NR 451 Week 1: Types of Nursing Models and Frameworks of EBP

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).

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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

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