. In addition, identify potential negative outcomes that could result from failing to use the evidence-based practice.
• Outline the strategy for disseminating the evidence-based practice that you identified throughout your practice setting. Explain how you would communicate the importance of the practice to your colleagues. Describe how you would move from disseminating the information to implementing the evidence-based practice within your organization. How would you address concerns and opposition to the change in practice?

By Day 7 of Week 10

This part of the Course Project is due. It should be combined with the other two components of the Course Project and turned in as your Portfolio Assignment for this course.

Note: In addition, include a 1-page summary of your project.

For this final iteration, you will need to:

• Submit your paper to Grammarly and SafeAssign through the Walden Writing Center. Based on the Grammarly and SafeAssign reports, revise your paper as necessary.
• Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week’s Learning Resources). All papers submitted must use this formatting.

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Evidence-based practice – strengths and weaknesses of a research study

DNP graduates are expected to apply research findings and integrate nursing science into evidence-based practice. To develop your ability to engage in this high level of nursing practice, you will analyze the strengths and weaknesses of a research study over the next several weeks using the concepts presented throughout Weeks 1 through 9 of the course. Your final analysis will be a 5- to 7-page paper in APA format, that includes the following:
1) Write an introduction ending with a purpose statement (e.g. “the purpose of this study is…).
2) Provide a two paragraph overviews of the study.
3) Identify three strengths of the study and support your selection (i.e. why is this a
strength)
4) Identify three weaknesses of the study and support your selection (i.e. why is this a
weakness)
Note: The strengths and weaknesses should be in relation to:
· Design
· Sampling
· Data collection
· Statistical analysis
· Results and discussion.
5) Propose changes to improve the quality of the study capitalizing on the strengths and
6) improving on the weaknesses you identified in the study.
7) Summarize the implications for nursing practice.
8) Write a conclusion for your paper
The purpose of the analysis is to help you develop a deeper understanding of the research process, to inspire you to think critically and deeply about research on a specific topic, and to strengthen your ability to integrate research findings into evidence-based nursing practice. This assignment also gives you practice in analyzing the research literature, which will support you when you begin your DNP project.
Due Wednesday October 25, 2017 before midnight!
Writing (5 points): Up to 5 points (20%) may be deducted for grammar and APA style errors.
To prepare for this week’s assignment complete the following:

Select one of the four research articles cited in this week’s required readings (SEE ATTACHED PDF FILE).

Review the various quantitative research designs presented in the textbook readings and research articles and discussed in the “Musings: Aligning Research Question and Methodology” media.
Consider the research design used in your selected article. Ask yourself the following questions. Is the design appropriate for the study? Would a different design provide better results?

Required Media
Laureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Selecting a research topic and developing a hypothesis. Baltimore, MD: Author.
Note: The approximate length of this media piece is 13 minutes.
In this week’s video, Dr. Leiyu Shi discusses the characteristics of a good research hypothesis and details the steps in developing a hypothesis that can be tested through research.
Laureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Musings: Aligning research question and methodology. Baltimore, MD: Author.
Note: The approximate length of this media piece is 6 minutes.
This video discusses the importance of having a well-defined research question, which informs the methodology that you use in creating a hypothesis for a research study
Laureate Education. (2011). Important events in clinical research history. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/CLRA/6100/01/mm/timeline/index.html
This timeline identifies and describes key historical events related to the development of clinical research throughout the ages.
Required Readings
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.
Chapter 5, “Research Problem and Purpose”
Chapter 5 outlines how to identify and develop a research problem statement, purpose, and research questions. The chapter also provides examples of both quantitative and qualitative research topics, problems, and purpose.
Chapter 6, “Objectives, Questions, Variables, and Hypothesis”
This chapter explains the different types of hypotheses and assesses how research variables can be used to formulate research objectives in both quantitative and qualitative studies.
Chapter 10, “Quantitative Methodology: Noninterventional Designs and Methods”
Chapter 10 describes the principles of research design and those foundational concepts that influence the selection of an appropriate quantitative design: causality, bias, manipulation, control, and validity.
Chapter 11, “Quantitative Methodology: Interventional Designs and Methods”
This chapter builds on the material presented in Chapter 10 and discusses how to select the most appropriate quantitative research design for addressing a particular research problem.
Select one of the following articles to use for this week’s Assignment:
· Fouquier, K.F. (2011). The concept of motherhood among three generations of African American women. Journal of Nursing Scholarship, 43(2), 145–153.
· Grey, M., Whittemore, R., Jaser, S., Ambrosino, J., Lindemann, E., Liberti, L., Northrup, V., & Dziura, J. (2009). Effects of coping skills training in school-age children with Type 1 diabetes. Research in Nursing & Health, 32, 405–418. (USE THIS ARTICLE FOR THIS ASSIGNMENT)
· Methey, N.A., Davis-Jackson, J., & Stewart, B.J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59, 18–25.
· Newhouse, R.P., Morlock. L., Pronovost, P., & Breckenridge-Sproat, S. (2011). Rural hospital nursing: Results of a national survey of nurse executives. Journal of Nursing Administration, 41(3), 129–137.
Handouts
Laureate Education. (2011). Litmus test for a doctoral-level research problem. Baltimore, MD: Author.
Optional Resources
Caress, A., Luker, K., & Chalmers, K. (2010). Promoting the health of people with chronic obstructive pulmonary disease: Patients’ and carers’ views. Journal of Clinical Nursing, 19(3–4), 564–573.
Mbeba, M. M., N., Jere, D. L., Kachingwe, S. I., Crittenden, K. S., McCreary, L. L., … Norr, K. F. (2011). Peer group intervention reduces personal HIV risk for Malawian health workers. Journal of Nursing Scholarship, 43(1), 72–81.
Miller, J., Gaboda, D., Nugent, C., Simpson, T., & Cantor, J. (2011). Parental eligibility and enrollment in state children’s health insurance program: The roles of parental health, employment, and family structure. American Journal of Public Health, 101(2), 274–277.
Su, C., Lu, X., Chen, W., & Wang, T. (2009). Promoting self-management improves the health status of patients having peritoneal dialysis. Journal of Advanced Nursing, 65(7), 1381–1389.

