Adopt an Evidence-Based Practice Model to Facilitate Practice Change
Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making. Oncology nurses are perfectly positioned to be adopters and promoters of EBP, resulting in practice change for improved quality and safety.
The impact of EBP on nursing and patient outcomes is clearly evident (http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html). Many organizations have developed competency-based, nurse-led EBP programs that are redesigning care delivery to increase the effectiveness and efficiency of interventions (http://onlinelibrary.wiley.com/doi/10.1111/wvn.12021/full) while reducing costs and safety risks. For EBP integration to be successful and sustainable, a culture of EBP readiness must exist through ongoing leadership support, EBP resource availability, and adoption of an EBP implementation framework.
In recent years, nurse scientists have developed several EBP models (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2012.06122.x/full) to help demystify the process of translating research into clinical practice. Although the models include varying levels of detail, they share the following basic phases of the EBP process.
- Ask: Identify a clinical problem.
- Attain: Review relevant literature.
- Appraise: Critically appraise evidence.
- Apply: Evaluate the need for practice change and potential implementation.
- Assess: Evaluate outcomes.
Organizations must adopt the EBP model that best fits their context of care, aligns with improvement goals, addresses priority clinical problems, and guides a systematic and evaluative approach to collaborative practice change.
Common EBP Models
The Iowa Model for Evidence-Based Practice to Promote Quality Care (https://uihc.org/iowa-model-revised-evidence-based-practice-promote-excellence-health-care%C2%A9) has been revised to better address sustainability of EBP, interprofessional change implementation, and patient-centric care for clinicians at all levels of practice, guiding them through a team-based, multiphase process. The path initiates with a clinical “trigger” that identifies a clinical problem and includes decision points with evaluative feedback loops when recommending and implementing practice change. The model phases are interprofessional team formation; evidence review, critique, and synthesis; change implementation through piloting; ongoing evaluation; and outcomes dissemination.
The Advancing Research and Clinical Practice Through Close Collaboration Model (http://onlinelibrary.wiley.com/doi/10.1111/wvn.12188/full) is for building resources and training mentors who play a central role in facilitating and sustaining EBP at the point-of-care and throughout the organization. The model has seven steps: cultivating a spirit of inquiry; asking a PICOT-formatted clinical question; collecting, critically appraising, and integrating the best evidence with clinical expertise and patient preferences; and evaluating and disseminating practice change outcomes.
The Johns Hopkins Nursing Evidence-Based Practice Model (https://www.hopkinsmedicine.org/evidence-based-practice/models-tools.html) is clinician-focused, allowing rapid and appropriate application of current research and best practices. It simplifies the EBP process and cultivates a culture of care based on evidence. It has three overall steps: practice question, evidence, and translation. Its directive tools are intended for practicing clinicians working individually or in a group to address clinical inquiries.
The Promoting Action on Research Implementation in Health Services (PARIHS) Framework (https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0398-2) has been revised into the integrated or i-PARIHS framework. The framework refers to evidence-based change as practice innovation. It contends the core elements of successful implementation of practice innovation is dependent on the type of evidence available, context of the care setting, and how the process is facilitated. The framework emphasizes the importance of taking into consideration the perspectives of all recipients of the intended change.
Although these are just a few models for translating evidence into practice, each outlines and promotes the need for a systematic approach to evidence-based change. Each addresses the sustainability of EBP through organizational culture change, stakeholder engagement, comprehensive literature review and appraisal, barrier identification, impact evaluation, and outcomes dissemination. Regardless of the preferred model, the EBP process should tell the story of how a problem was recognized, addressed, and improved, and that story should be shared.