2. Evidence Based Practice
Models
Conduct and Utilization of Research in
Nursing (CURN)
Stetler Model
Iowa Model
3. CURN Model
Designed by the Michigan Nurses
Association to develop and test the
facilitation of scientific nursing
knowledge in clinical practice settings.
4. CURN Model
Assists nurses to incorporate new research into
clinical practice:
Identify a patient care problem.
Find and assess research-based knowledge to apply
to the problem.
Adapt and design a nursing practice innovation from
the research base.
Decide whether to adopt, alter or reject the
innovation.
Develop the means to extend the new practice
beyond the trial.
Develop mechanism to maintain the innovation over
time.
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5. Stetler Model
This is a model of research utilization
to facilitate evidence-based practice
(EBP).
The model formulated a series of
critical-thinking and decision-making
steps designed to facilitate safe and
effective use of research findings.
Resource: Stetler, C.B. (2001). Updating the Stetler model of research utilization to
facilitate evidence-based practice. Nursing Outlook, 49(6), 272-279.
8. Stetler Model (Cont.)
Phase I – Preparatory phase – Define
the need for clarity of purpose and
potential significance of internal or
external factors.
Search, sort and select sources of
research evidence
Consider influential factors
Affirm priority
Define purpose and outcomes per issue or
catalyst
9. Stetler Model (Cont.)
Phase II – Validation – Reflect studied
relationships or variables in terms that
could pragmatically be used in daily
activities
Perform utilization focused critique &
synopsis
Identify and, if applicable, record key study
details and qualifiers
10. Stetler Model (Cont.)
Phase III – Comparative
Evaluation/Decision Making –
Synthesize findings and evaluate per
criteria -
Fit of setting
Feasibility
Current practice
Substantiating evidence
Decide to use, consider use or not use
11. Stetler Model (Cont.)
Phase IV – Translation/Application – Describes
how to implement findings or recommendations
–
Confirm type, level and method of application
Use – Review operational details -
Informally – Use in practice
Formally – Identify/design evidence-based documents;
package for dissemination; develop EBP change plan,
including evaluation
Consider Use
Informally – Obtain targeted practice information; evaluate
Formally – Do formal details as in “Use”; plan and
implement a pilot project of use, including evaluation
Decide to accept and extend, with or without
modification or reject and stop
12. Stetler Model (Cont.)
Phase V – Evaluation –
Evaluate dynamically –
Identify goal for each use
Obtain evidence re: change process and goal-
related progress, as well as end
result/outcomes
Use iterative evidence to achieve goals
Evaluate as part of routine practice
13. Iowa Model
Provides a guide for clinical decision-
making
Provides details regarding
implementation of evidence-based
practice
It includes both the practitioner and
organizational perspective.
14. The Iowa Model of Evidence-Based Practice to Promote Quality Care
15. The Iowa Model of Evidence-Based
Practice to Promote Quality Care
Problem Focused Triggers
Risk Management Data
Process Improvement Data
Internal/External Benchmarking Data
Financial Data
Identification of Clinical Problem
16. The Iowa Model of Evidence-Based
Practice to Promote Quality Care
Knowledge Focused Triggers
New Research or Other Literature
National Agencies or other Organizational
Standards and Guidelines
Philosophies of Care
Questions from Institutional Standards
Committee
17. The Iowa Model of Evidence-Based
Practice to Promote Quality Care
Is this topic a priority for the
organization?
If no, consider other triggers
If yes –
Form a team
Assemble relevant research and related
literature
Critique and synthesize research for use in
practice
18. The Iowa Model of Evidence-Based
Practice to Promote Quality Care
Is there a sufficient research base?
If no:
Conduct research
Base practice on other types of evidence such as
case reports, expert opinion, scientific principles or
theory
If yes – Pilot the change in practice:
Select outcomes to be achieved
Collect baseline data
Design EBP guidelines
Implement EBP on pilot units
Evaluate process and outcomes
Modify the practice guidelines
19. The Iowa Model of Evidence-Based
Practice to Promote Quality Care
Is change appropriate for adaptation to
practice?
If no – Continue to evaluate quality of care and
new knowledge
If yes – Institute the change in practice
Monitor and analyze structure, process and
outcome data, including environment, staff,
cost, and effect on patient and family
Disseminate Results
Source: Titler, M.G., Steelman, V.J., Budreau, G., Buckwalter, K.C., Goode, C.J. (2001). The Iowa Model of
Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America. 13(4)
13(4)
497-508.
