Common Nursing Practice Theory EBP Theory

EBP Theory

1. Evidence Based Nursing Practice Theory Shraboni Roy Teaching Assisstant Department of Graduate Nursing

2. Introduction A theory is a set of concepts and propositions that provide an orderly way to view phenomena. The purpose of a theory in scientific disciplines is to guide research to enhance the science by supporting existing knowledge or generating new knowledge”. A theory not only helps us to organize our thoughts and ideas, but it may also help direct us in what to do and when and how to do it.

3. Evidence Based Practice Evidence based Practice is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.  

4. Practice Based Evidence “Practice-based evidence” (PBE)—was introduced into the discussion of EBP a few years ago. PBE acknowledges the importance of the environment in determining practice recommendations and recognizes that knowledge can be generated from practice as well as from research (Chinn & Kramer, 2015).

5. EBP in Nursing Walker and Avant (2011) pointed out that practice is the central and core phenomenon and focus of nursing; arguably, it is the reason for nursing’s existence. Thus, it is critical to remember that theory guides practice, and it also generates models of testing in research through both PBE and EBP. For nursing, therefore, practice must not only be evidence-based but also be theory-based, for when research validates a theory, it provides the evidence required for EBP. Finally, as more research is conduced about a specific theory, more evidence is provided to support practice.

6. Components of a Theory A theory has several components including Purpose concepts and definitions theoretical statements structure/linkages and ordering assumptions

7. Level of Nursing Theory Grand Nursing Theory Middle Range Theory Practice/ Evidence Based Practice Theory

8. Theoretical of Evidence Based Practice/ Practice Theory Academic Center for Evidence-Based Practice Star Model (ACE Star Model) Advancing Research and Clinical Practice Through Close Collaboration (ARCC Model) Iowa Model Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model Stetler Model of Evidence-Based Practice

9. Academic Center for Evidence-Based Practice Star Model (ACE Star Model) The Star Model is depicted by five points of knowledge transformation. Discovery research Evidence summary Translation to guidelines Practice integration Process, outcome evaluation

10. ACE Star Model

11. Advancing Research and Clinical Practice Through Close Collaboration (ARCC Model) The AARC Model relates best to clinical practice, and much of the research supporting its development and implementation was conducted in acute care, pediatric settings. The central constructs are assessment of organizational culture and readiness for EBP, identification of strengths and major barriers to EBP, and development and use of EBP mentors.

12. Cont.. These constructs are done sequentially and followed by EBP implementation. Outcomes that should be evaluated include health care provider satisfaction, cohesion, intent to leave, turnover, improved patient outcomes, and hospital costs.

13. Iowa Model of Evidence-Based Practice to Promote Quality Care It incorporates starting points, which are nursing problems that are termed “triggers.” It continues through multiple decision points and feedback loops to provide for evaluation of any changes. When implemented, it will assist in providing quality care to clients of clinics, home health agencies, and hospitals. The Iowa Model is very detailed and specific and has been applied to address a number of clinical topics. It is also one of the best researched EBP models.

14. The Johns Hopkins Nursing Evidence-Based Practice Model The JHNEBP Model was designed as a problem-solving approach to clinical decision making. It combines elements of the nursing process, the American Nurses Association’s Standards of Practice, critical thinking, and research utilization processes.

15. Steps of the Johns Hopkins Nursing Evidence-Based Practice Model Practice Question Recruit interprofessional team Develop and refine the evidence-based practice (EBP) question (Apply PICO elements.) Define the scope of the EBP question and identify stakeholders Determine responsibility for project leadership Schedule team meetings

16. Cont.. Evidence Conduct internal and external search for evidence Appraise the level and quality of each piece of evidence Summarize the individual evidence Synthesize overall strength and quality of evidence Develop recommendations for change based on evidence synthesis

17. Cont.. Translation Determine fit, feasibility, and appropriateness of recommendation for translation pathway Create action plan Secure support and resources to implement action plan Implement action plan Evaluate outcomes Report outcomes to stakeholders Identify next steps Disseminate findings

18. Stetler Model of Evidence-Based Practice The current Stetler Model of EBP is similar to the nursing process; therefore, it is easily assimilated by practicing bedside nurses. The phases of the approach include Preparation Validation comparative evaluation/decision making translation/application, and evaluation. It provides practitioners with stepwise directions for integrating research into practice.

19. Preparation (purpose, control, and sources of research evidence) Define potential issues Seek sources of research evidence Perceive problems Focus on high-priority issues Decide on need for a team Consider other influential factors Define desired outcomes Seek systematic reviews Determine need for explicit research evidence Select research sources with conceptual fit

20. Validation (credibility of findings and potential for/detailed qualifiers of application) Credibility of findings Critique and synthesize resources Critique systematic reviews Reassess fit of individual sources Rate the level and quality of evidence Differentiate statistical and clinical significance Eliminate noncredible sources End the process if there is no evidence or clearly insufficient credible research evidence

21. Comparative evaluation/decision making (synthesis and decisions/recommendations for criteria of applicability) Synthesize the cumulative findings Evaluate the degree and nature of other criteria Make a decision whether/what to use If decide to “not use,” STOP use of the model If decide to use, determine recommendations for a specific practice

22. Translation/application (operational definition of use/actions for change) Types Methods Levels Direct instrumental use Cognitive use Symbolic use Caution: Assess whether translation/product or use goes beyond actual findings/evidence Formal dissemination and change strategies should be planned per relevant research Consider need for appropriate reasoned variation

23. Evaluation (alternative types of evaluation) Evaluation can be formal or informal, individual or institutional Consider cost-benefit of evaluation efforts

24. Thank You..

25. Reference McEwen.M .(2018).Theoretical Basis for Nursing, 5 th Edition.Wolters Kluwer.