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. 3) Explain why one model would work better than the other with your colleages or you organizational culture. 4) Supports your answer with referenceYOU CAN PICK TWO OF THE FOLLOWING:1)ACE Star Model2) ARRC Model3) Iowa Model4) Johns Hopkins EBP Model5) Stetler ModelI 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


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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:
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
Aim. To provide an overview, summary of key features and evaluation of
usefulness of six evidence-based practice models frequently discussed in the
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
Keywords: evidence-based practice, nursing education, nursing models, research
in practice
© 2012 Blackwell Publishing Ltd
M.A. Schaffer et al.
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). 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.
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.
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
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)
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. ‘Research utilization’, an older term, is
Research utilization
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
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).
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). 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.
The following concise overview presents six major EBP
models that can be used by staff nurses, educators, and
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
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
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
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
Advancing Research and Clinical Practice through Close
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; (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
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
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
6. Evaluate pilot success and if successful …
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