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Introducing evidence into nursing practice: Using the IOWA model



Evidence-based practice has gained increasing popularity in all healthcare settings. Nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform decisions, actions and interactions with patients, to deliver the best possible care. Within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based. In order for nurses to operate from an evidence-based perspective, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.
Introducing evidence into nursing practice: using the IOWA model
Catriona M Doody and Owen Doody
Evidence-based practice has gained increasing popularity in all healthcare settings.
Nurses are urged to use up-to-date research evidence to ensure better patient outcomes
and inform decisions, actions and interactions with patients, to deliver the best
possible care. Within the practice setting, there is an increasing challenge to provide
clearly measurable care of the highest quality, which is evidence-based. In order for
nurses to operate from an evidence-based perspective, they need to be aware of how
to introduce, develop and evaluate evidence-based practice. This article presents how
evidence may be introduced into practice using the Iowa model, offering practical
advice and explanation of the issues concerning nurses in practice.
Key Words: Evidence based practice, Nursing, IOWA model
Evidence-based practice has gained increasing popularity since its introduction in the
latter part of the twentieth century, aspiring to be a dominant theme of practice,
policy, management and education within health services across the world (Rycroft-
Malone et al, 2004; Ryan et al, 2006). Nurses are urged to use up-to-date research
evidence to deliver the best possible care (Haynes et al, 1996; Barnsteiner and
Prevost, 2002; LoBiondo-Wood and Haber, 2006). Research-based practice has better
patient outcomes than routine, procedural nursing care (Heater et al, 1988; Thomas,
1999) and informs nursing decisions, actions and interactions with patients. Nurses in
practice are increasingly challenged by patients and healthcare organizations to
provide clearly measurable care of the highest quality (Holleman et al, 2006).
Decision making in health care has changed dramatically, with nurses expected to
make choices based on the best available evidence and continually review them as
new evidence comes to light (Pearson et al, 2007). Evidence-based practice involves
the use of reliable, explicit and judicious evidence to make decisions about the care of
individual patients (Sackett et al, 1996), combining the results of well-designed
research, clinical expertise, patient concerns and patient preferences (Sackett et al,
1996; Flemming et al, 1997; Grol and Grimshaw, 1999; Holleman et al, 2006). A
major criticism of evidence-based practice is the lack of available evidence or
inconclusive research. While a lack of evidence can be perceived as a barrier, it
should be recognized that the need to base practice on evidence has only become a
concern for health professionals relatively recently (Pearson et al, 2007). Although the
drive for evidence-based practice has gained momentum, it is still dependent on the
nurse’s ability to gather and appraise the evidence on which they base their care.
The results of well-designed research provide an obvious source of evidence but these
are by no means the only data used in everyday practice (Pearson et al, 2007). The
limitations of research conducted became obvious when the nursing profession began
to adopt an evidence-based model. Biomedical knowledge alone is inadequate for the
practice of nursing. A holistic approach is necessitated, which acknowledges all
aspects of people while also understanding their experiences (Pearson et al, 2007).
All knowledge and information used to make decisions can be referred to as evidence;
however, the validity of this evidence may be variable. There is no necessary
relationship between quantity and quality, nor between either of these and evidence
usage (Newell and Burnard, 2006). Therefore, nurses must take into account the
quality of evidence, assessing the degree to which it meets the four principles of
feasibility, appropriateness, meaningfulness and effectiveness (National Institute for
Health and Clinical Excellence, 2003; Gagan and Hewitt-Taylor, 2004; Pearson et al,
2007). In order for nurses to operate in an evidence-based manner, they need to be
aware of how to introduce, develop and evaluate evidence-based practice. This article
presents how evidence may be introduced into practice using the Iowa model, offering
practical advice and explanation of the issues concerning nurses in practice.
Process of introducing Evidence-Based Practice:
The Iowa model focuses on organization and collaboration incorporating conduct and
use of research, along with other types of evidence (Titler et al, 2001). Since its origin
in 1994, it has been continually referenced in nursing journal articles and extensively
used in clinical research programmes (LoBiondo-Wood and Haber, 2006). This model
allows us to focus on knowledge and problem-focused triggers, leading staff to
question current nursing practices and whether care can be improved through the use
of current research findings (Titler, 2006). In using the Iowa model, there are seven
steps to follow. These are outlined in Figure 1.
