Compare and contrast two EBP models

Compare and contrast two EBP models ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Compare and contrast two EBP models 1) Compare and contrast two EBP models. 2) Discuss which would most likely work in your agency or clinical unit. Compare and contrast two EBP models 3) Explain why one model would work better than the other with your colleages or you organizational culture. 4) Supports your answer with reference YOU CAN PICK TWO OF THE FOLLOWING: 1)ACE Star Model 2) ARRC Model 3) Iowa Model 4) Johns Hopkins EBP Model 5) Stetler Model I WORK IN URGENT CARE COMMUNITY HEALTH CENTER WHERE POPULATION IS MOSTLY UNINSURED PEOPLE , HISPANIC WITH LOW INCOME LOW EDUCATIONAL LEVEL. PLEASE LET ME KNOW IF YOU NEED MORE INFO attachment_1 attachment_2 JAN JOURNAL OF ADVANCED NURSING DISCUSSION PAPER Evidence-based practice models for organizational change: overview and practical applications Marjorie A. Schaffer, Kristin E. Sandau & Lee Diedrick Accepted for publication 19 July 2012 Correspondence to M.A. Schaffer: e-mail: [email protected] Marjorie A. Schaffer PhD RN Professor of Nursing Bethel University, St. Paul, Minnesota, USA Kristin E. Sandau PhD RN CNE Professor of Nursing Bethel University, St. Paul, Minnesota, USA Lee Diedrick MAN RN C-NIC Clinical Educator Children’s Hospitals and Clinics of Minnesota, St. Paul, Minnesota, USA S C H A F F E R M . A . , S A N D A U K . E . & D I E D R I C K L . ( 2 0 1 3 ) 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 Abstract Aim. To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature. Background. The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting. Data sources. The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of ‘evidence’, ‘evidence-based practice’, ‘models’, ‘nursing’ and ‘research’; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice. Discussion. Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change. Implications for nursing. The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting. Conclusion. The Johns Hopkins Model and the Academic Center for EvidenceBased Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change. Keywords: evidence-based practice, nursing education, nursing models, research in practice © 2012 Blackwell Publishing Ltd 1197 M.A. Schaffer et al. Introduction Table 1 Definitions of key terms. In recent years, nursing scholars have developed a variety of evidence-based practice (EBP) models to facilitate the implementation of research findings into nursing practice (van Achterberg et al. 2008, Mitchell et al. 2010, RycroftMalone & Bucknall 2010, Wilson et al. 2010, Melnyk & Fineout-Overholt 2011). Compare and contrast two EBP models Application of EBP models is intended to break down the complexity of the challenge of translating evidence into clinical practice. Effective models to guide translation of research into practice are needed to avoid failure accompanied by a costly investment of time and resources. However, enthusiastic efforts by clinicians and educators to use EBP are often dampened by a confusing array of terms, a plethora of models and a growing variety of approaches to implementation of EBP. To help the practitioner decide which EBP model is most appropriate for a clinical or educational setting, an overview of commonly used nursing models is needed to assist the clinician in comparing, contrasting, and eventually selecting the model best-fit for their organization and a specific clinical problem. This article provides definitions of common EBP-related terms, a description of major EBP models with examples of use in practice and an evaluation of each model. Term Definition Evidence-based practice (EBP) ‘…a paradigm and life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence (including a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question) with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities and systems’ (Melnyk & Fineout-Overholt 2011, p. 575) Integrating best available research evidence with information about patient preferences, clinical skill level and available resources to make decisions about care (Ciliska et al. 2001) Use of research findings in clinical practice, often based on a single study (Melnyk & Fineout-Overholt 2011) [Note: Research utilization is a sub-set of EBP] A continuum of the rate and amount of practice change, starting with a decision of a practice change, moving to implementation and sustained, routine use in practice (Titler et al. 2007) ‘…the study of how to promote adoption of evidence in health care’ (Titler 2011, p. 1) ‘…scientific study of methods to promote the uptake of research findings into routine healthcare in both clinical and policy contexts’ (Implementation Science 2012) Background Clarification of terms It is important to begin with a clarification of related terms. The first term, EBP, has been defined a variety of ways. However, Melnyk and Fineout-Overholt’s (2011) definition captures the essence: Evidence-based practice is a paradigm and life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence (including a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question) with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities and systems (Melnyk & Fineout-Overholt 2011, p. 575). A similar definition is provided by Ciliska and colleagues, who described EBP as integration of the best available research evidence with information about patient preferences, clinical skill level and available resources to make decisions about care (Ciliska et al. 2001). Table 1 provides definitions for terms commonly used in EBP discussions. Compare and contrast two EBP models ‘Research utilization’, an older term, is 1198 Research utilization Adoption Translation research Implementation science now recognized as just one piece of the broader concept of EBP. EBP theories have undergone a change in focus over the past two decades, which is reflected in use of terms. Straus and Haynes (2009) delineated this process into ‘knowledge creation’ achieved through research, ‘knowledge distillation’ through systematic reviews and construction of guidelines and ‘knowledge dissemination’ through journal articles and presentations. Attempts have been made in EBP and change theory literature to distinguish between definitions of diffusion and dissemination. Diffusion