20. Comparison of the Stetler &
Iowa Models
Stetler Iowa
Focus is on how Explains how
individual organizations
practitioner change practice
implements the based on
research research
Prescriptive (step- Systematic
by-step) design design
21. Read, Think, Do Method of
Implementation
Not a model, but is a method
Acknowledges the complexity of
problem-solving processes by looking
for –
The evidence
Assessing the value to practice
Addressing the social and cultural milieu
of the practice setting to ascertain the best
strategies for initiating and sustaining
practice changes
22. Read, Think, Do Method of
Implementation
Read – Access the breadth of research
findings that will sufficiently inform the
change process
Think – Give critical thought about
applicability to the clinical setting
Do – Organize the effective
implementation of the practice change
within a local culture
Resource: Winch, S., Henderson, A., & Creedy, D.(2005). Read, think, do!: A method for
fitting research evidence into practice. Journal of Advanced Nursing, 31(3), pp. 20-
26.
23. Barriers to Connecting Research
and Practice
Organizational Culture
Belief Systems
Research Related Barriers
24. Perceived Barriers to Research Utilization:
Organizational Culture, Nurses’ Belief Systems and the
Research-related Barriers
Insufficient time on the job to implement new
ideas
Nurses feel they do not have the authority to
change practice
Facilities are inadequate for implementation
Statistical analyses are not understandable
Insufficient time on the job to read research
Source: Retsas, A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced
Nursing, 31, 599-606.
25. Perceived Barriers to Research Utilization:
Organizational Culture, Nurses’ Belief Systems and the
Research-related Barriers
Physicians will not cooperate with
implementation
Nurses are isolated from colleagues with
whom to discuss research findings
Nurse does not feel capable of evaluating the
quality of the research
Nurses feel the results cannot be generalized
to their setting
Other staff are not supportive of
implementation
Source: Retsas, A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced
Nursing, 31, 599-606.
26. Strategies Related to
Organizational Culture Barriers
To facilitate organizational support of
EBP –
Allow time for nurses to conduct activities that
foster EBP such as time for library searches
Ensure availability of adequate library resources
Start a journal club
Resource: Ciliska, et al. as cited in DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A
guide to clinical practice. Mosby, St. Louis, MO. P. 16.
27. Journal Clubs
Purpose –
To help staff stay abreast of clinical research
To improve clinicians’ ability to critically evaluate
published research
Process –
Develop a format that will entice busy staff to
attend
Select a challenging clinical situation and topic
Select a journal article
Hold the meeting
28. Journal Club (Continued)
Sample Guidelines and Format –
Purpose –
To foster excellence in nursing practice by
promoting evidence-based practice
Goals –
Improve nursing knowledge of current research
findings
Foster the application of clinical research and
best practice models to nursing practice
Provide a means by which to address clinical
issues
29. Journal Club (Continued)
Format for meetings and presentations -
Introduce topic and presenter
Test baseline knowledge and/or seek
opinions, attitudes of audience (optional).
Give brief synopsis of following
parameters –
Title of article
Study’s purpose
Setting
Population
30. Journal Club (Continued)
Discuss major findings of study
Discuss other relevant research that
supports or does not support this study
Discuss implications of article in terms of
impact on nursing practice
Documentation
Delegation
Patient education
Patient satisfaction
Patient/Family centered care
Interdisciplinary collaboration
31. Journal Club (Continued)
What is the relevance of this article to
our practice? Should we change our
practice based on this information? If
yes, then –
Group discussion/Questions
Evaluations
Resource: St. Pierre, J. (2005). Changing nursing practice through a nursing journal club. MedicalSurgical
Nursing, 14(5). 390 – 392.
32. Strategies Related to Belief
System Barriers
Simple dissemination of information is
generally ineffective.
Multi-faceted approaches are more likely to
succeed.
One-to-one sessions between experts such as
nurse facilitators and the staff who will implement
changes
Manual and computerized reminders of the
change
Educational meetings that are interactive
Audit and feedback on a regular basis
Resource: DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A guide to clinical
practice. St. Louis, MO: Mosby, p. 17.
