must consider how the topic under discussion correlates with organizational and departmental goals and priorities when formulating the question. Such correlation is essential if nurses expect to obtain the support of the organization’s leadership (Dang et al., 2022; Melnyk & Fineout-Overholt, 2019). Evidence Evidence, the second phase, addresses the “search for, appraisal of, and synthesis of best available evidence. Based on these results, the team makes recommendations regarding practice changes” (Dang et al., 2022). Translation During the third phase, translation, it is determined whether changes to practice are feasible, appropriate, and a good fit for the organizational setting. If so, an action plan is created, implemented, and evaluated. The results are communicated to appropriate persons within and outside of the organization (Dang et al., 2022). The Iowa Model of Evidence-Based Practice The Iowa Model of Evidence-Based Practice focuses on guiding clinicians at all levels of practice through a team-based, multiphase process according to the following phases (Iowa Model Collaborative, 2017): ● Identify triggers, issues, or opportunities. ● Evidence review, critique, and synthesis. ● Change implementation through piloting. ● Identify and sustain practice change. ● Outcome dissemination. The Iowa model identifies the following “triggers” for an EBP endeavor (Melnyk & Fineout-Overholt, 2019): ● Clinical or patient-identified issue. ● Organization, state, or national initiative. ● Data or new evidence. ● Accrediting agency requirements and regulations. ● Philosophy of care. These triggers activate paths that include decision points with evaluative feedback loops when identifying and implementing ● State the question or purpose. ● Interprofessional team formation. The Stetler model was initially developed to focus on research utilization. The model has been updated and refined to fit into the EBP paradigm, emphasizing helping nurses assess how research findings can help guide and improve clinical practice. The focus is on practitioner expertise, context, and evidence, as well as on the translation of evidence into practice (Melnyk & Fineout-Overholt, 2019; National Collaborating Centre for Methods and Tools, n.d.). The Stetler model consists of the following five phases (Melnyk & Fineout-Overholt, 2019; National Collaborating Centre for Methods and Tools, n.d.): 1. Preparation includes purpose, relative assessment, and the search for sources of evidence. 2. Validation of evidence involves validating evidence found in sources, such as the subject literature and quality improvement data. 3. Comparative evaluation/decision making involves critiquing, synthesizing, and deciding to use the evidence while considering internal factors, such as organizational practices and expertise of individual EBP clinicians, and external factors, such as research protocols and organizational standards. 4. Refinements guide the translation of evidence into clinical practice. 5. Evaluation involves assessing the impact of change, including outcomes met and the degree to which the practice change was implemented. Star Model of Knowledge Transformation The Star Model of Knowledge Transformation depicts the relationship between different stages of knowledge as newly practice changes. The Stetler model
discovered knowledge is moved into practice (School of Nursing UT Health Science Center San Antonio, 2015). The five stages of the model are referred to as star points (School of Nursing UT Health Science Center San Antonio, 2015): ● Star Point 1: Discovery research : Star Point 1 is the knowledge-generating stage. New knowledge is discovered through scientific inquiry and traditional research investigations. ● Star Point 2: Evidence summary : Evidence summary is also a knowledge-generating stage during which research knowledge is synthesized into a single meaningful statement of the state of the science. The evidence summary reduces large amounts of information into a manageable format. ● Star Point 3: Translation to guidelines : Transformation requires translating evidence into practice recommendations and integrating these recommendations into practice. The goal of translation is to provide useful and relevant summarized evidence for clinicians and clients. ● Star Point 4: Practice integration : Practice Integration involves changing individual and organizational practices through formal and informal methods. Important concepts addressed in this stage are factors that impact the individual and organizational rate of implementing changes in practice. ● Star Point 5: Outcome evaluation : Outcome evaluation is the final stage in knowledge transformation. Factors to be evaluated are the impact of EBP on patient health outcomes, provider and patient satisfaction, efficacy, efficiency, economic analysis, and health status impact. As new knowledge progresses through the five stages, the final desired outcome is evidence-based quality improvement of healthcare. Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model The ARCC model was developed to provide healthcare organizations with an organized conceptual framework for guiding systemwide implementation and sustaining EBP. The ultimate goal is to facilitate the achievement of quality outcomes. The ARCC model emphasizes sustainability throughout the organization and consists of the following five steps (Melnyk & Fineout-Overholt, 2019): 1. Assessment of the organizational culture and preparedness to implement practice changes. 2. Identification of organizational strengths as well as barriers to implementation of the EBP. 3. Identification of EBP mentors. 4. Implementation of the evidence into organizational practice. 5. Evaluation of outcomes because of practice change. Nursing consideration: The ARCC model emphasizes the importance of mentors and EBP for organizational effectiveness. Nurses who use this model of EBP must be willing to work with mentors and incorporate organizational culture as part of practice change (Melnyk & Fineout-Overholt, 2019). Promoting Action on Research Implementation in Health Services Framework (PARiHS) The PARiHS framework is often used as an “organizing or conceptual framework to help both explain and predict why the implementation of evidence into practice is or is not successful” (Harvey & Kitson, 2016). The PARiHS framework emphasizes the need for appropriate facilitators trained in implementing the framework. Effective facilitation increases the likelihood of successful implementation (Harvey & Kitson, 2016). The PARiHS framework was developed and revised over several years by several authors. The framework consists of several vital constructs (Harvey & Kitson, 2016; Melnyk & Fineout-Overholt, 2019).
Page 154
Book Code: AUS3024
EliteLearning.com/Nursing
Powered by FlippingBook