Figure 1. Seven steps of the IOWA model
1. Selection of a Topic
6. Implement the EBP
7. Evaluation
5. Developing an EBP
3. Evidence retrieval
2. Forming a
4. Grading the
Step 1: Selection of a topic
In selecting a topic for evidence-based practice, several factors need to be considered.
These include the priority and magnitude of the problem, its application to all areas of
practice, its contribution to improving care, the availability of data and evidence in the
problem area, the multidisciplinary nature of the problem, and the commitment of
Step 2: Forming a team
The team is responsible for development, implementation, and evaluation (LoBiondo-
Wood and Haber, 2006). The composition of the team should be directed by the
chosen topic and include all interested stakeholders. The process of changing a
specific area of practice will be assisted by specialist staff team members, who can
provide input and support, and discuss the practicality of guideline implementation
(Frost et al, 2003; Gagan and Hewitt-Taylor, 2004). A bottom-up approach to
implementing evidence-based practice is essential as change is more successful when
initiated by frontline practitioners, rather than imposed by management (Gough,
2001). Staff support is also important. Junior staff require support from senior staff to
effect change, as senior members or institutions often impede junior members from
implementing evidence-based practice (Bhandari et al, 2003). Without the necessary
resources and managerial involvement, the team will not feel they have the authority
to change care or the support from their organization to implement the change in
practice (Feasey and Fox, 2001).
To develop evidence-based practice at unit level, the team should draw up written
policies, procedures and guidelines that are evidence-based (LoBiondo-Wood and
Haber, 2006). Interaction should take place between the organization’s direct care
providers and management such as nurse managers, to support these changes (Retsas,
2000; Nagy et al, 2001; Berwick, 2003; LoBiondo-Wood and Haber, 2006). As social
and organizational factors interfere with the application of research findings, they
need to be identified and addressed prior to the development of evidence-based
practice or application of an evidence-based practice initiative to other practice areas
within the organisation. The factors identified within the literature include workload,
support of management and colleagues, level of education, experience of research,
lack of exposure to research, lack of training in research use, preference for practice
wisdom rather than research evidence, time availability, accessibility to research,
champion to assist efforts, organisation support to use and conduct research (Gerrish
and Clayton, 2004; Brown et al, 2009). Nurses or management may perceive task
performance as a more justifiable use of time than seeking evidence for action or
designing guidelines for existing practice (Gagan and Hewitt-Taylor, 2004; Pearson et
al, 2007).
Step 3: Evidence retrieval
From the team formation and topic selection, a brainstorming session should be held
to identify available sources and key terms to guide the search for evidence. Evidence
should be retrieved through electronic databases such as Cinahl, Medline, Cochrane,
Web of Science and Blackwell Synergy, utilizing key terms. Other sources of
evidence such as the National Institute of Health and Clinical Excellence (NICE) and
Quality Improvement and Innovation Partnership (QIIP) should be consulted with
regards to relevant care standards and guidelines.
Step 4: Grading the evidence
To grade the evidence, the team will address quality areas of the individual research
and the strength of the body of evidence overall. There is a tendency to classify
research as quantitative or qualitative. Qualitative data is collected in order to derive
understanding of phenomena from a subjective perspective. The focus is on
description, understanding, and empowerment. The theory is developed based on
inductive reasoning, and is grounded in reality as it is perceived and experienced by
the participants involved. Conversely, quantitative data is based on the process of
deduction, hypothesis testing and objective methods in order to control phenomena
with its focus on theory testing and prediction.
The relative merits of both of these forms of data are the subject of much heated
debate. On one hand, qualitative methods are seen to most certainly increase
understanding but they are often criticized as being biased, subjected to the question,
‘Well, now that we understand, so what?(Pearson et al, 2007). On the other hand,
quantitative methods are seen to give an apparently unbiased, objective picture of a
situation or phenomenon, but they are often criticized as being ‘only half the story’ or
of being overly concerned with numbers and statistics (Pearson et al, 2007). Central to
the debate however, must be the paradigmatic stance from which the researcher
works, and the stance from which the consumer of research reads. As long as the
method is consistent with, or true to, the paradigm that underpins the research, and is
the appropriate method to address the research question, in theory the debate becomes
redundant. However, the debate still continues to rage largely because of deeply
entrenched allegiances to a particular paradigm.