Evidence-Based Practice

Review “Prevention of Catheter-Associated Urinary Tract Infections in Patients with Hip Fractures Through Education of Nurses to Specific Catheter Protocols” from this week’s Electronic Reserve Readings 

 Write a 290 word message in which you discuss:

1-How does the process described in this article compare and contrast to any experiences you have had thus far with evidence-based practice in your work setting? Identify and explain the similarities and differences. 

2-How well does the process used in this article compare to the Johns Hopkins Nursing Evidence-Based Practice Model as described on Theoretical Basis for Nursing? 

3-Does your work setting use an evidence-based practice model? If so, summarize the process. 

4-What are the advantages, if any, of using a model?

Read instructions: ( Attached you will find the chapter and article  of the book that have the information for the discussion. My work setting is a Nursing Home and rehab. am a registered nurse. Discussion must be done from information given.  The discussion must be about the questions given above. thank you. )

Week 6 Assignment: EBP Change Process form :- ACE Star Model of Knowledge Transformation

Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.

Name: _____________________

Star Point 1: Discovery (Identify topic and practice issue)

Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)

Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.

Star Point 2: Summary (Evidence to support need for a change)

Describe the practice problem in your own words and formulate your PICOT question.

List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.

List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.

Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.

Outline one or two evidence-based solutions you will consider for the trial project.

Star Point 3: Translation (Action Plan)

Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).

List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).

What specifically is your nursing role in the change process? Other nursing roles?

List your stakeholders by position titles (charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project?

What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?

Star Point 4: (Implementation)

Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?

Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.

Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).

List the measurable outcomes based on the PICOT. How will these be measured?

What forms, if any, might be used for recording purposes during the pilot change process. Describe.

What resources are available to staff (include yourself) during the change pilot?

Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?

Star Point 5: (Evaluation)

How will you report the outcomes of the trial?

What would be the next steps for the use of the change process information?

CHAPTER 12: Evidence-Based Practice and Nursing Theory

Evelyn M. Wills

Melanie McEwen

Helen Soderstrom was stricken with changes in her vision, disturbances of gait, and occasional periods of severe fatigue during her senior year of nursing school. She experienced intermittent periods of normality as well as illness, and the periods when she had no symptoms lasted many months. During a time when her symptoms were unusually active, she sought medical help, and her physician determined that her symptoms were related to stress. Despite the periods of weakness and fatigue, she was able to complete the nursing program and graduated with honors.

During Helen’s first year of practice, she experienced two periods of symptom exacerbation, but each was short-lived. With full insurance, she was able to see a neurologist who concluded that she was experiencing the beginning stages of a neuromuscular disease. Because there was no “cure,” the neurologist worked with Helen to find interventions that helped her manage the symptoms when they became problematic.

After a few years in practice, Helen enrolled in a graduate program to work toward a career in nursing education. During her first year of graduate studies, she seldom experienced neurologic symptoms, but during her practice teaching course, they returned.

The recurrence of symptoms, along with a new understanding of evidence-based practice from her graduate courses, led Helen to make her personal health experience the topic of her final paper. To learn more, she sought resources that would help her gain better control of the neuromuscular symptoms as well as assist her in her studies. To that end, she contacted her University’s neuroscience department and joined a research team. As she learned more about EBP, she considered what system she would use to develop guidelines on symptom management and selected the Iowa Model because of its extensive use in research.

The idea of evidence-based practice (EBP) was introduced in the 1970s by Dr. Archie Cochrane, an Englishman who wrote a dynamic book questioning the efficacy of non–research-based practices in medicine (Melnyk & Fineout-Overholt, 2011). In particular, Dr. Cochrane emphasized the critical review of research, largely focusing on randomized control trials (RCTs) to support medical practice. His influence eventually led to development of the Cochrane Collaboration, an organization charged with developing, maintaining, and updating systematic reviews of health care interventions (Cochrane Collaboration, 2013). Although the notion of EBP was somewhat delayed in being recognized and implemented in nursing, over the past two decades, EBP has appeared with increasing frequency in the nursing literature and now has essentially become the standard for research-based, informed decision making for nursing care.

EBP is similar to research-based practice and has been called an approach to problem solving that conscientiously uses the current “best” evidence in the care of patients (LoBiondo-Wood & Haber, 2010). EBP involves identifying a clinical problem, searching the literature, critically evaluating the research evidence, and determining appropriate interventions. Nursing scholars note that EBP relies on integrating research, theory, and practice and is equivalent to theory-based practice as the objective of both is the highest level of safety and efficacy for patients (Fawcett & Garity, 2009).

