Week 1: Types of Nursing Models and Frameworks of EBP
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What are some of the models and frameworks of EBP currently in use? How does the strength of the evidence determine translation into practice? Why is it important to integrate both evidence-based practice and patient and family preferences? What is the nurse’s responsibility when EBP and patient and family practice do not match?
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Collapse SubdiscussionCandee Crane
Aug 28, 2017Aug 28, 2017 at 12:49pm
Professor Maddox and Classmates,
Evidence-based practice is not a new idea or concept. Its history dates to the mid-1800s with Florence Nightingale. “While outcomes are essential, the [Evidence-Based Practice] process itself provides a framework for clinicians, educators, and nurse researchers to ponder, and then expertly construct the most relevant, patient-centered, and testable questions, which in turn yield important practice guidelines for optimizing patient outcomes” (American Nurses Association, 2015, p. 18).The purpose of utilizing models in evidence-based practice is to develop a methodical and efficient approach when examining data. There are multiple models of evidence-based practice. No individual model will fit every area of patient care. Stevens states that there are “forty-seven prominent EBP models” (Stevens, 2013). Johns Hopkins Nursing Evidence-Based Practice Model, Stetler Model, Advancing Research and Clinical Collaboration Model, Iowa Model, Promoting Action Research Implementation in Health Services Framework Model, and the ACE Star Model of Knowledge Transformation are all models that are discussed in this week’s lesson.
After data is collected, it is important to decide the strength of the evidence to determine if practice changes should be implemented. Evidence is rated from Level I to Level VII. Level I means that the evidence is “from a systematic review of all relevant randomized controlled trials (RCT’s), or evidence-based clinical practice guidelines based on systematic reviews of RCT’s” and Level VII means that the evidence is “from the opinion of authorities and/or reports of expert committees” (LibGuides, n.d.). This hierarchy of evidence rates Level I as the strongest evidence for change. Reviewing the purpose, population, methods and materials is also important when determining strength. Verifying that the results are clearly defined and that the conclusions are based on supporting evidence is imperative. The stronger the evidence, the more likely the positive outcome from a change in practice.
It is important to integrate evidence-based practice with patient and family preferences when delivering patient care. For evidence-based practice to work, the patient must be willing to participate in the plan of care. Patients must be given all their choices and options for care prior to deciding the best fit. The Evidence-Based Practice “paradigm calls for the integration of patient preferences, best available evidence and clinical expertise within the context of healthcare planning and decisions” (Veterans Health Administration Office of Nursing Services Evidence-Based Practice Curriculum, 2016). In evidence based practice, “patient preferences are the ‘trump card’” and it is the nurse’s responsibility to adhere to the patient’s requests within the nursing scope of practice (Veterans Health Administration Office of Nursing Services Evidence-Based Practice Curriculum, 2016).
~Candee Crane
References:
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
LibGuides: Nursing Resources: Levels of Evidence (I-VII). (n.d.). Retrieved August 28, 2017, fromhttp://researchguides.ebling.library.wisc.edu/c.php?g=293229&p=Links to an external site. 1953406
Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), manuscript 4. doi:10.3912/OJIN.Vol1 8No02Man04. http://search.proquest.com.proxyLinks to an external site.. chamberlain.edu:8080/docview/1449497144?OpenUrlRefId=info:xri/sid:wcdiscovery&accountid=147674Links to an external site.
