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Evidence Based Practice Models in Nursing Essay

Evidence Based Practice Models in Nursing Essay

Evidence Based Practice Models Assignment Instructions Purpose

The purpose of this assignment is to identify a conceptual model for your DNP Project. [Module 2 Objective 3]

Read about the various EBP models in Chapter 13 in the Melnyk text.
Choose one model you believe to be applicable/best suited to your own topic. Evidence Based Practice Models in Nursing Essay.
Seek out additional articles and/or research/QI projects that have used the model as their framework.
Describe the model.

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Explain how you will use it step by step to guide/inform your project (e.g., how will you apply each step of this model to your own proposed project).
The paper should be approximately 4-5 pages (without the references) APA style.
First in 2-3 paragraphs in your own words, compare and contrast the eight models presented in Melnyk & Fineout-Overholt Chapter 13. No tables please. Synthesize across the models as opposed to giving annotated/individual summaries of each one.
Discuss the model that you’ve chosen and explain:
Why you chose this model – why is it applicable to your project. Evidence Based Practice Models in Nursing Essay.
The details of the model in your own words, where it originated, etc. Utilize primary sources from the literature as opposed to the secondary information/source in the Melnyk text.
How you would apply this model to your project (i.e., how you will apply each step of the model to each step of your proposed project)?
[You will later incorporate this information into your DNP project paper, as directed by your DNP Project Chair].

EBP Models
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeNarrative Structure & Logic
20.0 ptsExcellent

Section headings are present, manuscript well-organized, coherent and easy to follow progression of arguments/ideas

17.0 ptsAbove Satisfactory

Some structure present in manuscript and some natural progression of thoughts and ideas

15.0 ptsSatisfactory

Structure is choppy/disorganized; logic somewhat difficult to follow.

0.0 ptsBelow Satisfactory

Lack of structure; logic missing

20.0 pts
This criterion is linked to a Learning OutcomeUnderstanding of theory / concepts
30.0 ptsExcellent

Concepts and theories are clearly defined, information synthesized, and illustrated with examples.

25.5 ptsAbove Satisfactory

Concepts and theories discussed, but not well-synthesized.

22.5 ptsSatisfactory

Concepts and theory are correct, but only text book definitions and no elaboration.

0.0 ptsBelow Satisfactory

Incompletely describes concepts and constructs of models.

30.0 pts
This criterion is linked to a Learning OutcomeApplication of Model to Proposed Project
30.0 ptsExcellent

Discusses why the theory chosen is applicable to the proposed project; discusses how each step in the model chosen relates to proposed project steps. Evidence Based Practice Models in Nursing Essay.

25.5 ptsAbove Satisfactory

Discusses why the theory was chosen; articulation of how this model relates to the proposed project could be more explicit.

22.5 ptsSatisfactory

Minimal discussion why the theory was chosen; each step is discussed, though limited application to proposed project steps.

0.0 ptsBelow Satisfactory

No elaboration of model steps in relation to project steps

30.0 pts
This criterion is linked to a Learning OutcomeMechanics APA
20.0 ptsExcellent

<3 Writing or APA errors. 17.5 ptsAbove Satisfactory 3 writing or APA errors. 15.0 ptsSatisfactory 4 writing or APA errors. 0.0 ptsBelow Satisfactory >4 writing or APA errors.

20.0 pts
Total Points: 100.0

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Evidence Based Practice Models

Evidence-Based Practice (EBP) Models in nursing are organized to evaluate how aspects of EBP influence outcomes and advance patient care.  Research utilization is the “use of research knowledge in clinical practice” (Dang et al., 2015, p. 275).  The overarching characteristic in EBP models is encouraging nurses in the decision-making process to contemplate factors multi-dimensionally.  These include internal and external influences: 1) clinical state and circumstances; 2) patient preferences and actions; 3) research evidence; and 4) healthcare resources (Dang et al., 2015). Evidence Based Practice Models in Nursing Essay.  Eight identified models will be compared identifying similarities and distinct differences in the model designs.  The conceptual models will guide the process in changing practice and incorporating the multidimensional framework to assure process organization, strengthen the evidence, and implement the change.

The eight models as described by Dang et al., (2015) are differentiated by the focus of the intended user of the theoretical framework and results.  All the models systematically add organization to the method to change practice and lead the clinicians in applying and sustaining EBP.  The Stetler Model is practitioner focused, the Clinical Scholar Model, Model for EBP Change, and Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) models support bedside nurses.  Other models offer a step by step approach that leads to organizational change as described in the Iowa Model for EBP to Promote Quality Care, Stetler Model, the Model for EBP Change, and Promoting Action on Research Implementation in Health Services (PARIHS) model.  Advancing Research and Clinical practice through close Collaboration (ARCC©) is a broad systemwide approach for healthcare settings that creates a culture of EBP as a standard of care.  Both ARCC© and the Clinical Scholar Model support EBP mentors or a mentorship program to guide and support a spirit of inquiry, EBP culture, and an environment supportive of EBP that can be applied to nursing practice. Evidence Based Practice Models in Nursing Essay.

