Page 199 - Encyclopedia of Nursing Research

166 n EViDENCE-BASED PRACTiCE

O = outcome, and T = time) format leads to a at point of care), and (d) EBP mentors (i.e.,
more time efficient and effective search for advanced practice nurses with expertise in
E evidence. Articles from the search are then EBP as well as organizational and individ-
rapidly critically appraised, evaluated, and ual behavior change strategies) who work
synthesized to determine whether a prac- directly with clinicians at the point of care
tice change on the basis of the best evidence in implementing EBP (French, 2005; Kitson
is indicated. Relevant, reliable evidence is et al., 2008; Melnyk, 2007; Melnyk, Fineout-
then integrated with the clinician’s expertise Overholt, & Mays, 2008; Melnyk, Fineout-
and patient preferences and values in mak- Overholt, Stillwell, & Williamson, 2009).
ing a practice decision or change. Clinician There are several conceptual models that
expertise involves health care provider skills have been developed to facilitate a change to
and interpretation of patient assessment EBP in individuals and health care systems.
data, internal evidence, use of health care These models include (a) the EBP decision-
resources, and other important information making model by DiCenso, Ciliska, and
that is relevant to the clinical decision and Guyatt; (b) the Stetler model of EBP; (c) the
outcome. Once an evidence-based change is iowa model of EBP to promote quality care
made in clinical practice, measurement of key by Marita Titler and colleagues; (d) the model
outcomes is necessary to demonstrate that for EBP change by Rosswurm and Larabee;
the impact expected of the change indeed (e) the Advancing Research and Clinical
occurred in a clinician’s own practice setting. Practice Through Close Collaboration
The final step in EBP is disseminating the model by Melnyk and Fineout-Overholt;
outcomes of the evidence-based change so (f) the Promoting Action on Research
that others might benefit from the process. implementation in Health Services frame-
Although EBP produces better outcomes work by Rycroft-Mallone, Kitson, and col-
than care that is steeped in tradition and a leagues; (g) the clinical scholar model by
known process exists for implementing evi- Schultz; and (h) the Johns Hopkins nursing
dence-based care, there are multiple barriers EBP model by Newhouse and colleagues
that exist within individuals and institutions (Ciliska et al., 2011). it is increasingly recog-
that are slowing the widespread adoption of nized that efforts to change practice should
evidence-based care. Barriers in individuals be guided by conceptual models (Graham,
include (a) the perception that EBP takes too Tetroe, & the KT Theories Research Group,
much time, (b) the inadequate knowledge 2007). As these models are supported by evi-
and skills in EBP, and (c) a lack of confidence dence from research, they will become even
to implement change. System barriers include more valuable in helping clinicians deliver
(a) contextual environment and culture that evidence-based care.
does not support EBP, (b) lack of resources in summary, EBP is necessary to ensure
required for EBP, (c) lack of EBP mentors who the highest quality of cost-effective care
can assist with EBP implementation at point and the best patient outcomes. Efforts in the
of care, and (d) nurse administrators and future must be accelerated and placed on
managers who do not model EBP. Conversely, (a) educating both practicing clinicians and
there are a number of factors that facilitate health professional students in the EBP pro-
the implementation of EBP, including (a) EBP cess with emphasis on the building of EBP
knowledge and skills, (b) beliefs about the skills; (b) creating cultures of EBP that pro-
value of EBP and the ability to implement it, vide resources, EBP mentors, and support to
(c) a context and culture that supports EBP clinicians to engage in and sustain evidence-
and provides the necessary tools to support based care; (c) providing incentives for EBP;
evidence-based care (e.g., time to search and (d) establishing evidence-based clini-
for evidence, access to computer data bases cal practice guidelines and policies that are