is considered a natural and passive process, while dissemination is an active and planned persuasion and spread of knowledge. Straus and Haynes stated that these process components are not adequate for knowledge use in clinical decision-making and what is needed is ‘knowledge translation’. Thus, the current EBP focus has shifted to the process of moving existing knowledge into the daily routines of practice. ‘EBP is the process of integrating evidence into © 2012 Blackwell Publishing Ltd JAN: DISCUSSION PAPER healthcare delivery, whereas, translation science is the study of how to promote adoption of evidence into health care’ (Titler 2011, p. 291). It is important to note that the term ‘adoption’ has been used differently by scholars as if on a continuum. At the beginning of the continuum, adoption is described as a simple decision to accept a practice change (Greenhalgh et al. 2004, van Achterberg et al. 2008, Gale & Schaffer 2009). At the other end of the continuum, adoption has been described as a more complete incorporation of the practice change to the extent that is has become routine (Mitchell et al. 2010). Titler’s model for translation research uses the terms ‘rate’ and ‘extent of adoption’, suggesting a potential continuum of adoption starting with a decision of a practice change, moving to implementation and sustained, routine use in practice (Titler et al. 2007). The terms ‘translation research’ and ‘implementation science’ include a growing body of study – that of how to effectively facilitate full adoption of best practice into an organization. These terms have been used synonymously; it may be helpful to point out that usage of terms has been somewhat dependent on geographical region. The term research translation has been more prevalent in the U.S. (National Institutes of Health 2012). Since 2006, the NIH has prioritized translational research, creating centres for translational research at its institutes. The term implementation science has been used more in the UK and may become more commonly used due to ‘Implementation Science’, an open-access journal from the UK; implementation science is defined as the ‘scientific study of methods to promote the uptake of research findings into routine healthcare in both clinical and policy contexts’ (Implementation Science 2012). Aim The EBP models can support an organized approach to implementation of EBP, prevent incomplete implementation, improve use of resources, and facilitate evaluation of outcomes (Gawlinski & Rutledge 2008). Compare and contrast two EBP models However, clinicians find there is not one model that meets the needs of all the settings where nurses provide care. The purpose of this discussion is to present a succinct overview of selected EBP models that can be applied to nursing practice and to evaluate their usefulness in clinical and educational settings. It is beyond the scope of this paper to present an in-depth analysis of each EBP model for nursing practice. Rather, this review provides a concise description and evaluation of selected models that occur most frequently in the literature and are used in practice. In addition, this paper may serve as a guide to the © 2012 Blackwell Publishing Ltd Evidence-based practice models for organizational change evidence-based nursing practice of staff nurses, educators, and healthcare organizations. Data sources Selection of data sources to identify relevant EBP models involved four steps. First, Melnyk and Fineout-Overholt’s text on EBP provided an initial list of models to consider for application to nursing EBP projects (Melnyk & FineoutOverholt 2011). They described seven models that ‘have been created to facilitate change to EBP’ (Ciliska et al. 2011, p. 245). This approach was selected because the authors of the text have considerable expertise in application of models and frameworks for EBP. Second, to gain a broad perspective on EBP models used in nursing, CINAHL was searched using various combinations of terms: ‘evidence’, ‘evidence-based practice’, ‘models’, ‘nursing’ and ‘research’. Articles that described EBP models used in only one setting or were infrequently used in EBP projects were excluded. Third, following the initial review of the literature, two models described in the Melynk and Fineout-Overholt text (Ciliska et al. 2011) were excluded and one other model was added. An EBP change model, originally developed by Rosswurm and Larrabee (1999), was excluded because it was not predominant in current literature. Also, the Clinical Scholar Model (Schultz 2005) was excluded because it focused on strategies for preparing nurses to conduct and use research. The ACE Star Model, which was included in Melynk and Fineout-Overholt’s chapter on teaching EBP in academic settings (Melnyk & Fineout-Overholt 2011), but not in their chapter on EBP models, was added to the finalized list of EBP models because it was featured in several articles found in the literature. Fourth, once models were selected, specific names of models were used in the search process. The final list selected for inclusion were: (1) the ACE Star Model of Knowledge Transformation; (2) Advancing Research and Clinical Practice Through Close Collaboration (ARCC); (3) the Iowa Model; (4) the Johns Hopkins Nursing EvidenceBased Practice Model (JHNEBP); (5) Promoting Action on Research Implementation in Health Services Framework (PARIHS); and (6) the Stetler Model. Literature was searched in CINAHL to understand the history of model development from 1998 to the current year. Discussion The following concise overview presents six major EBP models that can be used by staff nurses, educators, and 1199 M.A. Schaffer et al. healthcare organizations to guide evidence-based nursing practice. Readers should note that although ‘model’ is the term used in this paper and was also used in the Melynk and Fineout-Overholt text, different terminology such as framework (PARIHS) or guidelines may be more appropriate. Table 2 includes a description of model steps and key features; abbreviated summaries of each model are provided, allowing for a general overview useful for comparing model features. The last column in Table 2 provides a simple classification of each model according to its original design for use. For example, some are designed for individual use, while