The research question influences the research methodology, which influences the way
in which data is collected and analysed, as the methods are also dependent on the
methodology adopted. Table 1 identifies a range of methodological approaches, which
are consistent with the philosophical view of knowledge embodied in each paradigm
and may guide staff in the appraisal of evidence.
Table 1. Paradigms, methodologies and methods for research studies (Pearson et
al, 2007)
Randomized controlled
Cohort studies
Case series studies
Time series studies
Methods that measure outcomes such as
temperature, blood pressure, and attitudes
Methods that measure outcomes (as above)
Methods that measure outcomes (as above)
Methods that measure outcomes (as above)
Grounded theory
Textual analysis; interviews; participant
observation; interviews of key informants
Textual analysis; interviews; participant
observation; interviews of key informants
Participant observation; interviews
Action research
Feminist research
Participative group interaction; observation;
Participative group interaction; observation;
Review protocols are vital to ensuring practices are based on the most current
research evidence. Criteria should be set for retrieval of the evidence so each team
member identifies areas for grading and grading criteria sheets should be given to
each staff member to complete on relevant studies. Addressing areas of effectiveness,
appropriateness and feasibility, Table 2 highlights the areas and criteria involved. A
three-tier grading system can be used: A. Strong support that merits application, B.
Moderate support that merits application, C. Not supported (Joanna Briggs Institute,
Table 2. Grading criteria
Relates to whether the
intervention achieves the
intended outcomes.
• Does the intervention work?
• What are the benefits and harm?
• Who will benefit from its use?
Concerned more with the
psychosocial aspects of care than
with the physiological.
• What is the experience of the consumer?
• What health issues are important to the
• Does the consumer view the outcomes as
Addresses the broader
environment in which the
intervention is situated and
involves determining whether
the intervention can and should
be implemented.
• What resources are required for the
intervention to be successfully implemented?
• Will it be accepted and used by healthcare
• How should it be implemented?
• What are the economic implications of using
the intervention?
Step 5: Developing an Evidence-Based Practice (EBP) standard
After a critique of the literature, team members come together to set recommendations
for practice. The type and strength of evidence used in practice needs to be clear
(LoBiondo-Wood and Haber, 2006) and based in the consistency of replicated studies.
The design of the studies and recommendations made should be based on identifiable
benefits and risks to the patients. This sets the standard of practice guidelines,
assessments, actions, and treatment as required. These will be based on the group
decision, considering the relevance for practice, its feasibility, appropriateness,
meaningfulness, and effectiveness for practice (Pearson et al, 2007). To support
evidence-based practice, guidelines should be devised for the patient group, health
screening issues addressed, and policy and procedural guidelines devised highlighting
frequency and areas of screening. Evidence-based practice is ideally a patient centred
approach, which when implemented is highly individualized. However, poor
implementation has the potential to give rise to ‘cookbook care’ where clinical
guidelines are used simply as a recipe for healthcare delivery without due
consideration for the individual patient (Pearson et al, 2007). Any practice failing to
consider the preferences of the individual patient is not evidence-based, so a
partnership approach is needed which takes into account patient autonomy, choice and
preference to be expressed (van Hooren et al, 2002).
Step 6: Implementing EPB
For implementation to occur, aspects such as written policy, procedures and
guidelines that are evidence-based need to be considered (LoBiondo-Wood and
Haber, 2006). There needs to be a direct interaction between the direct care providers,
the organization, and its leadership roles (eg. nurse managers) to support these
changes (Retsas, 2000; Nagy et al. 2001; Berwick 2003; LoBiondo-Wood and Haber,
2006). The evidence also needs to be diffused and should focus on its strengths and
perceived benefits (Berwick, 2003; Rogers, 2003), including the manner in which it is
communicated (Rogers, 1995; Titler and Everelt, 2001). This can be achieved through
in-service education, audit and feedback provided by team members (Jamtvedt et al,
2004; Titler, 2004). Social and organizational factors can affect implementation and
there needs to be support and value placed on the integration of evidence into practice
and the application of research findings (Gagan and Hewitt-Taylor, 2004; Pearson et
al, 2007).