Overview of Evidence-Based Practice

The concept of EBP is widely accepted as a requisite in health care. EBP is based on the premise that health professionals should not center practice on tradition and belief but on sound information grounded in research findings and scientific development (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012). Until the early part of the 21st century, the concept of EBP was more common in Canadian and English nursing literature than in U.S. nursing literature. Over the last decade, however, the term has become ubiquitous. This is attributed in part to the guideline initiatives of the Agency for Health Care Quality, the Institute of Medicine, and the U.S. Preventative Services Task Force, among others (Hudson, Duke, Haas, & Varnell, 2008; Melnyk & Fineout-Overholt, 2011).

Many nursing scholars (DiCenso, Guyatt, & Ciliska, 2005; Ingersoll, 2000; LoBiondo-Wood & Haber, 2010; Melnyk & Fineout-Overholt, 2011; Rycroft-Malone, 2004) have pointed out that EBP and research are not synonymous. They are both scholarly processes but focus on different phases of knowledge development—application versus discovery. In general, EBP refers to the integration of individual clinical expertise with the best available external clinical evidence from systematic research. It is largely based on research studies, particularly studies using clinical trials, meta-analysis, and studies of client outcomes, and it is more likely to be applied in practice settings that value the use of new knowledge and in settings that provide resources to access that knowledge.

Definition and Characteristics of Evidence-Based Practice

In medicine, EBP has been defined as the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). It is an approach to health care practice in which the clinician is aware of the evidence that relates to clinical practice and the strength of that evidence (Jennings & Loan, 2001; Tod, Palfreyman, & Burke, 2004).

To distinguish nursing from medicine in discussing EBP, a number of definitions have been presented in the literature. Sigma Theta Tau International (2005, para. 4) defined “evidence-based nursing” as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.” Similarly, DiCenso and colleagues (2005) defined EBP as “the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making” (p. 4). Both of these definitions use similar terms (e.g., best evidence, expertise, patient values). Ingersoll (2000) used slightly different terms when she suggested that evidence-based nursing practice “is the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences” (p. 152).

In nursing, EBP generally includes careful review of research findings according to guidelines that nurse scholars have used to measure the merit of a study or group of studies. Evidence-based nursing de-emphasizes ritual, isolated, and unsystematic clinical experiences; ungrounded opinions; and tradition as a basis for practice and stresses the use of research findings. Other measures or factors, including nursing expertise, health resources, patient/family preferences, quality improvement efforts, and the consensus of recognized experts, are also incorporated as appropriate (Melnyk & Fineout-Overholt, 2011; Schmidt & Brown, 2012).

In summary, EBP has several critical features. First, it is a problem-based approach and considers the context of the practitioner’s current experience. In addition, EBP brings together the best available evidence and current practice by combining research with tacit knowledge and theory. Third, it incorporates values, beliefs, and desires of the patients and their families. Finally, EBP facilitates the application of research findings by incorporating first- and second-hand knowledge into practice.  Link to Practice 12-1  presents information on databases that nurses and others can access to find specific information on current guidelines and other collections of “evidence” that can be used to improve health care.

Link to Practice 12-1: Key Resources for Evidence-Based Practice

Several important databases have been set up over the last 20 years to promote integration of “evidence” in health care. Information on three of the most influential are presented here.

Cochrane Collaboration –  http://www.cochrane.org/

The Cochrane Collaboration is an international network that helps health care practitioners, policy makers, patients, and their advocates make informed decisions about health care. The Cochrane Library prepares, updates, and promotes the accessibility of the Cochrane Database of Systematic Reviews.

Joanna Briggs Institute –  http://www.joannabriggs.edu.au/

The Joanna Briggs Institute is an international research and development organization from the School of Translational Science at the University of Adelaide, South Australia. The Institute and its collaborating entities promote and support the synthesis, transfer, and utilization of evidence through identifying feasible, appropriate, meaningful, and effective health care practices to assist in the improvement of health care outcomes.

Agency for Healthcare Research and Quality (U.S. Preventative Services Task Force/National Guideline Clearinghouse)  http://www.guideline.gov/

The National Guideline Clearinghouse (NGC) is a database of evidence-based clinical practice guidelines. It is intended to be used by health professionals, practitioners, patients, and others to obtain objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use.

Concerns Related to Evidence-Based Practice in Nursing

Despite growing acceptance of application of EBP in nursing, some criticisms and concerns have been voiced in the nursing literature. For example, there is the concern that EBP is more focused on the science of nursing than on the art of nursing. Some authors have expressed concern that strict concentration on empirically based knowledge will lead to the failure to capture the uniqueness of nursing and the importance of holistic care in contemporary practice (Fawcett, Watson, Neuman, Walker, & Fitzpatrick, 2001; Hudson et al., 2008; Upton, 1999).

Another concern is that strict reliance on EBP will place nurses in the role of medical extender or medical technician, where nursing will be reduced to a technical practice. This concern was voiced as equating EBP with “cookbook care” and a disregard for individualized patient care (Finkelman & Kenner, 2013; Melnyk & Fineout-Overholt, 2011). Indeed, although evidence may provide direction for development of procedures, techniques, and protocols for nursing, it has been established that these are not the only knowledge that informs the nursing practice and that consideration of individual needs and values is essential (Hudson et al., 2008; Mitchell, 2013).