The synthesis of evidence as illustrated by the ACE Star Model, the JHNEBP Model, Clinical Scholar Model, and the Iowa Model of EBP to Promote Quality Care is essential in identifying a change in practice, determines reliability, and links outcomes to practice.  Sustaining practice as a standard of care of best practice is outlined by ARCC©.  Only when a culture, an environment, leaders, administrators, and point of care providers espouse EBP in a readiness state can an organization begin to witness the outcomes of evidence-based practice.  The models have a spirit of inquiry, ask EBP questions, search and synthesize literature, translate research and outcomes, disseminate findings of evidence, transform and sustain the practice, and triangulate patient preference in the decision-making process.  The various models and the conceptual framework of each model “guides the design and implementation of approaches intended to strengthen evidence-based decision making and help clinicians implement an evidence-based change in practice” (Titler et al., 2001, p. 502). Evidence Based Practice Models in Nursing Essay.

The Iowa Model of Evidence-Based Practice to Promote Quality Care (hereafter known as the Iowa Model) was developed by nurses in the 1990’s at the University of Iowa’s Department of Nursing to guide research findings and apply to patient care.  The model was investigative, combining Roger’s 1983 theory of Diffusion of Innovations and was an extension of quality assurance that was by means of research.   Initially the authors of the model incorporated strategies from successful research utilization.  Over time, evidence-based practice advanced with development of sophisticated research synthesis, diffusion of best practice was enhanced, and the model was revised in 2001. Evidence Based Practice Models in Nursing Essay.  The Iowa Model adopted the definition of EBP as “the conscientious and judicious use of current best evidence to guide health care decisions” (Titler et al., 2001, p. 502).

The Iowa Model will be used as the framework for my project titled Impact of Bedside Shift Report on Patient Satisfaction with Nursing.  The model and step by step approach will assist in organizing and tracking the evidence of bedside shift report (BSR) into practice and monitoring the outcomes of patient satisfaction with nursing.  The framework allows nurses to make ordinary decisions in the day to day practice such as bedside report during transitions of caregivers, is intuitive, and suggests ease in understanding for all nurses.  The framework allows other sources of evidence to guide the practice.  Furthermore, the revised Iowa Model incorporates “reporting structural, process, and outcome data to internal networks illustrates value of EBP activities” to disciplines other than nursing, administration, and peers (Titler, et al., 2001, p. 507).

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

The 11 step framework of the Iowa Model is outlined to demonstrate the applicability of the model to the proposed project of BSR and the impact of patient satisfaction with nursing.

Triggers

The new knowledge focused triggers of the project include process improvement data associated with poor nursing domain patient satisfaction results in the organization’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.  External benchmarking of the HCAHPS, the financial impact and risk of poor performance, and harm to the patient place the organization at risk.  Deviations from organizational goals to improve communication and outcomes, decrease serious safety events, and improve the financial impact of such deviations prompted the BSR project. Evidence Based Practice Models in Nursing Essay.

Priority of the Topic

A new decision point in the model is aligning a project as a top priority of the organization.  One of the five top priorities of the organization are to improve overall patient satisfaction as evidenced by the HCAHPS scores.  The executive organizational leaders have embraced and supported EBP and the BSR project as a priority across the organization.         

Forming a Team

The proposed project team will be multidisciplinary incorporating nurse managers both inpatient and procedural, surgical services, unit educators, Department of Excellence, Educational Services, staff nurses, physicians, VOICE Congress, and nurse executive sponsor.  The proposed project team executive sponsor will sit on the organization’s Quality Management Committee. Evidence Based Practice Models in Nursing Essay.  The project team is designed to investigate, develop, implement, and evaluate the EBP.

Assemble Relevant Research and Related Literature

The committee will retrieve relevant literature utilizing available resources in the organization to include recent systematic reviews of handoff, bedside report, impact on patient satisfaction, and evidence-based guidelines for nursing handoff and relevant findings.  The proposed Iowa Model step aligns with the assembled literature of the 2016 systematic review, National Clearinghouse Guideline, using key search terms of bedside report, handoff, patient satisfaction in the database search.

Critique and Synthesis of Research

The critique and synthesis of the literature is crucial in determining the validity and reliability of the studies.  The intent of the Iowa model in this step is to “understand the state of the practice and science” (Titler et al., 2001, p. 504).  Synthesizing and the decision to incorporate studies includes overall science merit, type of subjects in the study, and clinical relevance.  The strength of the BSR studies and overall outcome measures will be evaluated in the synthesis of the studies. Evidence Based Practice Models in Nursing Essay.  Several systematic reviews have been conducted on BSR with outcomes and satisfaction results reported.          

