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1. NURS FPX 4025 Assessment 2 Applying an EBP Model
Student Name
Capella University
NURS-FPX4025
Instructor Name
Date
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NURS FPX 4025 Assessment 2

2. Applying an Evidence-Based Practice Model
Evidence-Based Practice (EBP) integrates the best available research, clinical expertise, and
patient preferences to enhance health outcomes and optimize care delivery. The implementation
of an EBP model provides a systematic framework for identifying clinical gaps, analyzing
practice issues, and developing data-driven strategies for improvement. By promoting
interdisciplinary collaboration and continuous evaluation, EBP facilitates sustainable and
measurable improvements in healthcare quality. This assessment explores the application of a
structured EBP model to address diagnostic inaccuracies, particularly the misdiagnosis of
Trichomonas vaginalis (TV), and how it can be used to strengthen healthcare quality
improvement through more accurate clinical protocols and interventions.
Identifying the Issue Requiring Evidence-Based Practice
One significant issue warranting the implementation of an EBP model is the overuse of empirical
treatment without laboratory confirmation in diagnosing Trichomonas vaginalis. Clinical
manifestations of trichomoniasis—such as vaginal discharge, dysuria, and irritation—are
nonspecific and often overlap with bacterial vaginosis (BV) and vulvovaginal candidiasis
(VVC). Therefore, clinical judgment alone frequently leads to diagnostic inaccuracies. Benedict
et al. (2022) reported that over 60% of patients suspected of having VVC received no diagnostic
assessment, and empirical prescriptions of antifungal and antibacterial medications were
widespread. This highlights the urgent need for evidence-based diagnostic frameworks to
improve precision and reduce unnecessary antimicrobial use.
Implementing an EBP approach ensures that diagnosis and management are guided by validated
evidence and patient-centered considerations. Utilizing diagnostic methods such as multiplex
polymerase chain reaction (PCR) testing and vaginal cultures before treatment supports the
incorporation of accurate, evidence-based diagnostic processes. These methods enhance patient
safety, reduce inappropriate antimicrobial use, and improve care quality by aligning diagnosis
with clinical evidence (Workowski et al., 2021). Additionally, EBP-driven approaches empower
nurses to provide patient education on sexually transmitted infections (STIs), leading to better
prevention and long-term health outcomes.
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3. Appropriate EBP Model Selection and Rationale
The Iowa Model Revised is an effective and systematic EBP framework for addressing clinical
practice problems (Cullen et al., 2022). Its structured process begins with identifying a clinical
issue, assembling a multidisciplinary team, appraising evidence, and implementing a pilot
practice change before institution-wide adoption. In this case, the Iowa Model is applied to
reduce empiric management of trichomoniasis through the establishment of standardized
diagnostic protocols.
The process begins with identifying the problem—symptom-based diagnosis without
confirmatory testing—and assembling a team of nurses, clinicians, microbiologists, and quality
improvement professionals. Together, they perform a systematic literature review and evaluate
diagnostic strategies, including microscopy, PCR, and culture-based methods. Through
Resource Credibility Assessment and Clinical Relevance Evaluation, only high-quality,
applicable studies are selected (Workowski et al., 2021). The findings are translated into a
standardized diagnostic workflow supported by training, decision-support tools, and pilot testing
in outpatient clinics. Evaluation metrics include diagnostic accuracy, prescribing rates,
turnaround times, patient satisfaction, and cost-effectiveness.
Following successful pilot testing, the refined protocol is scaled up institution-wide. Ongoing
staff education, audit feedback loops, and real-time dashboards support sustainability and
compliance. The Iowa Model Revised was selected due to its focus on interdisciplinary
collaboration, iterative improvement, and long-term integration into practice—all of which align
with healthcare quality improvement initiatives.
Applying the EBP Model in the Evidence Search Process
Identifying the Issue or Opportunity
Practice issue analysis and audit data revealed a trend of empiric treatment of trichomoniasis
without diagnostic confirmation (Benedict et al., 2022; Tse et al., 2024). The literature also
confirmed overlapping symptoms among vaginitis types, underscoring the need for evidence-
based diagnostic refinement.
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4. Stating the Purpose
The primary objective was to determine whether molecular diagnostic tools reduce misdiagnosis
rates compared to empiric therapy. Outcome measures included diagnostic accuracy,
appropriateness of treatment, and patient safety (Rawson & Moore, 2023).
Forming a Team
A multidisciplinary team comprising nursing, microbiology, infectious disease, and quality
improvement professionals was formed. Each member contributed expertise in literature search,
evidence appraisal, and protocol design—reflecting effective EBP collaboration.
