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WHY IS EVIDENCE BASED PRACTICE MODEL NEEDED?
To translate research findings into practice.
To provide framework for understanding the evidence based practice process.
MODELS OF EVIDENCE BASED PRACTICE
Stetler model
Iowa model
Rossworm and larrabee model
D.Censo model of evidence based practice
STETLER MODEL Developed as ‘practitioner oriented’
model in 1994 Revised in 2001 without a change in its
focus on critical thinking. Deemphasized unsystematic clinical
experiences. Raised awareness about the importance
of applying research findings in nursing practice.
MEANING OF ‘EVIDENCE’ AS PER STETLER MODEL ‘Evidence’ is defined as information or
facts that are obtained systematically. ‘Evidence’ comes from two different
sources-external and internal evidence
External evidence: Derived from opinions of experts.
Internal evidence: It comes from systematically obtained facts or information
FIVE PROGRESSIVE CATEGORIES OF STETLER MODEL:-
1.Preparation:• Identify a priority need• Review the content in which research
utilization would occur• Organize the work • Initiate the research systematically.
FIVE PROGRESSIVE CATEGORIES OF STETLER MODEL:-(Contd..)
2.Validation:• Critique each study systematically.• Choose and summarize the collected
research that relates to the identified need.
3.Decision making: Make decisions about use after
synthesizing body of summarized evidence.
FIVE PROGRESSIVE CATEGORIES OF STETLER MODEL:-(Contd..)4.Translation: Converting findings, planning their
application, putting the plan to use and then implementing use with an evidence based practice.
5. Evaluation: Evaluate the plan in terms of goals.
CRITICAL ASSUMPTIONS Both formal and informal use of research
findings can occur in the practice setting. Individual, research utilization competent
practitioners also can use the model’s process and interaction with others.
Skills are required for effective use of findings Research findings may be used in multiple ways Contextual and personal factors can influence
research evidence The data provides probabilistic information
about individuals for whom the evidence is generally believed to fit
IOWA MODEL
It incorporates the use of research and other forms of evidence
Infrastructure to support research use might involve every level of the organization
Evidence based practice is linked to quality assurance.
Staff are given recognition for research work.
Clinicians are given time and resources for research work.
ROSSWORM AND LARRABEE MODEL Developed by Rossworm and Larabee in
1999. It is based on theoretical and research
literature It begins with the assessment of need
and integration of an evidence based protocol
STAGES OF ROSSWORM AND LARRABEE MODEL Assess needs of stakeholders Build bridges, make connections Synthesize the evidence and determine
relevancy Plan the practice change Implement and evaluate the practice
change Integrate and maintain the practice
change
Evidence Based Practice ModelAssess need for change
Link problem, interventions & outcomes
Synthesize best evidence
Design practice change
Implement and evaluate change in practice
Integrate and maintain change in practice
Link problem, interventions & outcomes
Select outcome indicators
Use standardized classification system and language
Identify potential interventions and activities
PROCESS OF EVIDENCE BASED PRACTICE Haynes and colleagues model(2002) of
evidence based practices involves the following processes:
Formulating a clinical question Systematically searching for relevant
research evidence Critically appraising the evidence Making an evidence based decision
regarding implementation Implementing of the practice change Evaluating the change in practice
D.CENSO’S MODEL OF EVIDENCE BASED DECISION MAKING
COMPONENTS: Patient preferences and actions will be
dominant element in their decision making
Patient’s clinical state and circumstances should be considered
Resources are considered before making a decision
Clinical expertise integrates the other model components
STEPS IN EVIDENCE BASED DECISION MAKING
1. Compiling guidance: Search for relevant and high quality research studies that address the clinical question.
2. Planning a change: The administrators are consulted for planning a change.
3. Integrating skills and experiences: Clinical skills include the expertise
that develops from multiple observations of patients and the interventions carried on patients.
CLINICAL EXPERTISE It has a influence on: Quality of the initial assessment of the
client’s clinical state and circumstances Problem formulation. Decision about the best evidence Exploration of patient’s preference Delivery of the clinical intervention Evaluation of the outcome for that
particular patient