Research & EBP: Two Flavors of Professional Practice


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Research & EBP: Two Flavors of Professional Practice
EBP
• Translation of evidence to practice
▪ Evidence appraisal ▪ Translation ▪ Implementation ▪ Evaluation
• Plethora of EBP models • PDSA-type cycle • Not “research”, which is about producing new generalizable
evidence
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EBP Models: What do they describe?
• All models share a cyclical “PDSA-type” foundation • EBP domains
▪ Evidence appraisal: systematic review or meta-analysis
✓Evidence summaries can also be purchased for a price
▪ Evidence implementation & evaluation
✓Change management ✓Cultural readiness
• Most models have no health system context; all EBP is
assumed to occur in a vacuum of a single unit or hospital
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EBP Model

Focus Areas

Strengths

Weaknesses

EBP Models Side-by-Side ACE Star Model of Knowledge
Transformation - 2004

Bedside nurses Innovation adoption Knowledge transformation

Comparison No health system context

Advancing Research and Clinical Practice Through Collaboration (ARCC) - 2011

Change management Adoption readiness

Health system context

Does not guide EBP appraisal

Iowa Model - 2001

Flow diagram Problem-solving Pilot

Prescriptive; easy to follow

No health system context

Johns Hopkins Nursing Evidence Based Practice Model - 2007
Promoting Action on Research Implementation in Health Services Framework - 2004 Stetler Model - 2001
Cochrane Collaboration - 1993

Individual nurse Practical guidance for staff nurses Appraisal
Implementation Factors for success

Nursing-centric EBP model Includes appraisal tools
Considers culture/readiness

Individual nurse Critical thinking
Evidence appraisal

Comprehensive guide for both appraisal and implementation
Very robust guidance

No health system context
Does not guide EBP appraisal No health system context No guidance for implementation

Joanna Briggs Institute - 1996 Delivery Science Model - 2015 Learning Health System - 2010

Global evidence System view
Research emphasis
Technical/data-driven approaches Delivery science

Very robust guidance
System-view Strong track record at KP System-view

Cost-prohibitive?
Does not guide EBP process Physician-centric
Limited applicability outside of informatics/data projects Physician-centric

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ACE Star Model of Knowledge Transformation - 2004
▪ Stevens K.R. (2004) ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-Based Practice.
▪ The University of Texas Health Science Center at San Antonio ▪ http://www.acestar.uthscsa.edu ▪ Discovery, Evidence Summary, Translation, Integration,
Evaluation ▪ Foci:
✓Nursing evidence for bedside nurses ✓Knowledge transformation; innovation adoption
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Advancing Research and Clinical Practice Through Collaboration (ARCC) - 2011
▪ Ciliska D., DiCenso A., Melynk B.M., Fineout-Overholt E., StettlerC.B., Cullent L., Larrabee J.H., Schultz A.A., Rycroft-Malone J.,Newhouse R. & Dang D. (2011) Models to guide implementation of evidence-based practice. In Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (Melynk B.M., Fineout-Overholt E., eds), Wolters Kluwer, Philadelphia, PA, pp. 241–275
▪ Dr. Ciliska is professor emerita at McMaster University in Ontario, Canada; Dr. Melnyk is a champion in US:
https://stti.confex.com/stti/congrs18/webprogram/Paper91692.html
▪ Assess organizational culture and readiness for system-wide implementation; identify organizational strengths and barriers to EBP; identify EBP mentors within the organization to mentor direct care staff on clinical units; implement evidence into practice; evaluate outcomes
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Iowa Model - 2001
▪ Titler M.G., Kleiber C., Steelman V., Goode C., Rakel B., Budreau G., Everett L.Q., Buckwalter K.C., TrippReimer T. & Goode C.J. (2001) The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America 13(4), 497–509.
▪ Dr. Marita Titler is the Department Chair of Systems, Populations and Leadership in the University of Michigan, School of Nursing
▪ Identify practice questions; determine whether or not the topic is an organizational priority; form a team to search, critique, and synthesize the evidence; determine if evidence is sufficient; pilot the recommended practice change; evaluate pilot; disseminate results and implement
▪ Foci: Flow diagram, includes problem-solving steps, pilot
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Johns Hopkins Nursing EvidenceBased Practice Model - 2007
▪ Newhouse R.P., Dearholt S.L., Poe S.S., Pugh L.C. & White K.M.(2007) Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. Sigma Theta, Indianapolis, IN
▪ Robin Newhouse is Dean, Indiana University School of Nursing ▪ Identify the EBP question using a team approach; search,
critique, summarize, rate evidence strength, and develop recommendations for change based on evidence strength; determine feasibility, create an action plan, implement change, evaluate, and communicate findings ▪ Foci: Individual use, practical guidance for staff nurse, appraisal
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Promoting Action on Research Implementation in Health Services Framework (PARIHS) - 2004
▪ Rycroft-Malone J. (2004) The PARIHS framework – A framework for guiding the implementation of evidencebased practice. Journal of Nursing Care Quality 19(4), 297–304.
▪ Jo Rycroft-Malone is Vice-Chancellor for Research and Impact at Bangor University in Wales, UK
▪ Search for evidence from research, clinical experience, patient experience, and local data and information; adoption of an innovation is influenced by the organizational culture, leadership support, and evaluation practices; individuals in the organization use their knowledge and skills to assist with implementation of the practice change
▪ Foci: implementation, factors for success
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Stetler Model - 2001
▪ Stetler C.B. (2001) Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook 49, 272–278.
▪ Cheryl B. Stetler, Independent Consultancy, Amherst, MA, USA, and formerly Research Associate, Boston University School of Public Health,
▪ Define priority need and initiate a search for evidence; systematically critique and summarize evidence; make a decision about what evidence to use; plan change; implement evidencebased change plan; determine whether goals for using the evidence were accomplished
▪ Foci: individual nurse use, critical thinking, internal vs. external evidence
See: Schaffer MA, Sandau KE, Diedrick L. Evidence-based practice models for organizational change: overview and practical applications. J Adv Nurs. 2013 May;69(5):1197-209. doi: 10.1111/j.1365-2648.2012.06122.x. Epub 2012 Aug 9. Review. PubMed PMID: 22882410.
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Cochrane Collaboration -1993
▪ Headquarters: London, UK with world-wide network including NIH and NHS; subsidiary of Wiley & Sons
▪ Very robust guidance for conducting systematic reviews ▪ The gold standard? https://training.cochrane.org/handbook
• Identification of relevant studies from a number of different
sources; selection of studies for inclusion and evaluation of their strengths and limitations; systematic collection of data; synthesis of data
▪ Focus: Evidence appraisal
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Research & EBP: Two Flavors of Professional Practice