Stetler model ppt latif sir (2)

EBP VS STETLER MODEL

1. Subject : Theoretical Foundation of Nursing Topic – Model of Evidence Based Practice Stetler Model of Evidence Based Practice Integration of Stetler Model with the following article: A Quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines ( Roseann P Velez, Kathleen Lent Becker, Patricia Davidson and Elizabeth Sloand ) Faculty Md. Abdul Latif (RN) MSc (Nursing Admin), PSU, Thailand PhD (Nursing), PSU, Thailand Faculty of Nursing Management NIANER

2. SL.NO NAME ID 1 Aklima Akter MSN 190501 2 Sageda Akter MSN 190502 3 Rabya Akter Monni MSN 190503 4 Farhana Armin MSN 190504 5 Sabein Islam MSN 190505 6 Most.Rozina Begom MSN 190506 7 Baby Kirttania MSN 190507 8 Morzina Akter MSN 190508 GROUP-E (Community Health Nursing )

3. Number of EBP models have been developed by nurses encourage translation of nursing research into practice. There are five models of EBP includes: Academic center for EBP star model Advancing Research and clinical pratice through close collabaration . Iowa model Jhons Hopkins nursing EBP model Stetler model of EBP EVIDENCE BASED PRACTICE MODEL

4. Purpose of evidence based practice model: To translate research findings into practice. To provide framework for understanding the evidence based practice process. Models of evidence based practice

5. STETLER MODEL This is a model of research utilization to facilitate evidence-based practice (EBP). 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. STETLER MODEL

6. The model formulated a series of critical-thinking and decision-making steps designed to facilitate safe and effective use of research findings. The  Stetler model of evidence - based practice  would help individual public health practitioners to use  evidence  in daily  practice  to inform program planning and implementation. For example, this  model  is a useful guide to using research  evidence  in developing health messages for breastfeeding. STETLER MODEL

7. 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 STETLER MODEL

8. This model consists of five phases ( Stetler , 2001, p. 276): Phase I: Preparation Phase II: Validation Phase III: Comparative Evaluation/Decision Making Phase IV: Translation/Application Phase V: Evaluation Phases of stetler model

9. 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

10.  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

11.  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. FIVE PROGRESSIVE CATEGORIES OF STETLER MODEL

12. 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 CRITICAL ASSUMPTIONS

13. A Quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines ( Roseann P Velez, Kathleen Lent Becker, Patricia Davidson and Elizabeth Sloand ) In this article stetler model is used for raised awareness about the importance of applying research findings in nursing practice. Integration of the Model with the Given Article

14. In this article authors used stetler model to implement an evidence-based clinical practice guideline (CPG) in order to minimize the inappropriate using of antimicrobial agent prescribing. Their goal was to evaluate the impact of a provider focused quality improvement educational intervention on appropriate prescribing for community associated methicillin -resistant Staphylococcus aureus infection. Integration of the Model with the Given Article

15. A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines. Here PICOT stands for- P = Patient,Population (18 medical doctor, physician assistant and nurse practitioner providers)/Problem( increase CA-MRSA infection) I = Intervention or prognostic factors being considered/ area of interest(The need to influence prescribers’ treatment of community acquired methicillin -resistant Staphylococcus aureus (CA-MRSA) infection through education. PICOT FORMAT

16. C= Comparison( Evaluation revealed treatment of CA-MRSA by prescribers as inconsistent with clinical guidelines . O = 12 of the 18 (67%) participants showed an increase in knowledge. Forty three per cent of prescribers’ charts demonstrated improved practice through use of the guidelines. Out of 18 prescribers, 44% sent a total of 21 cultures for abscesses. There was no difference in practice behaviours between professional groups. PICOT FORMAT

17. The Stetler (2001) was used to guide the development of the intervention. The Stetler Research Utilization model provided a conceptual framework for integrating evidence based practice findings using phases of preparation, validation, comparative evaluation/decision-making, translation/application, and evaluation. Integration of stetler model with provided article

18. Preparation phase: 1. Identify priority: The need to influence prescribers’ treatment of community acquired methicillin -resistant Staphylococcus aureus (CA-MRSA) infection through education 2. Identify problem: a. CA-MRSA infection increasing b. Evidence validating prescribers’ treatment contributes to CA-MRSA resistance c. Inconsistent use of clinical guidelines by prescribers d. Factors influencing prescribers’ treatment of CA-MRSA infection 3. Project purpose: Confirmed Practice project based on Stetler model framework

19. Validation phase: 1. Critique and synopsis of qualitative and quantitative research and clinical guidelines as best practice treatment determine quality of evidence Comparative evaluation by decision-making phase: 1. Evaluation revealed treatment of CA-MRSA by prescribers as inconsistent with clinical guidelines Phases of stetler model

20. Translation and application: 1. Project steps planned to reflect the project guiding inquiry 2. Operational details planned to explain use of guidelines as best practice treatment for prescribers rather than current practice treatment 3. Operational details planned to measure the influence of education and prescribers’ adherence to clinical guidelines as outcomes 4. Project implementation as per plan Phases of stetler model

21. Evaluation 1. Outcome of education measured by test scores 2. Outcome of prescriber adherence to clinical guidelines measured by chart audit 3. Report and dissemination of findings PHASES OF STETLER MODEL

22. According to Abbo et al. 2012. Studies estimate that up to 30–50% of all antimicrobial use is inappropriate despite clinical guideline recommendations, and multiple studies from various parts of the world demonstrate the association between antimicrobial use and resistance at the community level. Integration

23. Public commitment intervention, a new ,low-cost approach to decrease antibiotic prescribing , was studied by Meeker et al. (2014) at the University of Southern California. ( Reference:Meeker D, Knight T, Friedberg M, Linder J, Goldstein N, Fox C, Rothfeld D, Diaz G & Doctor J (2014) Nudging guideline- concordant antibiotic prescribing.) Integration cont.

24. Prescribers globally can implement public commitment intervention as an effective, low-cost tool to address AR. The evolution of providers’ prescribing habits is such that the pressure on providers to prescribe antibiotics is a daily part of clinical practice. Influencing prescribing through provider commitment to best practice can reduce infection and AR and significantly improve health and economic outcomes. Reference: Charani E, Edwards R, Sevdalis N, Lexandrou B, Sibley E, Mullett D & Holmes A (2011) Behavior change strategies to influence antimicrobial prescribing in acute care: a systematic review. Clinical Infectious Diseases 53, 651–662. Integration cont.

25. We conclude that integration of stetler Model of research utilization to facilitate evidence-based practice (EBP) in the provided article was done in a successful way to implement an evidence-based clinical practice guideline (CPG) in order to decrease overprescribing of antimicrobials in clinical and community practice guidelines. Authors conclude that the overuse and inappropriate use of antibiotics increases the risk of side effects, drug resistance, drug toxicity, and increases healthcare expenditures. CONCLUSION

26. Authors also conclude that Community acquired methicillin resistant Staphylococcus aureus is a global health threat directly related to overprescribing of antimicrobials. Authors recommended that Public commitment intervention, a new, low-cost approach to decrease antibiotic prescribing. Prescribers globally can implement public commitment intervention as an effective, low-cost tool to address Antibiotic Resistance. By practicing public commitment intervention 26 million unnecessary antibiotic prescriptions can be eliminated, saving $704 million annually on drug costs (Meeker et al.2014) in united states.