3.2 Models of EBP

Question 1

EBP Models

Answer 1

• Specifically designed to facilitate the use of best evidence in nursing practice

Ex
- Finding research studies
- Finding evidence from qualitative/quantitative studies
- Finding evidence from case reports and practice guidelines

• There’s not always adequate evidence from research studies to apply to practice so we also use case reports and expert guidelines.

Question 2

EBP Models

Answer 2

• Translates knowledge to real-life nursing.
• Problem solving framework in clinical setting.

Question 3

Johns Hopkins EBP Model

Answer 3

PET

Practice question
1. Recruit an interprofessional team
2. Develop and refine the EBP question
3. Define the scope of EBP question and identify stake holders
4. Determine responsibility for project leadership
5. Schedule team meetings

Evidence
6. Conduct internal and external search for evidence
7. Appraise the level of quality of each piece of evidence
8. Summarize the individual evidence
9. Synthesize overall strength and quality of evidence
10. Develop recommendations of change based on evidence synthesis
- Strong, compelling evidence, consistent results
- Good evidence, consistent results
- Good evidence, conflicting results
- Insufficient or absent evidence

Translation
11. Determine fit, feasibility, and appropriateness of recommendations for translation path
12. Create action plan
13. Secure and support resources for action plan
14. Implement action plan
15. Evaluate outcomes
16. Report outcomes to stakeholders
17. Identify next steps
18. Disseminate results

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Question 4

Steven Star Model

Answer 4

Knowledge Transformation

1. Discovery Research
2. Evidence Summary
   - Synthesize/summarize all the research together
3. Translation to Guidelines
   - Clinicians sit down, look at the summaries of evidence, and add clinical expertise to missing research
   - The outcome of this is a clinical practice guideline based on best available evidence combined with clinical expertise
4. Practice Integration
   - How to integrate the guideline into practice.
   - Patient advocacy is important here
5. Process, outcome, evaluation
   - Did we produce the impact that we wanted to in clinicians providing care, in the patient satisfaction, and in organization.
   - How do we maintain new practice without going back to old habits.
   - Benchmarks are a way of telling us how well new practice is working.

Question 5

Iowa Model

Answer 5

• Problem that occurs that can be improved
• During literature review, if not sufficient evidence is found, consider conducting a study. Combine these studies with existing knowledge to develop and implement these practices. If a study is not feasible, using case reports, scientific principles, and theories can be used.

Question 6

Similarities between EBP models

Answer 6

• Johns Hopkins and Steven Star model both use physician/nursing champions as strategies for implementation of new practices.
• They also both show audit feedback to offer reflective practice.

Key Stakeholders
- Individual clinicians (they have alot of stake giving up their old practice for new)
- Care teams (adjusts and bounces off each other as a microsystem to hold steady the practice that is in place)
- Organizational level (policy and procedures)
- External Environment of policy

Both emphasize the importance of a team approach. Both agree that a multidisciplinary approach needs to be taken to change practice.

Question 7

Steven Star Model Change Management

Answer 7

Step 1 - Create a sense of urgency
Step 2 - Building a guiding team
Step 3 - Develop a change vision & strategy
(Shared mental model)
Step 4 - Understanding and buying in
(Getting people who aren’t early adopters get on board)
Step 5 - Empower others
Step 6 - Short term wins
Step 7 - Be Relentless
Step 8 - New Culture