Chapter on "Achieving Evidence Based Practice Through Model Synthesis"

Chapter 15 pages (4448 words) Sources: 1+

[EXCERPT] . . . .

The 5-step phases of the Stelter model are preparation, validation, decision making/comparative evaluation, application/translation, and evaluation. However, the Iowa model stages are longer than the phases of Stelter model. The phases of Iowa mode are trigger problem, organization priority, team formation; collect evidence, research critique and synthesis, pilot changes, decision, implementation and dissemination of results. The fundamental difference between Iowa model and Stelter model is that Stelter model focuses on the method individual practitioners implement research, however, Iowa model discusses on how organizations are able to change practice based on research. Moreover, Stelter model uses prescriptive approach for evidence-based practice; however, Iowa model focuses on the systematic approach.

Unlike Stelter model that may be difficult for the nurses to implement, the Iowa model logically flows, intuitive design, and easily understood by the nurse's professionals. Moreover, the Iowa model assists nurses to accumulate knowledge and developing problem-solving skills to evaluate administrative and clinical practice. Similar to the Stetler model that promotes nursing research, and reflects the contemporary to achieve an evidence evaluation for the clinical practice, Iowa model promotes a nursing research when there is a lack of evidence. Similar to the Iowa model, the Stelter model assists in using the research utilization to facilitate the EPB, and safe effective research findings.

Similar to the Stetler model that use the five-phase step to describe the evidence-based practice, the Ace Star model also uses the 5-point step to deliver the knowledge transformation. The Acer Star model discusses the concepts translation, summary integration and evaluation of EBP to enhance a transformation of knowledge within the clinical practice. Despite the benefit of the Acer Star model within the clinical setting, the model is less prescriptive when compared to another EPB model. The ACE Star model is also similar to the Stelter model that uses the five-stage phases for the evidence-based practice. The stages of the ACE Star model are knowledge discovery, evidence summary, translation into practice, integration into practice, and evaluation.

Similar to other EPB models that have been analyzed, the John Hopkins model uses the logical, and intuitive approach to demonstrate the usefulness and clarity of the direct nursing practice. The John Hopkins model is similar Iowa model that focuses on the organizational process revealing the strategy to manage the department unit. Moreover, John Hopkins model uses the evidence-based research to implement the research results. The model also uses the problem-solving approach with an aspect of clinical decision-making. The John Hopkins model is similar to other models that use the research approach to demonstrate the EBP within the clinical setting, the John Hopkins model also focuses on the core of experimental research approach. Unlike the Iowa model that uses the systematic design and Stelter model that uses the prescriptive research approach, the John Hopkins model uses the experimental, quasi-experimental, non-experimental and qualitative research for the evidence-based approach.

"With an exception of the ACE Star model," (Melnyk, Gallagher-Ford, Long, et al. 2014) all other models use the step-wise, evidence-based approach to translating evidence into practice. Contrary to the approach of other models, the Star model explains the strategy of translating the knowledge into practice. Thus, the model assists in using knowledge accumulation for a direct care. Thus, the ACE Star model assists in enhancing a greater understanding the method of using knowledge for a clinical decision.

The ARCC ("Advancing Research and Clinical Practice through Close Collaboration") model (Melnyk, & Fineout-Overholt, 2014 p 289) identifies different barriers to the EPB within the healthcare practice. The model argues that inadequate skills and knowledge of the EPB practitioner is one of the barriers. The model also points that many healthcare organizations are not ready to implement the EBP to improve the patient's outcomes. Contrary to other models that do not discuss the behavioral change to improve the evidence-based practice in the hospital setting, the ARCC model discusses the behavioral change, which is an effective strategy that can change an individual clinician towards the application of the evidence-based practice. Contrary to the other models, ARCC believes in strengthening the beliefs of the clinicians towards the EBP. It is critical to understand that the support of the clinicians is very critical for an effective implementation of the EBP within the healthcare environment. Thus, the model argues that the foundation of the EBP is to change the behaviors of clinicians positively towards the application of the evidence-based practice.