Veterans Health Administration Office of Nursing Services Evidence-Based Practice Curriculum: Patient Preferences. (2016, August 30). Retrieved August 28, 2017, fromhttps://www.va.gov/nursing/ebp/docs/DefiningPatientPreferencesCurriculumLinks to an external site._www.pdf
Collapse SubdiscussionMELISSA MADDOX
Aug 29, 2017Aug 29, 2017 at 2:52am
Class,
I was reading a nursing text on policy for one of my classes and did not realize that in history the separation of nursing from medicine really did not start until 1929 when a nurse in the Philippines was convicted of manslaughter for following an erroneous order from a physician (the physician was found not guilty). Until that time, nursing was loyal to the Physician. It was not until the courts decided that we had a duty to use our own knowledge to practice did we come out as a profession. This still did not fully blossom until the 1950-1960s with feminism and consumer rights bring the concept of nursing as being the advocate for the patient sometimes being at odds with the medical profession. EBP for nurses really did not come into the lime light until 1970s-1980s. I never heard of EBP in my first nursing program and in my AD program, it was mentioned but not dwelled upon. In my BSN and MSN program, is were I learned the most about EBP and how to become a change agent for the good of the patient.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (Eds). (2016). Policy & politics in nursing and healthcare (7th ed.). Retrieved from https://bookshelf.vitalsource.com
Sep 3, 2017Sep 3, 2017 at 4:45pm
Hello Professor and Class,
Professor I agree with your post. I finished my LPN in 2009. I do not remember learning anything about EBP. I received my ADN in 2013. I may remember my professor mentioning EBP but not in detail. I was thinking that it only came about in the last 2 years. To read in this post that it arrived before I was born is new news to me. While obtaining this degree I have learned to evaluate research and evidence. This has helped me to understand EBP and its importance. “EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence. EBP promotes an attitude of inquiry in health professionals and starts us thinking about: Why am I doing this in this way?” “EBP is important because it aims to provide the most effective care that is available, with the aim of improving patient outcomes. Patients expect to receive the most effective care based on the best available evidence.”
http://canberra.libguides.com/evidence
Aug 30, 2017Aug 30, 2017 at 6:05am
Candee,
I agree that each patient is different and we should use the best practice depending on that patient. Sometimes as nurses we may struggle at times on how to find the right practice for a patient. The patients beliefs may interfere with the best practice. You are correct when you say the patient preference is the “trump card”. In the nursing home with new regulations it is very important to follow what the residents like. For instance if the resident is a pureed diet for swallowing reason, but they say I want a hamburger with fries we have to honor that! The state says they have the right to eat what they want even if it goes against safety reasons.
Kristen
Sep 2, 2017Sep 2, 2017 at 7:15pm
Candee,
Great discussion this week. I agree with you that EBP is not a new concept and started with Florence Nightingale. Also the importance of using the models to develop different approaches for nurses giving care to patients. Your explanation about rating EBP is great and something that was I unaware of. Also using the nursing process to prove the EBP is important as well. I also agree that is of the greatest importance that the patient is willing to be a part of the EBP if the research is still being completed, or even when the research is completed, and the EBP is placed into practice. According to Veterans Health Administration Office of Nursing Services (2017), “Evidence isn’t actionable without the patient. In EBP, patient preferences are the “trump card”. Patients can’t have a preference if they don’t have (or aren’t given) a choice; and, patients can’t have a choice if they aren’t truly informed of all options.” Again great post.
Betsy
Reference:
Veterans Health Administration Office of Nursing Services. (2017). Evidence-Based Practice Curriculum: Patient Preferences. Received from https://www.va.gov/nursing/ebp/docs/DefiningPatientPreferencesCurriculum_www.pdf
Collapse SubdiscussionKristen Roland
Aug 28, 2017Aug 28, 2017 at 4pm
There are many different models and frameworks that are currently used for evidence based practice. One includes the ACE Star Model of Knowledge. This nursing model of EBP is a good starting for place for nurses as it incorporates five points to help the nurse integrate new practice. “The model of evidence translation that will prove most useful depends on the type of practice, the setting, and the practitioner’s needs(Houser,2018, p.468). The stronger the research the more informative a nurse can be about translating it into their practice. While implementing the evidence nurse have to take the patient into consideration as they may not agree with the new practices. As nurses, we are taught to respect the patient and the family preferences to make sure the patient receives the best care possible. If the patient and family does not agree with EBP the nurse can try to educate the patient and family. If at the end of the education they still do not agree respect the wishes of the patient and family, and take care of the patient with other methods that they wish to be taken care of. As nurses, we are taught to critically think, and adjust our practices to individualize for each patient that we meet. “EBP is aimed at hardwiring current knowledge into common care decision to improve care processes and patient outcomes”(Steven, 2013, p.2)
Lesson Week 1
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.).Sudbury, MA: Jones and Bartlett.
Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), manuscript 4.doi:10.3912/OJIN.Vol18No02Man04.