Step 7: Evaluation
Evaluation is essential to seeing the value and contribution of the evidence into
practice. A baseline of the data before implementation would benefit, as it would
show how the evidence has contributed to patient care. Audit and feedback through
the process of implementation should be conducted (Thomson O Brien et al, 2003;
Jamtvedt et al, 2004) and success will not be achieved without support from frontline
leaders and the organization (Baggs and Mick, 2000; Carr and Schott, 2002; Stetler,
2003). Evaluation will highlight the programme’s impact but its consistency can only
be assessed against an actual change occurring and having the desired effect (Pearson
et al, 2007). For any change to take place, barriers that could hinder its progress need
to be identified. Information and skill deficit are common barriers to evidence-based
practice. A lack of knowledge regarding the indications and contraindications, current
recommendations, and guidelines or results of research, has the potential to cause
nurses to feel they do not have sufficient training, skill or expertise to implement the
change (Pearson et al, 2007). Lack of awareness of evidence will inhibit its translation
into practice (Scullion, 2002). A useful method for identifying perceived barriers is
the use of a force field analysis conducted by the team leader. Impact evaluation,
which relates to the immediate effect of the intervention, should be carried out
(Naidoo and Wills, 2002). However, some benefits may only become apparent after a
considerable period of time. This is known as the sleep effect. On the contrary, the
back-sliding effect could also occur where the intervention has a more or less
immediate effect, which decreases over time. If we evaluate too late, we will miss
measuring the immediate impact. Even if we do observe the early effect, we cannot
assume it will last (Green, 1977; Nutbeam, 1998). Therefore, evaluation should be
carried out at different periods during and following the intervention.
The effectiveness of clinical care and treatment is central to the quality of health care
(Thompson, 2000) and providing a high quality care based on best practice is the
responsibility of nurses. In many clinical settings, nurses are under increased time
pressure and evidence-based practice may fail, having a low priority among
competing duties (Lawrie et al, 2000; Bhandari et al, 2003; Frost et al, 2003; Thomas
et al, 2003). Quality improvement is often seen as an additional task to an already
busy workload (Long, 2003). However, it may be that nurses perceive activity to be a
more worthy use of time than seeking evidence upon which to act (Gagan and Hewitt-
Taylor, 2004). For evidence-based practice to be implemented, this value system and
the norms that lead to it need to be addressed as a priority, and this is the
responsibility of each practitioner in any given situation (Gagan and Hewitt-Taylor,
2004). As the largest group providing care to patients and having the most contact
with them, nurses have the opportunity to influence the course of their illness and
recovery. If care is not evidence-based, the potential of harm increases (Newell and
Burnard, 2006). Therefore, nurses must actively engage in reading, critiquing and
grading the evidence to continually challenge the practice.
Key points
Nurses need to continuously update their knowledge and act from an
evidence-based approach rather than working solely from practice wisdom.
There is a constant challenge for nurses in the practice setting to provide
measurable care and outcomes of the highest standard in an evidence-based
Evaluation of evidence and development of evidence-based practice will
empower nurses.
Collective work and the use of tools such as the IOWA model can assist
nurses with EBP.
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... They are built upon critical steps or phases that need to be followed or focused upon in order to reach successful implementation. These main phases or steps can either be aimed at the implementation process itself (31,32) or at the process of using research to initiate change (42,51). In such models, key drivers or components tend to be highlighted that are necessary for change (33,49) and/or they have a thorough focus on those strategies that will lead to sustainable change, which is referred to as general implementation strategies (31), transfer strategies (30), capacity-building strategies (32) et cetera. ...
... Most models require that intervention designers synthesize existing evidence (38,39,42,44), or that they conduct their own (discovery) research (44,46). This will lead to either a theory (38), approach or practice (46), or research findings that can be translated into an evidence based practice (EBP) standard (42) or guidelines (44). ...