Assembling, Appraising, and Synthesizing Evidence
Databases such as PubMed, CINAHL, and Cochrane Library were searched using structured
strategies. Tools like the CASP and Joanna Briggs Institute checklists ensured rigorous quality
appraisal (Long et al., 2020). Evidence was compared based on diagnostic accuracy, resource
needs, and clinical feasibility through Scholarly Resource Triangulation.
Designing and Piloting the Practice Change
Evidence-informed diagnostic protocols integrating PCR testing and targeted staff training were
piloted. Metrics included lab turnaround time, treatment appropriateness, and workflow
integration (Rajsic et al., 2021). Challenges like limited resources and staff readiness were
addressed through tailored education initiatives, demonstrating effective nursing practice
transformation.
Integrating and Sustaining the Practice Change
Implementation science tools, including the Consolidated Framework for Implementation
Research (CFIR), guided long-term integration. Real-time audit dashboards and feedback
mechanisms ensured continuous quality improvement (Ellis et al., 2022). Sustainability was
achieved through iterative training, leadership engagement, and the establishment of clear
accountability mechanisms.
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5. Dissemination
Results were disseminated through clinical governance meetings, national conferences, and
journal publications (Cullen et al., 2022). Summaries and infographics were shared with frontline
staff to reinforce institutional learning and ensure compliance with scholarly communication
standards.
Evaluating Evidence for Diagnostic Improvement
The application of diagnosis-specific evidence improves the precision of identifying
Trichomonas vaginalis and reduces misdiagnosis rates. Tse et al. (2025) analyzed electronic
medical records of over 14,000 patients and found that empirical treatment was used in over half
of cases, with antifungal misuse rates as high as 13%. Similarly, Benedict et al. (2022) revealed
that most suspected VVC cases lacked diagnostic testing, resulting in widespread inappropriate
empiric management. Hillier et al. (2021) further demonstrated that empirical treatment led to
higher return visit rates, underscoring the need for standardized molecular diagnostics.
Using the CRAAP framework for resource credibility assessment confirmed that these studies
were current, authoritative, and methodologically robust. The data strongly support the adoption
of molecular diagnostic protocols to improve diagnostic accuracy and promote evidence-based
antimicrobial stewardship.
Conclusion
The implementation of the Iowa Model Revised effectively addresses the problem of empiric
trichomoniasis treatment by promoting evidence-based diagnostic practices. This approach
strengthens the EBP process through multidisciplinary collaboration, structured evidence
synthesis, and the use of diagnostic technology. Long-term sustainability is achieved through
audit feedback systems, continuous education, and outcome monitoring. Ultimately, this
evidence-based initiative enhances diagnostic accuracy, optimizes treatment protocols, reduces
antimicrobial misuse, and fosters nursing practice transformation—all contributing to improved
patient outcomes and institutional quality performance.
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6. References
Benedict, K., Lyman, M., & Jackson, B. R. (2022). Possible misdiagnosis, inappropriate empiric
treatment, and opportunities for increased diagnostic testing for patients with vulvovaginal
candidiasis—United States, 2018. PLOS ONE, 17(4).
https://doi.org/10.1371/journal.pone.0267866
Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa’s
implementation of the sustainability framework. Implementation Science, 17(1), 1.
https://doi.org/10.1186/s13012-021-01157-5
Ellis, L. A., Sarkies, M., Churruca, K., Dammery, G., Meulenbroeks, I., Smith, C. L., Pomare,
C., Mahmoud, Z., Zurynski, Y., & Braithwaite, J. (2022). The science of learning health systems:
Scoping review of empirical research. JMIR Medical Informatics, 10(2).
https://doi.org/10.2196/34907
Hillier, S. L., Austin, M., Macio, I., Meyn, L. A., Badway, D., & Beigi, R. (2021). Diagnosis and
treatment of vaginal discharge syndromes in community practice settings. Clinical Infectious
Diseases, 72(9), 1538–1543. https://doi.org/10.1093/cid/ciaa260
Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimizing the value of the critical appraisal
skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research
Methods in Medicine & Health Sciences, 1(1), 31–42.
https://doi.org/10.1177/2632084320947559
Rajsic, S., Breitkopf, R., Bachler, M., & Treml, B. (2021). Diagnostic modalities in critical care:
Point-of-care approach. Diagnostics, 11(12). https://doi.org/10.3390/diagnostics11122202
Rawson, T. M., & Moore, L. S. P. (2023). Understanding how diagnostics influence
antimicrobial decision-making is key to successful clinical trial design. Clinical Microbiology
and Infection, 29(6), 666–669. https://doi.org/10.1016/j.cmi.2023.03.010
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