Types of Nursing Models and Frameworks of EBP

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What are some of the models and frameworks of EBP currently in use? How does the strength of the evidence determine translation into practice? Why is it important to integrate both evidence-based practice and patient and family preferences? What is the nurse’s responsibility when EBP and patient and  family practice do not match?

Identifying Research and Evidence-Based Practice and Quality Improvement models

There are many challenges in nursing today. As a registered nurse, you practice in complex and ever-changing environments. You must be knowledgeable about these changes in order to ensure that your nursing practice evolves in a positive direction. Healthcare professionals must be educated to deliver patient-centered care while functioning as members of interdisciplinary teams. Ability to analyze and synthesize research, integrate evidence-based practice (EBP), quality improvement (QI) approaches, and informatics are all critically important for patient safety and improved patient outcomes. The approach to changing the current situation or problem depends on many factors, such as your facility preference, and the setting or the type of problem itself.

Why should nursing focus on raising the standard or bar of practice? By raising the bar, quality, safe, patient-centered care can be administered in an environment where nurses can provide the best nursing care, think critically, ask clinical questions, and initiate change to improve outcomes for the patients and themselves. During this course, we’ll consider healthcare environments and problems within these environments as well as what can be done to resolve these problems. As you read this material, consider your experience with these types of situations. You will reflect on how to verify the dimensions of a problem within your work setting. As you reflect, try to identify specific strategies that might be used to produce a more positive outcome.

So, what are research, EBP, and QI, and what are the differences?

Research requires systematically investigating numerous sources and materials over time in order to establish new conclusions for a problem. This can take years to be able to come up with the best conclusion to report.

EBP uses current best conclusions or evidence produced by current research efforts to make decisions about patients’ care.

QI consists of a systematic and data -driven approach to find measurable improvement in healthcare services, processes, and outcomes (Conner, 2014).

There are four QI principles.

· QI work as systems and processes

· Focus on patients

· Focus on being part of a team

· Focus on the use of data

See if you can correctly choose the correct principles in the exercise below.

View the models below and determine if it is Research, EBP or QI

Enter “1” for Research, “2” for EBP, and “3” for QI in the space provided.

The input textbox will turn green if you enter the correct answer and red if you enter the wrong answer.

Improve diabetes rates in American Indian populations

Effect of education for prevention of readmission of heart failure

Effect of routine aspirin in prevention of myocardial infarction

Improve process for education for patients with kidney disease

Prenatal breast-feeding education and effect on breast-feeding rates

Improve discharge process

Obesity in school children

Transcript

Moving Nursing Research Into Evidence-Based Practice to Improve Patient Outcomes

Whenever an issue seems to be a problem, one of the first steps in addressing the issue is assessment of the presence, extent, and seriousness of the issue. In some healthcare organizations today, there are individuals, committees, and departments charged with collecting data related to identifying problems, tracking the data over time, and establishing strategies for improving the outcomes related to problem areas.

What about the bedside nurse? What can the nurse do to move newly discovered knowledge onto the clinical setting much quicker than waiting for a long, proper procedural committee to take action?

The first activity in this internal data collection process is to recognize that a situation exists with the potential to create a problem in a structure or process that can affect the outcome of providing care. The next activity is to identify the possible data that verify the existence of the problem, as well as the extent, causes, and consequences of the problem. The third activity is analysis of the data—a method that reveals whether the problem is related to the structure (building, equipment, personnel) or the processes (policies and procedures) of the healthcare organization. This analysis leads directly to the identification of the specific nature of the problem.

In order to verify the extent of the problem, the internal data should be compared to relevant data from other sources. These sources can be within the institution itself or extracted from outside sources. For example, similar data from different departments might be compared to identify variations in outcomes. Or data may be compared to another organization that provides similar services in the local or regional market. At the national level, an organization can compare its performance against data collected and published by official agencies or in research reports.

Reflection

Think about how you would go about identifying a problem or area that needs to be changed within your work environment. Then consider how you would collect data to determine the extent of the problem.

Overview of Different EBP Models

Although no one likes change, it often becomes necessary to try new strategies for improvement due to newly discovered research. New research on the topic of interest gives us a broader look at possibilities that could possibly improve our way of delivering nursing care.

As with anything else, we need to know what we are going to do and how we are going to accomplish it, such as with a road map, a set of directions, or a blueprint. Nursing models give us direction and are what we will use to change practice. These models are specifically designed for nursing situations in many aspects of nursing and nursing settings.

Evidence-based nursing models include, but are not limited to, the following.

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNNEBP) (Dearholt & Dang, 2012) has a main focus of translation of research into practice. This model has a team approach to determining the evidence-based question for inquiry. The model uses three major steps.

· P: Practice question

· E: Collection of evidence

· T:  Translation of the evidence to use in practice

The Stetler Model (Schaffer, Sandau, & Diedrick, 2013) considers characteristics of individual evidence-based users. This model focuses on critical thinking and emphasizes evaluation of the evidence. In this model, evidence may include data from the consensus of experts or quality improvement data.

According to Schaffer, Sandau, and Diedrick (2013), the Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model emphasizes evidence-based implementation at a system level. One of the major differences in this model is the use of an EBP mentor. The focus is on the organizational environment but with less emphasis on evidence appraisal.

Schaffer, Sandau, and Diedrick (2013) identify that the EBP Iowa Model focus is at the organizational level. The model has defined decision points and feedback loops represented as an algorithm. The model addresses translation and implementation of EBP.

Finally, the Promoting Action on Research Implementation in Health Services Framework (PARIHS) model has three elements: evidence, context, and facilitation. This model has applicability for engaging stakeholders (Schaffer, Sandau, & Diedrick, 2013).

The ACE Star Model of Knowledge Transformation (Schaffer, Sandau, & Diedrick, 2013) is defined as an interdisciplinary approach for translating research into practice and attaining quality improvement. The model, which is illustrated above as a five-point star, has five steps that represent

1 discovery of new knowledge;

2 summary of the evidence;

3 translation of the evidence;

4 integrating change into practice; and

5 evaluation of the change.

This sounds very similar to the nursing process that bedside nurses are familiar with in practice, doesn’t it?

Summary

Not all nursing models of EBP will fit all organizations. Nursing models help guide nurses into planning an EBP or change projects in the most productive manner. The ACE Star Model focus is on knowledge transformation and this is one model that bedside nurses can identify with because it so closely resembles the nursing process. We will be discussing the ACE Star Model’s five points next week!

References

Conner, B. T. (2014). Differentiating research, evidence-based practice and quality improvement. American Nurse Today, 9(6). Retrieved from https://americannursetoday.com/differentiating-research-evidence-based-practice-and-quality-improvement/

Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International.

Gawlinski, A., & Rutledge, D. (2008). Selecting a model for evidence-based practice changes: A practical approach. AACN Advanced Critical Care, 19(3), 291–300. Retrieved from http://www.kau.edu.sa/Files/0004020/Subjects/EBP%20Changes%20project.pdf#page=6&zoom=auto,-116,706

QI Guide on Improved Nursing Care. (2015).  Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). Retrieved from http://www.ahrq.gov/professionals/systems/monahrq/myqi/nursing.html

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197–1209. doi:10.1111/j.1365-2648.2012.06122.x

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