... Most models require that intervention designers synthesize existing evidence (38,39,42,44), or that they conduct their own (discovery) research (44,46). This will lead to either a theory (38), approach or practice (46), or research findings that can be translated into an evidence based practice (EBP) standard (42) or guidelines (44). Other models have a different focus and depart from the idea of planning (26) for an intervention or a more general exploration phase (22,45). ...
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Background: Our aim is to identify the core building blocks of existing implementation frameworks and models, which can be used as a basis to further develop a framework for the implementation of complex interventions within primary care practices. Within the field of implementation science, various frameworks, and models exist to support the uptake of research findings and evidence-based practices. However, these frameworks and models often are not sufficiently actionable or targeted for use by intervention designers. The objective of this research is to map the similarities and differences of various frameworks and models, in order to find key constructs that form the foundation of an implementation framework or model that is to be developed. Methods: A narrative review was conducted, searching for papers that describe a framework or model for implementation by means of various search terms, and a snowball approach. The core phases, components, or other elements of each framework or model are extracted and listed. We analyze the similarities and differences between the frameworks and models and elaborate on their core building blocks. These core building blocks form the basis of an overarching model that we will develop based upon this review and put into practice. Results: A total of 28 implementation frameworks and models are included in our analysis. Throughout 15 process models, a total of 67 phases, steps or requirements are extracted and throughout 17 determinant frameworks a total of 90 components, constructs, or elements are extracted and listed into an Excel file. They are bundled and categorized using NVivo 12© and synthesized into three core phases and three core components of an implementation process as common elements of most implementation frameworks or models. The core phases are a development phase, a translation phase, and a sustainment phase. The core components are the intended change, the context, and implementation strategies. Discussion: We have identified the core building blocks of an implementation framework or model, which can be synthesized in three core phases and three core components. These will be the foundation for further research that aims to develop a new model that will guide and support intervention designers to develop and implement complex interventions, while taking account contextual factors.
... The "problem-focused trigger" is present within the student body, with the students showing significant levels of stress and anxiety. A "knowledge-based trigger" is revealed in the lack of education on the importance of using available mental health resources and the stigma which psychologically limits students from accessing mental health services (Doody & Doody, 2011;Melnyk & Fineout-Overholt, 2015). (Goh & Agius, 2010;Hazelden Foundation, 2008;Zubin & Spring, 1977). ...
... The focus of this project is the gap in the help-seeking of mental health services by students in a college setting. The Iowa Model of EBP guided the process of discovery and learning about mental health from macro to micro-level through a systematic method of inquiry(Doody & Doody, 2011). the DNP-scholar developed a hearty project proposal to meet the needs of this vulnerable population.The unfolding the literature was central to the development of the DNP project, determining what was already known about college students and their attitudes and behaviors around issues of mental health. ...
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Abstract IMPLEMENTATION OF THE NATIONAL ALLIANCE ON MENTAL ILLNESS, IN OUR OWN VOICE EDUCATIONAL INTERVENTION ON STIGMA ATTITUDES REGARDING MENTAL ILLNESS IN A COLLEGE SETTING by Bethany Ann Thrasher Background: The WHO estimates depression will be the number one cause of disease burden globally by 2030. In the United States, mental health illness is a priority concern for adults 18 to 24 years. Approximately 75% of all mental illness surface by age 24 years, yet only 64% of college students experiencing mental illness seek treatment. Early identification and access to treatment for mental health care is essential for college student. Stigma associated with mental illness remains a barrier to help-seeking. Implementing a contact-based strategy to reduce stigma produces change in attitudes surrounding mental illness and improves health outcomes. Purpose: To evaluate the effectiveness of a contact-based educational intervention on stigma attitudes concerning mental illness in a college setting. Methods: Pre- and Post-survey were conducted during a college orientation to evaluate students stigmatizing attitudes towards people with mental illness. The participants completed the Stigma Evaluation Survey (SES) before and after the National Alliance on Mental Illness, In Our Own Voice