others place more emphasis on organizational processes. Compare and contrast two EBP models Table 3 provides a brief evaluation of each EBP model using the four criteria for selecting an EBP model identified by Newhouse and Johnson (2009). Although other criteria exist for evaluation of model selection, the following criteria are particularly relevant to the needs of nurses in practice. The EBP model should: (1) facilitate the work required for completing an EBP project; (2) have educational components that help nurses to critique and assess the strength and quality of the evidence; (3) guide the process of implementing practice changes; and (4) potentially be implemented across specialty practice areas (Table 3). In addition, an implementation or application example is provided for each model. Overview and evaluation of evidence-based practice models ACE Star Model of Knowledge Transformation The Academic Center for Evidence-Based Practice (ACE) developed the ACE Star Model as an interdisciplinary strategy for transferring knowledge into nursing and healthcare practice to meet the goal of quality improvement (Stevens 2004). This model addresses both translation and implementation aspects of the EBP process. The five model steps are: (1) discovery of new knowledge; (2) summary of the evidence following a rigorous review process; (3) translation of the evidence for clinical practice; (4) integration of the recommended change into practice; and (5) evaluation of the impact of the practice change for its contribution to quality improvement in health care. The model emphasizes applying evidence to bedside nursing practice and considers factors that determine likelihood of adoption of evidence into practice. The Ace Star Model has been used in both educational and clinical practice. In an educational example, the University of Wisconsin-Eau Claire used the ACE Star Model to design an evidence-based approach to promote student 1200 success on the NCLEX-RN® exam. Authors reviewed trends in exam pass rates, conducted a review of the literature on student success strategies, made recommendations to improve student performance, implemented the strategies, and achieved a statistically significant increase in student pass rate (Bonis et al. 2007). Other educational projects that have applied the ACE Star Model include identification of EBP competencies for clinical nurse specialists (Kring 2008) and use of the ACE Star Model as an organizing framework for teaching EBP concepts to undergraduates (Heye & Stevens 2009). Clinically, practitioners have used the model to guide development of a clinical practice guideline for ventilator-associated pneumonia (Abbot et al. 2006) and apply knowledge on social support and positive health practices to working with adolescents in community and school settings (Mahon et al. 2007). The ACE Star Model can be used by both individual practitioners and organizations to guide practice change in a variety of settings. The model has been used as a guide to incorporate EBP into nursing curriculum and is also easily understood by staff nurses, in part due to similarity to the nursing process. The emphasis on knowledge transformation contributes to validating the contribution of nursing interventions to quality improvement. Additionally, the translation stage includes clinician expertise and has potential to discuss patient expertise, but is not addressed in the model. Strategies for successful implementation of a practice change are less well defined, such as the organizational culture and context that influence adoption of a practice change. Advancing Research and Clinical Practice through Close Collaboration The ARCC model focuses on EBP implementation and promotes sustainability at a system wide level (Melnyk & Fineout-Overholt 2002, Melnyk et al. 2010, Levin et al. 2011). The model has five steps: (1) assessment of organizational culture and readiness for implementation in the healthcare system; (Compare and contrast two EBP models 2) identification of strengths and barriers of the EBP process in the organization; (3) identification of EBP mentors; (4) implementation of the evidence into organizational practice; and (5) evaluation of the outcomes resulting from the practice change (Ciliska et al. 2011). The key feature is the use of an EBP mentor to facilitate nurses’ development of skills and knowledge to implement EBP projects effectively. In addition, scales have been developed based on the model for assessment of the organizational culture and measurement of effectiveness of EBP in practice. Levin et al. (2011) piloted the implementation of the ARCC model with nurses working in a community health © 2012 Blackwell Publishing Ltd JAN: DISCUSSION PAPER Evidence-based practice models for organizational change Table 2 Evidence-based practice models for guiding change. Model/EBP steps Key features Model classification ACE Star Model of Knowledge Transformation (Stevens 2004, Kring 2008) 1. Discovery – search for new knowledge through traditional research 2. Evidence Summary – a rigorous systematic review process of multiple studies to formulate a statement of evidence 3. Translation – creation of a practice document or tool that guides practice, such as a clinical practice guideline 4. Integration – change in practice; supports EBP through influencing individual and organizational change 5. Evaluation – consider impact of EBP practice change on quality improvement in health care Advancing Research and Clinical Practice Through Close Collaboration (ARCC) (Ciliska et al. 2011) 1. Assess organizational culture and readiness for system-wide implementation 2. Identify organizational strengths and barriers to EBP 3. Identify EBP mentors within the organization to mentor direct care staff on clinical units 4. Implement evidence into practice 5. Evaluate outcomes Iowa Model (Titler et al. 2001) 1. Identify practice questions (problem-focused or knowledge-focused ‘triggers’) 2. Determine whether or not the topic is an organizational priority 3. Form a team to search, critique, and synthesize available evidence 4. Determine the sufficiency of the evidence (if insufficient, conduct research) 5. If evidence base is sufficient and the change appropriate, pilot the recommended practice change 6. 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