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SUNY-Downstate Medical Research Library of Brooklyn: Evidence-Based Nursing Practice

a Libguide

What is Evidence-Based Nursing?

Is it a concept, a process, and/or  the same as Evidence-Based Care?  Is it the same as Research Based Practice?

Scott and McSherry (2009)  reviewed the literature of Evidence-Based Nursing and came up with this synthesized definition:

An ongoing process by which evidence, nursing theory and the practitioners’ clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide delivery of optimum nursing care for the individual. The literature uses the terms Evidence Based Nursing and Evidence Based Practice interchangeably.

Why do we need so many models of Evidence Based Nursing Practice?

Nursing  has always tried to improve patient care.  (Remember Florence Nightingale).  Traditionally there have some stumbling blocks.   It has been said that it takes 17 years to change a nursing practice.  Each model has a slightly different idea of how to speed up the process of change to improve patient care.   Each model, to be successful has to solve two main problems - how to communicate the model to professional nurses and how to gain institutional support for changes in nursing practice. 

Many models are associated with individual Educational Institutions.  These programs often offer books,  tutorials, and seminars to spread their model.  This EBNP Lib-Guide will link to resources available through our library.  Since many models were developed years ago, we will show the date they were last updated.

Nurse-Educators have always been interested in implementing best practices. Some of these models pre-date the most common term used now,  "Evidence-Based Practice"

 

Even though a model may have been formulated decades ago, nurse researchers do continue to use it for their research. For example.  the PARiHS started in 1990's. Researchers in 2020 found that more than 300 papers applied  the PARiHS model in the intervening years.  

Evidence-Based Practice ....is a lifelong problem solving approach to clinical practice that integrates.......

Bernadette Mazurek Melnyck's and  Ellen Fineholt-Overholt  see Evidence Based Nursing as a process.

  • A systematic search for as well as critical appraisal and syntheses of the relevant and best research ..to answer a burning clinical question.

  • One's own clinical expertise, which includes internal evidence generated from outcomes, management or quality improvement projects, a thorough patient assessment, and evaluation and use of available resources to achieve desired patient outcomes

  • Patient preferences and values.

ARCC -Melnyk's Seven Steps to Evidence-Based Practice 

Melnyk and Fineholt-OverHolt wrote a series of 12 articles in AJN  on their seven steps to evidence based practice.  Each step is linked to the appropriate article(s) in this series.  They have done studies to support the utility of this model.  Fineholt-Overholt has published on Implementation Science applied to EBNP.  One emphasis of this plan is the financial savings that can  accrue to institutions who use EBNP.  See also Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice 4th Edition (8/2021)

 

Step Explanation
0

Cultivate a spirit of inquiry within an EBP culture and environment.

1 Ask the burning clinical question in PICOT format.
2 Search for and collect the most relevant best evidence.
3

Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, synthesis, and recommendations).

Part 2 Critical Appraisal

Part 3 Critical Appraisal

4

Integrate the best evidence with one’s clinical expertise and patient preferences and values in making a practice decision or change.

Part 2 Implementation

Part 3 Implementation

5 Evaluate outcomes of the practice decision or change based on evidence.
6 Improving healthcare quality, patient outcomes, and costs with evidence-based practice

Johns Hopkins Nursing Center for Evidence-Based Practice (Updated 2017)

This center has its own  twist of the Evidence Based Process:

"The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model is a powerful problem-solving approach to clinical decision-making, and is accompanied by user-friendly tools to guide individual or group use. It is designed specifically to meet the needs of the practicing nurse and uses a three-step process called PET: practice question, evidence, and translation. The goal of the model is to ensure that the latest research findings and best practices are quickly and appropriately incorporated into patient care."

The Iowa model for Evidence-Based Nursing (updated 2017)

University of Iowa Health care is one of the centers of Evidence Based Nursing. 

The article "Introducing evidence into nursing practice: using the IOWA model" ( Doody, C & Doody ,2011)  introduces the defining concepts of their model.

Cabarrus College of Health Sciences Library: IOWA Model LibGuide has a detailed descriptions of the model

Evidence-Based Nursing Practice is the "Foundation of Everything Else"

This may seem obvious, but clinicians who know about Evidence-Based Practice who believe that is possible, and who have support from their institutions are more likely to implement Evidence Based Nursing Practice. (Melnyk, Fineholt-Overholt, Gallagher-Ford, JONA Volume 42(9), 2012, pp 410–417).

Evidence-Based Nursing Practice allows clinicians to ethically provide the best possible patient care.

Other benefits of EBP include patient outcomes that improve by 28-35% (Heater, BS " Nursing interventions and Patient Outcomes:  a Meta-Analysis of studies, Nursing Research 1988 Vol. 37(5), pp. 303-7.)

There are barriers to implementing EBP. Chief among them: Most clinicians were never taught about EBP and organizational support is lacking.

But only when EBP is seen as "the foundation of clinical practice" rather than something that is added on to current practice will change occur.

JBI approach to EBHC (updated 2019)

JBI's approach is different from Sackett approach.  It is more detailed and expansive. It is specifically designed for those in the health professions who are not MDs.

The Stetler Model of Research Utilization (last updated 2001) 

The Stetler model looks at Evidence Based Practice from a different angle.  It starts from the idea that  evidence for a particular change  in practice  is available.  It suggests a five-step plan to adapt this new evidence to to a particular clinical setting. 

The ACE-Star Method of Knowledge Translation (Last updated by Dr. Stevens in 2004)

This model was devised by Kathleen R. Stevens, Professor at the University of Texas at San Antonia College of Nursing.  The ACE Center no longer exists at that College of Nursing. 

The e original paper is no longer in print.  This paper explains the model clearly.  However though it refers to Dr. Stevens 2004 paper, it  itself is unsigned and undated..

The PARiHS Framework for Implementation (last explained 2014)

This is another plan that emphasizes implementation.  Here is a recent presentation of its main points by P. Ullrich (2014)

Rossrum and Larrabee's A model for change to Evidence-Based Practice (last updated 1999)

This model was mostly likely one of the first to use the phrase " Evidence-Based Practice " in nursing.  It gave a new name to ideas that had circulating for years.  Rossrum continued applying her model ro apecific clincal sites and and authoring journal articles about these applications.