Third, because research involving humans is complex, findings may be open to interpretation and therefore should not be the sole basis for practice. Research must be considered within the context of the practice prescribed by theory, and it must integrate the values and beliefs of nursing philosophy (Chinn & Kramer, 2011; McKenna & Slevin, 2008; Walker & Avant, 2011).

A fourth concern relates to promoting a link with evidence-based medicine and its emphasis on positivist thinking and the dominance of randomized clinical trials as the major evidence. This concern is related to the absence of consideration of evidence gathered through qualitative research and theory development (Fawcett et al., 2001; Jennings & Loan, 2001; Stevens, 2001).

A fifth concern relates to the potential for linking health care reimbursement exclusively to interventions that can be substantiated by a documented body of evidence (Ingersoll, 2000). This leads to a number of ethical questions and issues that should be considered.

Finally, it is argued that not all practice in the health professions can or should be based on science. In many cases, researchers have yet to accumulate a sufficient body of knowledge. In other cases, a different frame of reference provides a different rationale for action (McKenna & Slevin, 2008). In these instances, strict reliance on EBP may result in numerous voids when developing a plan of care.

Concerns such as these have been addressed by DiCenso and colleagues (2005), who assert that a fundamental principle of EBP is that research evidence alone is not sufficient to plan care. Other ethical and pragmatic factors, such as benefits and risks, associated costs, and patient’s wishes, should be considered. Further, they note that “best research evidence” can be quantitative or qualitative and does not necessarily rely on RCTs. These notions are also supported by Rycroft-Malone (2004), who maintains that well-conceived and well-conducted qualitative and quantitative research evidence, clinical experience, and patient experiences, combined with local or organizational influences, are necessary to facilitate EBP.

Evidence-Based Practice and Practice-Based Evidence

Recently, a new concept—“practice-based evidence” (PBE)—was introduced into the discussion of EBP (Horn & Gassaway, 2007). The notion of PBE addresses many of the concerns noted previously and is grounded in the recognition that frequently interventions have limited formal research support, particularly in the number or quality of RCTs.

The premise of PBE is that large databases—not just clinical research—should be reviewed or “mined” to gather data to demonstrate quality and effectiveness. This type of review can provide comprehensive information about patient characteristics, care processes, and outcomes while controlling for patient differences (Walker & Avant, 2011). PBE acknowledges the importance of the environment in determining practice recommendations and recognizes that knowledge can be generated from practice as well as from research (Chinn & Kramer, 2011).

The intent behind PBE is to determine what works best for which patients, under what circumstances, and at what costs by providing a more comprehensive picture than RCTs, which typically examine one intervention with limited populations and under strictly controlled circumstances (Huston, 2011). Additional sources beyond formal research studies that are appropriate as PBE include benchmarking data, clinical expertise, cost-effective analyses, infection control data, medical record data, national standards of care, quality improvement data, and patient and family preferences (Huston, 2011).

Horn and Gassaway (2007) concluded that use of the PBE analyses can uncover better practices more rapidly leading to improved patient outcomes.  Figure 12-1  illustrates one interpretation of the interrelationships among EBP, PBE, research, and theory in nursing.

Figure 12-1: Relationships among practice, theory, research, and the PBE/EBP cycle.

(From Walker, L. O., & Avant, K. C. [© 2011]. Strategies for theory construction in nursing [5th ed., Fig. 2-3; p. 46]. Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.)

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Promotion of Evidence-Based Practice in Nursing

Implementation of EBP in nursing is still evolving, as often, nursing interventions are based on experience, tradition, intuition, common sense, and untested theories. While emphasis on EBP is growing rapidly, the actual incorporation of nursing research findings in practice has lagged. Melnyk and Fineout-Overholt (2011) have outlined barriers to implementation of research and EBP in nursing ( Box 12-1 ).

Box 12-1: Barriers to Evidence-Based Practice in Nursing

·  Lack of EBP knowledge and skills

·  Misperceptions or negative attitudes about research and evidence-based care

·  Lack of belief that EBP will result in more positive outcomes than traditional care

·  Voluminous amounts of information in professional journals

·  Lack of time and resources to search for and appraise evidence

·  Overwhelming patient loads

·  Organizational constraints (e.g., lack of administrative support or incentives)

·  Demands from patients for a certain type of treatment

·  Peer pressure to continue with practices that are steeped in tradition

·  Resistance to change

·  Lack of consequences for not implementing EBP

·  Lack of autonomy over practice and incentives

·  Inadequate EBP content and behav

·  Lack of autonomy over practice and incentives

·  Inadequate EBP content and behavioral skills in educational programs

·  Continued teaching of rigorous research methods in BSN and MSN programs instead of teaching evidence-based approach to care

Source: Melnyk and Fineout-Overholt (2011).

There is significant support for increasing emphasis on EBP in nursing, and many organizations such as the Institute of Medicine, Sigma Theta Tau International, and the Magnet Recognition Program of the American Nurses Credentialing Center, among others, have designed initiatives to advance EBP (Finkelman & Kenner, 2013; Huston, 2011; Melnyk & Fineout-Overholt, 2011). Indeed, practitioners, researchers, and scholars should welcome it because a systematic process of EBP may assist nurses in reducing the gap between theory and practice.

Theory and Evidence-Based Practice

The growing interest and appreciation of EBP in nursing, along with its considerable interconnectedness with research, has served in some ways to de-emphasize theory. As nurses become more aware of and attuned to EBP, however, they are renewing their appreciation of the linkages among research, theory, and practice. It has been observed that nursing focus on EBP has the potential to promote and draw new attention to this connection (Chinn & Kramer, 2011).