presentation. Descriptive statistics of participants include age, gender, ethnicity, education, and experience with persons with a mental illness. Results: Independent t-test showed significant decrease in the SES aggregate mean scores from pre-intervention (M= 47.18, SD=8.90) to post-intervention (M= 43.20, SD= 6.99) conditions; t(92)= 2.39, p = .019. The SES survey is a 20-item Likert scale with subscale areas: Stereotyped Attributions, Expressions of Social Distance, and Feelings of Social Responsibility towards people with mental illness. The SES subscale, Expressions of Social Distance for the female participants p = .002. Participants with experiences with mental illness experienced a drop in stigma with Expressions of Social Distance, p = .009, and Stereotyped Attributions, p = .041. Conclusions: Contact-based educational interventions targeting stigma in higher education are essential in advancing sustainable processes to reduce stigma and improve mental health. The In Our Own Voice presentation is effective in reducing stigma and improving attitudes of college students even when delivered virtually. Significance: By understanding the factors that produce stigma in college settings, institutions can improve help-seeking behavior. Enhancing academic outcomes will promote the mental health and wellness of college students. Keywords: College students, Mental disorders, Social stigma, Stigma, Contact-based
... El modelo Iowa se ha utilizado por muchos estudios para aplicar su metodología en la búsqueda e implementación de la evidencia encontrada. Según algunos autores, este modelo ofrece un camino en la aplicación de la investigación práctica (Doody y Doody, 2011). El modelo aporta un árbol de decisiones en función de unos puntos de inflexión sobre las acciones que habrá que tomar durante el proceso de la PBE. ...
... En conclusión, el consenso general es que cualquier implementación de la PBE incluya una recogida de medidas base previas al inicio de la intervención, que sirva como medida de referencia, seguida de medidas periódicas de seguimiento para supervisar el cambio (Doody y Doody, 2011;Maglione, Gans, Das,Timbie y Kasari, 2012). Este tipo de recogida de evidencias probablemente corresponda con los diseños 1, 2 y 3 de la figura 1 sobre diseños experimentales en estudios de intervención. ...
... Evidencebased treatment integrates the result of other well research, clinical competence, patient requirements, and customer outcomes to make judgments regarding particular patients' wellbeing based on clear, explicit, and judicious evidence.Despite the fact that a lack of proof may appear to be a barrier,it's important to note that the necessity for health professionals to base their decisions on evidence has only lately become a priority. It makes little difference whether the need for evidence-based therapy has gained traction or not [1]. ...
Background: Head injuries are a regular occurrence in emergency departments around the world, with more than 2 million annual visits in North American EDs and more than 400 000 in the United Kingdom alone. Despite the fact that the mechanism of injury is consistent,, Head injuries are a regular occurrence in emergency departments around the world, with over 2 million visits in North American EDs and over 400 000 in the European Union alone. Regardless of how consistent the injury mechanism is. Objectives: Holds data what nurses already know about the modified LOWA model. 2. Develop and test a protocol using a IOWA model that was adjusted. 3. Assess the updated LOWA model's effectiveness 4.To connect the knowledge score to demographic data. Research Approach: Interventional approach Research design: - One group pre test and post test. Setting of the study: - The study will be conducted in AVBRH Hospital. Sample: - Staff Nurse Sample Size is 50Sampling Technique is Purposive sampling. Setting of the study is The study will be conducted in AVBRH Sample: - Staff Nurse Sampling Technique: - convenient sampling Data Collection: - Field data Will be collected by the use of standardised questionnaires with three key sections: Section A (Standard standards), Section B (Socio-demographics and work history of staff) used the modified LOWA model and check list). Expected Results: Oriented it toward the application of the LOWA model. Those characteristics are what evidence-based practise on trauma care nurses concerning head injury entails, but they may be able to address the issues that Traumatic Brain Injury Nursing faces. Adopting this paradigm into traumatic brain injury nursing units is worth a shot.With the assistance of a specific case, this article will discuss the clinical application of the Lowa Model in traumatic brain injury nursing care. Conclusion: In the light of the study findings, this study shows that, the implementation of LOWA Model evidence based practice has a positive effect on nurse’s knowledge and practices regarding trauma care nurses regarding head injury. There was a significant improvement in the nurses ‘knowledge and practice regarding LOWA Model evidence-based practice implementation compared with that before it. There was positive significant correlation between nurses’ knowledge and their practice before and after program. Nurses’ knowledge and practice about LOWA Model improved after application of this program.
