Discussion 1: Summarize, compare and contrast two of the EBP models to change practice in an organization as listed in Melnyk text – Solution

Summarize, compare and contrast two of the EBP models to change practice in an organization as listed in Melnyk text, pages 382-420. (Related to MO2,3,4)

The IOWA Model of evidence-based practice, aims to promote quality and excellence in health care, by providing guidance for nurses and clinicians in making decisions about clinical and administrative practices that can affect healthcare outcomes (Melnyk & Fineout-Overholt, 2019). The model algorithm starts by encouraging the clinician to identify triggering issues or opportunities for improvement. Once these triggers are identified, the clinician begins by questioning current practice standards, followed by formulating a question or purpose for change, and determining if this issue is a priority in need of change.

A team of stakeholders is assembled, who then gather, appraise and synthesize body of existing evidence. Once there is sufficient evidence, the team designs and pilots the practice change. Determining whether this practice change is suitable for adoption is the next step. Once positive outcomes are achieved through the pilot, integration and of the practice is achieved by key stakeholders (such as patients and leaders). Sustainability is then assessed by local champions, leaders and senior leadership support and continuous monitoring of outcomes.

Dissemination of results is the final step, by sharing project reports within and outside the organization through presentations and publications. This step is key in promoting this change across the greater health care system (Melnyk & Fineout-Overholt, 2019).

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The Evidence-Based Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model aims to provide a systems-wide conceptual framework to guide, implement and sustain evidenced based practice (EBP) (Melnyk & Fineout-Overholt, 2019). The ARCC is used to guide behavioral change towards EBP. The model was conceptualized as a strategic planning initiative to unify research and clinical practice to promote EBP with the ultimate purpose of improving health care quality and patient outcomes. First, they had to determine what the barriers were in facilitating EBP.

They found through surveys, along with control theory and cognitive behavior theory, that having a mentor was an important EBP facilitator in implementing and sustaining EBP. The first step of the ARCC model involves organizational assessment of readiness for EBP. This also involves evaluating the key strengths and opportunities for fostering EBP within the organization, as well as identifying potential barriers such as lack of EBP mentors, inadequate EBP knowledge and skills and low beliefs and values of EBP.

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EBP models to change practice in an organization
EBP models to change practice in an organization

Having EBP mentors within the organization is key in facilitating and supporting the change towards EBP as they can serve as role models, stimulating, facilitating and educating nursing staff towards a culture of EBP, and involving staff in research, and using evidence to support best practice, and collaborating with interdisciplinary health professionals to advance and sustain EBP. Implementing EBP involves the EBP mentors engaging in a 12-month program to prepare working directly with point of care clinicians to implement and sustain EBP throughout the entire system or institution.

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The EBP implementation in the ARCC model is measured via an 18-item Likert scale/EBPI scare answering how often in the last 8 weeks the clinicians have performed certain EBP initiatives. It was found that the greater EBPI scores, the higher nurse satisfaction, which can greatly reduce turnover rates and healthcare expenditures.

Although both models promote health care quality and evidence-based practice, there are some noticeable differences. The IOWA model begins with the triggering issues for practice change, whereas the ARCC begins first with the assessment for EBP readiness. Additionally, the IOWA Model appears to address practice change at a smaller, more direct-patient care level, as opposed to the ARCC that targets a more system-wide, organizational focus.

While the IOWA model involves a team of stakeholders to perform appraisal and synthesis of evidence to formulate a pilot of change, the ARCC focuses more on use of EBP mentors to promote behavioral and perceptual change towards EBP. The IOWA model involves the stakeholders in designing, implementing and sustaining the practice change for practice adoption, while the ARCC uses the EBP mentor, who then facilitates staff involvement in research to generate external evidence and to use this evidence to foster a change to promote best practice.

References:

Melnyk, B. M. & Fineout-Overholt, E. (2019).  Evidence-based practice in nursing & healthcare. A guide to best practice. (4th ed.). Philadelphia: Lippincott Williams & Wilkins. 

Moran, K., Burson, R., & Conrad, D. (2020).  The Doctor of Nursing Practice Project: A framework for

success (3rd Ed.) Burlington, MA: Jones & Bartlett.

Polit D & Beck, C. (2017).  Nursing research generating and assessing evidence for nursing practice. (10th ed.). Philadelphia: Lippincott Williams & Wilkins.

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Zaccagnini, M.E, & White, K.W. (2014).  The Doctor of Nursing Practice Essentials: A new model for advanced practice nursing. (2nd ed). Burlington: Jones & Bartlett.

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