Walker and Avant (2011) pointed out that practice is the central and core phenomenon and focus of nursing; arguably, it is the reason for nursing’s existence. Thus, it is critical to remember that theory guides practice and it also generates models of testing in research through both PBE and EBP. Further, research and clinical data provide evidence for EBP or PBE and can generate practice guidelines and/or theories (e.g., situation-specific theories). This process is interactive and iterative (Walker & Avant, 2011). For nursing therefore, practice must not only be evidence-based but also theory-based, for when research validates a theory, it provides the evidence required for EBP. Finally, as more research is conduced about a specific theory, more evidence is provided to support practice (Chinn & Kramer, 2011; George, 2011).

Fawcett and colleagues (2001) wrote of a preference for the term “theory-guided, evidence-based practice,” noting that theory is the reason for, and the value of, evidence. The “evidence,” they stated, must extend beyond an emphasis on empirical research and RCTs to include evidence generated from theories. Indeed, the evidence itself refers to evidence about theories. Further, they contend that theory determines what counts as evidence; thus, theory and evidence are inextricably linked.

Theoretical Models of EBP

Numerous models of EBP have been developed by nurses to encourage translation of nursing research into practice. In many instances, the goal or intent is to create or establish EBP protocols, procedures, or guidelines. In some instances, universities and hospital groups have developed models to assist students or health care professionals in implementing EBP in their setting. In other instances, nurse researchers and scholars have interpreted the transfer of research evidence to nursing education and practice through processes that progressed from theory-based nursing, quality improvement, research utilization, and lately, evidence-based nursing practice. This section reviews five EBP models that are among the most frequently cited in the nursing literature. These have been widely studied and applied, many in multiple settings and for a variety of patient issues, situations, or nursing care processes. These models include:

·  Academic Center for Evidence-Based Practice Star Model (ACE Star Model) (Stevens, 2004)

·  Advancing Research and Clinical Practice Through Close Collaboration (ARCC Model) (Melnyk & Fineout-Overholt, 2011)

·  Iowa Model (Titler et al., 2001)

·  Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) (Newhouse, Dearholt, Poe, Pugh, & White, 2007)

·  Stetler Model of Evidence-Based Practice (Stetler, 2001)

These models can provide guidance for practicing nurses and advanced practice nurses to promote or enhance EBP and to develop practice guidelines, protocols, or interventions as appropriate. Each model will be described briefly and reviewed for its utility in nursing practice and education.

ACE Star Model of Knowledge Transformation

The ACE Star Model was developed by faculty at the University of Texas Health Science Center at San Antonio (UTHSCSA) (Stevens, 2004). The Star Model is depicted by five points of knowledge transformation. The five forms of knowledge transformation occur in “relative sequence” when research evidence progresses through several cycles and is combined with other knowledge and then applied in practice.

Each point of the star represents a step in a process. The step-wise depiction allows for easy comprehension and is therefore useful even for novice nurses. In order, the points are:

· 1. Discovery research

· 2. Evidence summary

· 3. Translation to guidelines

· 4. Practice integration

· 5. Process, outcome evaluation (UTHSCSA, 2012) ( Figure 12-2 )

Figure 12-2:Diagram of the ACE star model for evidence-based practice.

(Used with permission from Stevens, K. R. (2012). ACE Star Model: Knowledge transformation©. Academic Center for Evidence-Based Practice. Available at  http://www.acestar.uthscsa.edu/acestar-model.asp )

This sequence allows the nurse to move research-based knowledge from one point to the next in sequence to provide a translation of evidence on which to base practice (Stevens, 2004, 2005). Knowledge transformation consists of eight premises that underlie and explain the position of the researchers who created the model. These are presented in  Box 12-2 . The rigor of the process the nurse or committee uses is part of the value of the knowledge transformation that occurs when using this model.

Box 12-2: ACE Star Model: Knowledge Transformation—Underlying Premises

· 1. Knowledge transformation (KT) is necessary prior to using research results in clinical decision making.

· 2. KT derives from multiple sources, including research, experience, authority, trial and error, and theoretical principles.

· 3. Systematic processes control bias; the research process is the most stable source of knowledge.

· 4. Evidence can be classified into a hierarchy of strength of evidence depending on the rigor of the science that produced the evidence.

· 5. Knowledge exists in a variety of forms. As research is converted through a system of steps, other knowledge is created.

· 6. The form in which knowledge exists can be referenced to its use.

· 7. The form of knowledge determines its usability.

· 8. Knowledge is transformed through steps, such as summarization, translation, application, integration, and evaluation.

Abstracted from Stevens, K. R. (2012). ACE Star Model, UT Health Science Center, San Antonio.  http://www.acestar.uthscsa.edu/acestar-model.asp  (Accessed May 29, 2013).

The model is used at UTHSCSA hospitals, and their nursing program maintains a very detailed and informative online educational site ( http://www.acestar.uthscsa.edu/ ). The website provides an extensive online tutorial on the ACE Star Model complete with detailed information, resources, instructive videos, and slides. A quiz and a certificate of attendance are available for those completing instruction in the model (see  Link to Practice 12-2 ). The ACE Star Model is useful in teaching nurses and nursing students the process of research evidence utilization in practice (Schaffer, Sandau, & Diedrick, 2013). One concern or criticism of the ACE Star Model has been noted by White (2012), who pointed out that it does not use evidence other than research per se.