... This pilot project was guided by the Iowa Model of Evidence-based Practice to provide a pathway for implementing evidence from the literature into practice. This model has been used in many health care settings to increase evidence-based practices at the front lines of nursing and increase the success and sustainability of clinical practice changes (Doody & Doody, 2011). As evidenced in Table 1, the Iowa Model of Evidence-Based Practice strategies include identifying the triggering issue/opportunity, stating the question or purpose, forming a team, assembling, appraising, and synthesizing the body of evidence, then conducting research or designing and piloting the practice change, and lastly, integrating and sustaining the change. ...
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Introduction: The dedicated education unit (DEU) is an innovative clinical model that prepares preceptors for success in clinical settings with nursing students. Though the DEU is mostly used in acute-care settings, this project explores the implementation of a DEU in a public health setting. Objectives: Better preparation of public health nurses and social workers as clinical preceptors for nursing students with the implementation of a DEU in a public health setting. Design: IRB approved, pre/post survey with participant comments. Measurements: Clinical Nurse Teacher Survey was assessed pre/post intervention with registered nurses and social work staff (n = 13). Paired t-tests analysis was used to determine significance. The Clinical Learning Environment and Nurse Teacher (CLES+T) scale completed postimplementation by nursing students (n = 8) after the clinical rotation. Results: Clinical Nurse Teacher Survey mean scores preintervention was 4.56 and increased postintervention to 4.89, though not statistically significant (p-value .11). CLES+T showing 100% fully agree or agree that the Public Health DEU is an effective learning environment. Conclusions: The DEU model in a public health setting is an opportunity to improve lived clinical experiences of preceptors and nursing students, which may increase nursing students’ positive perceptions of, and increase interest in serving as a public health nurse after graduation.
As the progress of critical care medicine has improved the survival rate of critically ill patients, comorbidities and long-term health care have attracted people's attention. The terms "post-intensive care syndrome" (PICS) and "PICS-family" (PICS-F) have been used in non-neurocritical care populations, which are characterized by the cognitive, psychiatric, and physical sequelae associated with intensive care hospitalization of survivors and their families. An intensive care unit (ICU) diary authored by the patient's family members may alleviate the psychological distress of the patient and his or her family. This quality improvement project focused on the development and implementation of the pediatric intensive care unit (PICU) diary in the pediatric critical care setting. The project aims to evaluate the feasibility and the potential efficacy of the PICU diary, measured through parental acceptance and satisfaction. Seventeen families of critically ill children admitted to the PICU received the PICU diary during the implementation period. Twenty-four parents completed the weekly follow-up, and 15 subsequently completed the diary entry evaluation. The use of the diary in the PICU setting is feasible and considered beneficial by families of critically ill children.
When a child is newly diagnosed with cancer, parents report feeling overwhelmed with the amount of information that they must process in order to safely care for their child at home. The Children’s Oncology Group (COG) Nursing Discipline has focused on examining current practices for educating families of children newly diagnosed with cancer, and developing tools to enhance the process of patient/family education at the time of diagnosis, including development of a COG Standardized Education Checklist, which classifies education into primary, secondary, and tertiary topics. The COG Nursing Discipline awarded nursing fellowships to two doctorally prepared nurses practicing at two distinct COG institutions to evaluate the checklist implementation. This project addressed the primary topics on the checklist essential to safely care for the child at home following the first hospital discharge. Checklist feasibility was determined by the proportion of checklists completed. Checklist fidelity was determined by review of documentation on the checklist regarding educational topics covered, learner preferences, and methods used. Checklist acceptability was assessed through parent/caregiver and nurse feedback. Project implementation occurred over a 5-month period and involved 69 newly diagnosed families. Implementation of the checklist was feasible (81%), with moderate fidelity to checklist topics taught across the two sites. Verbal instruction and written documentation were the most prevalent form of education. The return rate for the parent/caregiver and nurse acceptability questionnaires was moderate to low (68% and 12%, respectively), parent/caregiver feedback was positive and acceptability among responding nurses was high, with 92% of nurses identifying the primary checklist as useful.