Similar to the Stelter model and Iowa model, the PARIHS "(the promoting Action on Research Implementation in Health services) model)" (Melnyk, & Fineout-Overholt, 2014 p 294) also uses the research approach to understand the evidence-based practice. The elements of the model are research, clinical experience, patient experience, local data and information. The PARIHS model departs itself from the other models by pointing out that a cultural practice is very critical to the application of evidence-based practice. Typically, the model believes that understanding the values and belief of patients are very important for the application of the EBP. Similar to the Iowa model that identifies the organizational value to the EBP, the PARIHS model argues that organizational resources such as human resources, financial and equipment have been the effective tools for the implementation of the evidence-based practice.

Similar to the Iowa model, Stelter model and other models of the evidence-based practice, the Clinical Scholar Model is also adapted to the evidence-based practice approach. The model identifies the clinical and empirical research for the organizational changes. Moreover, the Scholar model argues that it is very critical to educate the health care providers to use the EPB and research for the point of care. Similar to the Iowa model and Stelter model that focuses on research for the application of the evidence-based practice, the Scholar model also uses the research practice to achieve an interactive educational program to achieve a direct care for patients.

Moreover, "The model for evidence-based practice" (Melnyk, & Fineout-Overholt, 2014 p 287) also uses the six-step approach to understanding the evidence-based practice similar to the Iowa model and Stelter model. The six-step approach is to assess a need for a change in the clinical practice. The next stage is to locate the effective and best evidence, followed by analyzing the evidence effectively. The next step is to plan for the practice change by evaluating the change in practice. The last stage is to maintain and integrate the change in practice.

5. Synthesizing the Results

The comparative analysis of all the eight models reveals that nearly all the models support the use of a research approach for the evidence-based clinical practice. However, the outcome of the analysis reveals that ARCC model is the best EBP approach to answering the PICOT question. Although the John Hopkins model can also be used to modify the lifestyle of the patients through the physical activity compared to sedentary life because the model identifies the behavioral modification of the practitioners as an appropriate strategy for the EBP, however, the review of the ARCC model reveals that it is more beneficial to the clinical practice. Several criteria have made this study to identify the ARCC model as the appropriate model for the lifestyle modification for the post liver transplant patients. The ARCC model identifies different barriers to the effective implementation of the EBP within the clinical practice, which include the lack of belief in the EBP, inadequate knowledge and skills in EBP, "lack of administrative support," nurse manager and leader resistance, "lack of an EBP mentor," perceived lack of authority to change patients' care procedure" (Melnyk, & Fineout-Overholt, 2011 p 290). According to ARCC model, an organization is required to choose the EBP mentors who have accumulated an in-depth knowledge of organization change to assist in removing the barriers. Moreover, the mentors should use the role modeling to facilitate the skills and knowledge of clinicians and improve their beliefs towards EBP implementation. As the barriers diminish, clinicians will have the opportunity to implement an evidence-based practice to achieve patient's outcomes.

The goal of the ARCC model is to enhance a "behavioral change in individual clinician towards EBP" (Melnyk, & Fineout-Overholt, 2011 p 290). The ARCC model also uses the CBT (cognitive behavioral therapy) to assist effective change of clinician's idea to achieve patient's outcomes. The CBT stresses the benefits of social, environmental factors to influence cognition, emotion, learning and behavior. The ARCC model is better than other EBP models because the model focuses on the cognitive behavioral changes, which is very critical to answer the PICOT question. Essentially, behavioral changes are very important because it influences healthcare professionals to make policy that will favor the patients' physical activity, which will assist in removing barriers to the experimental research to answer the PICOT question. The mainstream of behavioral therapy is to identify maladaptive behaviors. After identifying the behaviors that need changing, the therapist will use CBT technique to assist the individuals to modify the pattern of behaviors. As being pointed out by the ARCC model, the… READ MORE

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