Is There Sufficient Research to Guide Practice?

Synthesis methods as described in the Iowa Model include criteria of appraising consistency of findings, quality and type of studies, clinical relevance for the practice, number of studies with sample characteristic that align with the proposed project, feasibility for practice, and risk to benefit associated with practice change.  The handoff and BSR literature search has produced thousands of articles, research studies, and improvement projects that are relevant to the proposed project.  The framework considers a step in insufficient research to guide practice which is not the case in the BSR project. Evidence Based Practice Models in Nursing Essay.

Pilot the Change in Practice

Utilizing a pilot to assess feasibility and effectiveness using the established guidelines in the practice setting is prudent to ascertain the likelihood of achieving desired outcomes prior to organization-wide deployment.  This step is relevant in the BSR project as the proposed population will include two medical surgical units in the organization to pilot before the adoption of the practice guideline.  Identified steps include selecting outcomes to measure, collection of baseline data, written EBP guideline, trailing the guideline on one or two units, evaluating the process, guidelines and modifying according to the evaluation data.  This aligns with the proposed BSR and measuring the patient satisfaction nursing domain data results.

Adoption of Practice

The adoption of the practice or decision not to adopt is based on the results of the piloted EBP.  This step will evaluate expected to data outcomes, and the decision to adopt and spread will also be determined.  The new knowledge introduced will continue to stimulate process change, and if the results do not support the change, a cycle of new knowledge and innovation for practice change will continue to be evaluated and trialed.  At this juncture a consideration of “expert opinion, scientific principles, or theory can be used to determine best practice” (Titler et al., 2001, p. 507). Evidence Based Practice Models in Nursing Essay.

Institute the Change in Practice

Instituting a change in practice for an organization is dependent on the evidence of the pilot.  Facilitating the practice adoption includes organizational support, policy, education of the practice, ownership by nursing, perception the clinical practice improves the quality of care, and timeline to complete the previous steps.  The proposed project, if proven relevant based on the data, will incorporate the steps listed to create a sustained change in practice with supporting data that is shared and associated with the BSR.     

Monitor and Analyze Structure, Process, and Outcome Data

The BSR will be monitored for sustainability and patient satisfaction results.  The evaluation of the data and sustainability of the practice of BSR is critical in that the literature outlines sustainability in a practice change is challenging while an organization enculturates staff in the standard work of BSR (Ford & Hymen, 2017; Scheidenhelm & Reitz, 2017).  Additional secondary outcome measures may include financial, environmental, and structural that is important to other disciplines such as administration, policy creators, or providers (Titler et al., 2001). The BSR project literature provided secondary evidence of the financial impact and savings to organizations with operational costs (Mardis et al., 2016).  Evidence Based Practice Models in Nursing Essay. This bolsters EBP support for the present and future studies.

Disseminate Results

The final step in the Iowa Model is the dissemination of EBP and outcomes in the local sector, national organizations, conferences, and journals. Incorporating scientific evidence, EBP, and sharing outcomes demonstrates the applicability of the findings and the development of nursing researched-based guidelines.

The Iowa Model of Evidence-Based Practice to Promote Quality Care is the framework of choice as it will organize, guide and strengthen the design and approach of the BSR and impact on patient satisfaction with nursing.

Evidence Based Practice Models References

Dang, D., Melnyk, B. M., Fineout-Overholt, E., Ciliska, D., DiCenso, A., Cullen, L., … Stevens, K. R. (2015). Models to guide implementation and sustainability of evidence-based practice. In B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed., pp. 374-315). Philadelphia, PA: Wolters Kluwer.

Ford, Y., & Heyman, A. (2017). Patients’ perceptions of bedside handoff: Further evidence to support a culture of always. Journal of Nursing Care Quality, 32, 15-24. https://doi.org/10.1097/NCQ.0000000000000201

Kowal, C. D. (2010). Implementing the critical care pain observation tool using the Iowa model. Journal of the New York State Nurses Association, 4-10. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=6&sid=9fb3e51e-c1a5-4ad8-aa01-2031d0fe995b%40sessionmgr4009. Evidence Based Practice Models in Nursing Essay.

Mardis, T., Mardis, M., Davis, J., Justice, E. M., Riley-Holdinsky, S., Donnelly, J., … Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs: A systematic review of the literature. Journal of Nursing Care Quality, 31, 54-60. https://doi.org/10.1097/NQT.0000000000000142

Scheidenhelm, S., & Reitz, O. E. (2017). Hardwiring bedside shift report. The Journal of Nursing Administration, 47, 147-153. https://doi.org/10.1097/NNA.0000000000000457. Evidence Based Practice Models in Nursing Essay.

Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, L. Q., … Goode, C. J. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13, 497-508. Evidence Based Practice Models in Nursing Essay.

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