Link to Practice 12-2: ACE Star Model of Knowledge Transformation

Access the website, take the tutorial, and complete the quiz to obtain a certificate of completion of the program at  http://www.acestar.uthscsa.edu/acestar-model.asp . This Web site may be useful for teaching the elements of evidence-based practice to nursing students.

Advancing Research and Clinical Practice Through Close Collaboration Model

Melnyk and Fineout-Overholt (2002) developed the ARCC Model through their work with many health care institutions seeking to advance and sustain EBP. This development was a process that involved many iterations and empirical testing of key relationships. The framework of the ARCC Model is taken from control theory and cognitive behavioral theories, which help guide nurses’ behaviors as they gain acumen in EBP (Melnyk & Fineout-Overholt, 2011). Numerous studies and examples of how the ARCC Model has been implemented in clinical practice are available in the literature (Melnyk, 2002; Melnyk, 2004; Melnyk, Feinstein, & Fairbanks, 2002; Melnyk et al., 2011).

The AARC Model relates best to clinical practice, and much of the research supporting its development and implementation was conducted in acute care, pediatric settings. The central constructs are assessment of organizational culture and readiness for EBP, identification of strengths and major barriers to EBP, and development and use of EBP mentors. These constructs are done sequentially and followed by EBP implementation. Outcomes that should be evaluated include health care provider satisfaction, cohesion, intent to leave, turnover, improved patient outcomes, and hospital costs (Melnyk & Fineout-Overholt, 2011).

In employing the ARCC Model, the authors developed several scales to measure the ability to implement EBP. These are the Organizational Culture and Readiness Scale for System-wide Integration of Evidence-based Practice (OCRSIEP) and the EBP Beliefs scale (EBPB) (Melnyk & Fineout-Overholt, 2011). Organizational readiness is first assessed, and when feasible, mentors are identified and developed. The clinical nurses are then mentored through use of the ARCC system. Melnyk and Fineout-Overholt (2011) state that measuring the key constructs along with workshops and academic offerings assist organizations to adopt and sustain EBP. Finally, Melnyk and Fineout-Overholt (2011) developed a flow chart to assist in use of the model.  Box 12-3  gives examples of research that has been conducted employing the ARCC Model of EBP.

Box 12-3: Research Based on the ARCC Model of EBP

· O’Haver, J., Moore, I. M., Reed, P. G., Melnyk, B. M., & Savoie, M. (2010). Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis. Pediatric Nursing, 36(6), 284–291.

· Levin, R. F., & Lewis-Holman, S. (2011). Developing guidelines for critical protocol development. Research and Theory for Nursing Practice, 25(4), 233–237.

· Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410–417.

· Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Cruz, R. (2010). Correlates among cognitive beliefs, EBP implementation, organizational culture, cohesion and job satisfaction in evidence-based practice mentors from a community hospital system. Nursing Outlook, 58(6), 301–308.

· Thorsteinsson, H. S. (2013). Icelandic nurses’ beliefs, skills, and resources associated with evidence-based practice and related factors: A national survey. Worldviews on Evidence-Based Nursing, 10(2), 116–126.

The Iowa Model of Evidence-Based Practice to Promote Quality Care

The Iowa Model of EBP was developed in 1994 to promote quality care through research utilization. It is intended to provide guidance for nurses and others in making decisions about practice that affects patient outcomes. The Iowa Model incorporates starting points, which are nursing problems that are termed “triggers.” It continues through multiple decision points and feedback loops to provide for evaluation of any changes (Titler et al., 2001).

The model has been refined over time to produce the current iteration (Titler, 2004; Titler & Adams, 2010). The diagram of the model shows the starting points, decision points, and feedback loops. When implemented, it will assist in providing quality care to clients of clinics, home health agencies, and hospitals (Titler et al., 2001) (see  Figure 12-3 ). The Iowa Model is very detailed and specific and has been applied to address a number of clinical topics. It is also one of the best researched EBP models.  Box 12-4 shows some of the recent research studies that have us Figure 12-3: Diagram of the Iowa method of evidence-based practice.

(Reprinted with permission from University of Iowa Hospitals and Clinics. © 1998. For permission to use or reproduce the model, please contact University of Iowa Hospitals and Clinics at 319-384-9098.)

Box 12-4: Research Based on the Iowa Model of Evidence-Based Practice to Promote Quality Care

· Alexander, L., & Allen, D. (2011). Establishing an evidence-based inpatient medical oncology fluid balance measurement policy. Clinical Journal of Oncology Nursing, 15(1), 23–25.

· Bergstrom, K. (2011). Development of a radiation skin care protocol and algorithm using the Iowa Model of Evidence-Based Practice. Clinical Journal of Oncology Nursing, 15(6), 593–597.

· Chung, K., Davis, I., Moughrabi, S., & Gawlinski, A. (2011). Use of an evidence-based shift report tool to improve nurses’ communication. Medsurg Nursing, 20(5), 255–268.

· Hermes, B., Deakin, K., Lee, K., & Robinson, S. (2009). Suicide risk assessment: 6 steps to a better instrument. Journal of Psychosocial Nursing and Mental Health Services, 47(6), 44–49.

· Kowal, C. D. (2010). Implementing the Critical Care Pain Observation Tool using the Iowa Model. Journal of the New York State Nurses Association, 41(1), 4–10.