33. Strategies Related to Research-
related Barriers
Research related barriers include
nurses’ lack of understanding of how
to read and critique research studies
Foster nurse researcher positions or nursing
research committees
Link staff nurses and advanced practice nurses
with nursing researcher faculty at universities
Provide training on how to conduct searches,
read and critique research studies
Resource: Ciliska, et al. as cited in DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A
guide to clinical practice. St. Louis, MO: Mosby. P. 16.
34. Making Change Happen
What is change?
To give a completely different form or
appearance to; transform
Resource: The American Heritage® Dictionary of the English Language, Fourth
Edition. Retrieved from Dictionary.com website:
http://dictionary.reference.com/browse/change
35. Making Change Happen
Engaging others to change
Kotter’s Change Model
Change has an emotional and a
situational component
Source: Campbell, R.J. (2008). Change management in health care. Health Care Manager. 27(1), 23-39.
Manager. 27(1),
36. Making Change Happen
Kotter’s Change Model
Phase 1 - Creating a climate for change
Establish Urgency
Create Coalition
Develop Vision
Phase 2 - Engaging and enabling the whole
organization
Communicate Vision
Empower Action
Generate short-term wins
Phase 3 - Implementing and sustaining change
Consolidate Gains/Produce more
Anchor Approaches
37. Kotter’s Change Model
Establish Urgency – “Making sure that
sufficient people act with sufficient
urgency – with on your toes behavior
that looks for opportunities and
problems, that energizes colleagues,
that beams a sense of let’s go!”
38. Kotter’s Change Model
Create Coalition – Build a guiding team.
Members must –
Have relevant knowledge about the change.
Be willing to establish credibility with peers.
Have expertise regarding the inner workings of
the organization.
Have formal authority.
Have Leadership skill.
39. Kotter’s Change Model
Develop Vision – The vision must be
expressed in a clear, concise statement
about the direction in which the
organization is headed.
Paint a picture of the future.
Focus on how service will be improved.
Must call on emotion and motivate to
action.
40. Kotter’s Change Model
Communicate Vision –
Develop methods of communication that
address any negative feelings.
Help employees to think and act in
accordance with the new direction.
Identify groups affected by the change and
project their needs, concerns and roles.
Continuum of feelings: Awareness,
Understanding, Collaboration,
Commitment, Advocacy.
41. Kotter’s Change Model
Empower Action – Give team the power
to eliminate barriers such as
supervisors, the system, mental
barriers and lack of information.
42. Kotter’s Change Model
Generate short-term wins – Choose
and complete tasks that show the
change management project is
succeeding.
Teams should achieve visible,
meaningful and unambiguous progress
quickly.
43. Kotter’s Change Model
Consolidate Gains/Produce More –
Include ongoing comparison to
competitors to re-energize the change.
Anchor approaches – Culture change
comes when a new way of operating
has been shown to succeed over a
period of time.
44. Kotter’s Phases of Change Model
Worksheet– Sample Completed Tool
Intervention to be implemented:
A distraction-free zone for medication administration will be
established.
Stakeholders identified:
Nurses, Support staff, Physicians, patients, families.
Policy and procedures identified as needed or updated:
Medication Administration policy – Add: Nurses will wear a red vest
when administering medications. When the vest is on, there may be
no interruptions of the nurse.
45. Kotter’s Phases of Change Model
Worksheet– Sample Completed Tool
Project Establish Create Develop Communicate Empower Generate Consolidate Anchor
Coalition Vision Action Short Gains Approaches
Name Urgency Vision term Produce
Wins More
Pilot - Creating Develop Assemble How does Develop a Team Compile Expand pilot Discuss at
a Distraction Power Point Team – this affect: Power Point works 1:1 and to additional staff meeting
Free Zone presentation – Director of Nurses, presentation with staff present units after 3 monthly for
During Med #1 leading Nurses, Support staff, showing the on first med error months. 6 months.
Administration cause of med Nurse Physicians, process of med day of rates Team
errors in nation Manager, Patients, administration pilot. monthly conducts
& our hospital. Staff nurse Care, in distraction Blog set and report audit of
Include from each Competitors, free zone up where at unit implementati
statistics. shift on Revenues staff can meeting. on monthly
Highlight pilot unit Develop anonymously Publish by direct
specific errors. vision send
article observation
questions of med pass.
statement or about pilot
concerns in hospital
to team. newsletter