· Myrick, K. M. (2011). Improving follow-up after fragility fractures: An evidence-based initiative. Orthopaedic Nursing, 30(3), 174–181.

· Popovitch, M. A., Boyd, C., Dachenhaus, T., & Kusler, D. (2012). Improving stable patient flow through the emergency department by utilizing evidence-based practice: One hospital’s journey. Journal of Emergency Nursing, 38(5), 474–478.

The Johns Hopkins Nursing Evidence-Based Practice Model

The Johns Hopkins Nursing EBP (JHNEBP) Model was developed to accelerate the transfer of research to practice and to promote nurse autonomy, leadership, and engagement with interdisciplinary colleagues (Melnyk & Fineout-Overholt, 2011). The JHNEBP Model was designed as a problem-solving approach to clinical decision making. It combines elements of the nursing process, the American Nurses Association’s Standards of Practice, critical thinking, and research utilization processes (Newhouse et al., 2007). The model has numerous levels of activity, but it is based on practical teaching processes to promote use by novice nurses as well as more experienced nurses.

The JHNEBP process is based on three core elements: a practice question, evidence, and translation (PET) (Newhouse et al., 2007). As presented in  Box 12-5 , 18 steps are included in the model. As shown, each of the PET phases is based on several steps that clarify how the processes are to proceed.

Box 12-5: Steps of The Johns Hopkins Nursing Evidence-Based Practice Model (PET)

P: Practice Question Steps

· 1. Identify an EBP question (PICO).

· 2. Define the scope of the practice question.

· 3. Assign responsibility for leadership.

· 4. Recruit an interdisciplinary team.

· 5. Schedule a team conference.

E: Evidence Steps

· 6. Conduct an internal and external search for evidence.

· 7. Appraise all types of evidence.

· 8. Summarize the evidence.

· 9. Rate the strength of the evidence.

· 10. Develop recommendations for change in systems or processes of care based on the strength of the evidence.

T: Translation Method of Evidence-Based Practice Steps

· 11. Determine the appropriateness and feasibility of translating recommendations into the specific practice setting.

· 12. Create an action plan.

· 13. Implement the change.

· 14. Evaluate outcomes.

· 15. Report the results of the preliminary evaluation to decision makers.

· 16. Secure support from decision makers to implement the recommended change internally.

· 17. Identify the next steps.

· 18. Communicate the findings.

Source: Newhouse et al., 2007, pp. 42–47.

This method begins with an EBP question, and the first step is to generate an answerable Practice question which includes the patient, population, and the problem. It goes on to define an Intervention, makes a Comparison with other treatments if possible, and finally defines the desired Outcome (PICO) (Newhouse et al., 2007). Four other steps in the “practice question” phase include defining the scope of the question, assigning responsibility for leadership, recruiting a team, and scheduling conferences. In the evidence phase, literature searches and appraisal and recommendations come from the team (Newhouse et al., 2007).

In the third phase, translation, the team decides whether or not and how to implement the changes, evaluate any such implementation, and communicate the findings to appropriate individuals or groups (Newhouse et al., 2007). The JHNEBP Model is clearly explained and simple to apply. Related writings include the guidelines and definitions of the background, elements of the process, and the steps of the model (Newhouse et al., 2007).

Stetler Model of Evidence-Based Practice

The Stetler Model of EBP was initiated in the 1970s as a quality improvement (QI) effort using the research utilization (RU) ideals then in widespread use (Melnyk & Fineout-Overholt, 2011). Through several iterations, Stetler updated the approach and clarified the series of phases of the model such that it is readily implemented by practicing nurses and useful at the bedside (Stetler, Ritchie, Rycroft-Malone, Schultz, & Charns, 2007). Stetler and colleagues (1998) and Stetler and Caramanica (2007) argued that all research studies are not ready for use at the bedside. Further, they explained that alternative sources or evidence are necessary to fill the gaps in nursing research evidence.

The Stetler Model is similar to the nursing process; therefore, it is easily assimilated by practicing bedside nurses. The phases of the approach include preparation, validation, comparative evaluation/decision making, translation/application, and evaluation. It provides practitioners with stepwise directions for integrating research into practice. See  Table 12-1  for description of the phases. The Stetler Model incorporates five steps to generate a process that takes into account the many other facets of nursing and the clinical situation prior to using research findings in the nurse’s clinical practice. When implemented, the results should be systematically evaluated to track goal-oriented outcomes and proffer both formative and summative evaluation strategies. The major outcomes of RU or EBP should be improved patient results as well as enhanced professional practice (Stetler & Caramanica, 2007).

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Table 12-1: Phases of the Stetler Model

Theoretical Models: A Summary

The five EBP models described above are compared in  Table 12-2  on  page 272  using the following criteria:

Table 12-2: Comparison of Selected Models of EBP

·  Groups of health care professionals affected (Groups Affected)

·  Environmental factors in which the model is useful (Environment)

·  Analysis of the model (Analysis)

·  Implementation: barriers/facilitators (Implementation)

·  Evaluation of effectiveness identified by the model (Evaluation)

· As shown, there are a number of similarities among the models. Schafffer and colleagues (2013) recently compiled a review of models for organizational change based on EBP. Similar to what has been presented here, their overview examined the key features of six models with the view to change practice in organizations. Most of the models incorporate the steps of the research process in some way, and all the models are focused on bringing the best in safe and effective nursing care to their major focus: the patient, or recipient of nursing care. Nurses who are actively engaged in promoting EBP are encouraged to review these as well as other published models and to select the one that best fits their needs and desired outcomes.

Helen, the nurse from the opening case study, conducted a systematic review of neuromuscular illnesses and treatments using the Iowa Model of EBP. During this process, she came to better understand her illness and the treatments that would most likely forestall deterioration of her condition. The complexity and high level of information she accumulated through her review of the research guided by theories of EBP and PBE brought Helen to a level of practice where she could not only help herself but also her patients and clients. Following graduation, she based her clinical practice on the expertise she had gained through her extensive study of the research and practice in neuromuscular diseases.

Summary

There is little doubt that EBP has become one of the key tenets of quality nursing care. As described, however, it is critical to remember that EBP must go beyond research per se and emphasis on RCT but must also be theory based. Indeed, the growing attention to the concept of PBE has renewed attention to the essential role of theory in excellent nursing practice. Many authors have written about the problems and barriers to EBP, and others have written on how to strengthen the process and make it relevant to practicing nurses.

Over the last decade, a number of models have been constructed to assist nurses to learn how to proceed in the development of evidence-based guidelines and promotion of EBP, as illustrated by the work of Helen in the case study. The five models described here, along with a number of others that have been mentioned in the nursing literature, give nurses information about the steps and processes necessary to elicit the evidence that is needed to provide safe, effective interventions that are effective in nursing practice. Nurses who seek to use research in their clinical areas are advised to seek out a working model of EBP and follow it through to effect reasonable, safe, and effective changes for the benefit of their patients or clients.

Key Points

·  In nursing, research, theory, and practice are integrated; EBP is a key element and outcome of that linkage.

·  EBP is an approach to problem solving that uses the current best evidence in the care of patients.

·  In nursing, EBP has been defined as “the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery … in consideration of individual needs and preferences.”

·  Nursing as a profession has been relatively slow to incorporate EBP; that has changed in recent years.

·  Many nurses are concerned that too much attention to EBP will draw attention away from the art of nursing care—that nursing will become lost in the science.

·  Models of EBP have developed from early studies of research utilization and quality improvement. Many of these models have been developed with the impetus of hospitals or educational institutions’ support.

·  The major impetus for integration and implementation of research evidence—guided by EBP—should be reasonable, effective, and safe care for patients.

· REFERENCES

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· Hudson, K., Duke, G., Haas, B., & Varnell, G. (2008). Navigating the evidence-based practice maze. Journal of Nursing Management, 16(6), 409–416.

· Huston, C. J. (2011). Professional issues in nursing: Challenges & opportunities (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.

· Ingersoll, G. L. (2000). Evidence-based nursing: What it is and what it isn’t. Nursing Outlook, 48(4), 151–152.

· Jennings, B. M., & Loan, L. A. (2001). Misconceptions among nurses about evidence-based practice. Journal of Nursing Scholarship, 33(2), 121–127.

· LoBiondo-Wood, G., & Haber, J. (2010). Integrating the processes of research and evidence-based practice. In G. LoBiondo-Wood & J. Haber (Eds.), Nursing research: Methods, critical appraisal, and utilization (7th ed., pp. 5–26). St. Louis: Mosby.

· McKenna, H. P., & Slevin, O. D. (2008). Nursing models, theories and practice. West Sussex, United Kingdom: Blackwell Publishing.

· Melnyk, B. M. (2002). Strategies for overcoming barriers in implementing evidence-based practice. Pediatric Nursing, 28(2), 159–161.

· Melnyk, B. (2004). Sparking a change to evidence-based practice in health care organizations. Evidence-Based Nursing, 1(2), 83–84.

· Melnyk, B. M., & Fineout-Overholt, E. (2002). Key steps in implementing evidence-based practice: Asking compelling, searchable questions and searching for the best evidence. Pediatric Nursing, 28(3), 262–266.

· Melnyk, B. M., & Fineout-Overholt, E. (2011). Making the case for evidence-based practice and cultivating the spirit of inquiry. In B. M. Melnyk & E. Fineout-Overhold (Eds.), Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed., pp. 3–24). Philadelphia: Lippincott Williams & Wilkins.

· Melnyk, B. M., Feinstein, N. F., & Fairbanks, E. (2002). Effectiveness of informational/behavioral interventions with parents of low birth weight (LBW) premature infants: An evidence base to guide clinical practice. Pediatric Nursing, 28(5), 511–516.

· Melnyk, B. M., Fineout-Overholt, E., Feinstein, N. F., Li, H., Small, L., & Kraus, R. (2004). Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews on Evidence-Based Nursing, 1(3), 185–193.

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· Newhouse, R. P., Dearholt, S. Poe, S., Pugh, L. C., & White, K. (2007). Organizational change strategies for evidence-based practice. Journal of Nursing Administration, 37(12), 552–557.

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SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Evidence-Based Practice in Nursing

Assignment: Evidence-Based Project, Part 5: Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

In this Assignment, you will identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

To Prepare:

• Reflect on the four peer-reviewed articles you critically appraised in Module 4.
• Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
  • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
  • An explanation about what you learned from completing the evaluation table (1 slide)
  • An explanation about what you learned from completing the levels of evidence table (1 slide)
  • An explanation about what you learned from completing the outcomes synthesis table (1 slide)

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – Evidence-Based Practice in Nursing

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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