Purpose The purpose of this research study was to improve communication and reduce critical information loss between the ambulatory postanesthesia care unit (PACU) and ambulatory surgical center (ASC) nurses by developing, piloting, and evaluating a hand-off communication tool. Design Descriptive study. Methods This pilot study was conducted in an outpatient surgery unit located at a large Magnet university hospital in New Jersey. Twenty ASC registered nurses (RNs) evaluated the hand-off tool developed for this study. Descriptive statistics were used to analyze the data from the 20 ASC RNs using three Likert-scale questions. Findings Three Likert-style questions guided the rating of this tool. Using correlation analysis, the results support that the tool may be perceived as an instrument that was simultaneously easy to use, helpful, and communicated relevant patient data. The calculation of the reliability coefficient was 0.89. Conclusions This standardized hand-off tool relayed the pertinent and relevant patient data needed to support handoff from the ambulatory PACU to the ASC. Only ASC RNs rated the tool in this study. A planned second phase will evaluate PACU nurse's perception of the tool.
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Background Nowadays, having knowledge of Evidence Based Practice (EBP) and its implementation strategies are critical skills for nurses to promote delivery of safe, effective and quality care. Nursing care delivery is faced with a challenge of delivering EBP. The purpose of this study was to build the capacity of and support nurses to implement an EBP change using Iowa Model of EBP. Methods Action research using quantitative approaches was conducted in intensive care unit at Kamuzu Central Hospital (KCH). A descriptive, pretest-posttest design using repeated measures was employed. Iowa model was used to implement change. Convenient sampling of six-co researchers and 26 patients was done, the inclusion criteria was all patients with fever. STATA 12.0 software was used to analyze data and paired t-test was used to determine the mean difference of the paired temperature observations. Results Iowa model effectively supported and guided nurses to: identify fever as a clinical problem; select fever control interventions; implement and evaluate the evidence-based interventions; refine and integrate the evidence-based interventions in routine practice. After Paired t-tests were run; there was an insignificant mean difference for exposure 0.07 °C, t (85) = 1.4123 and the P = 0.1615. This suggest that exposure has minimal effect on temperature reduction. The mean difference for paired temperature observation for: tepid sponge bath was 0.6 °C/hour, (t (85) = 9.8427, P = <0.001.); Ice packs 0.5 °C/hour, (t (56) = 6.7854, P = <0.001); antipyretics-paracetamol 0.3 °C/hour, t (23) = 3.4371, P = <0.002) and intravascular cooling 2.4 °C/hour (t (21) = 19.8080, P = <0.001). These methods had a significant mean difference of temperature reduction. This shows that the methods are effective in reducing temperature. Then a fever guideline was developed to guide nurses in smooth integration of the evidence-based fever control intervention into routine nursing care delivery to ensure sustainability. Conclusion Using Iowa model improves nurses' EBP capability and capacity. Increasing knowledge of key staff members, team work, availability of local resources are crucial to increase nurse’s capacity of taking their EBP role. For effective EBP initiative it is recommended to: utilize of EBP models, ensure active participation of all nurses at the unit level, have supportive leadership, communicate available EBP policies, guidelines and job description to providers, and integrate the pilot EBP innovation in routine nursing care operations.
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Seven dilemmas of evaluation and measurement posed by the nature of health education are presented, together with suggestions for their resolution. These include the dilemmas of : 1) rigor of experimental design vs significance or program adaptability; 2) internal validity or "true" effectiveness vs external validity or feasibility; 3) experimental vs placebo effectsl 4) effectiveness vs economy of scale; 5) risk vs payoff; 6) measurement of long-term vs short-term out-comon. Emphasis is placed on the need to develop a more cumulative data base through standardization of measures, replication of experiments in different settings, and better documentation, reporting, and diffusion of experiences in practice.
IntroductionEvidence-based health care (EBHC)Evidence-based medicineEvidence-based practice around the worldEvidence-based practice: beyond medicineA multidisciplinary affairThe roles of consumersCriticisms of the evidence-based approachConclusion Further reading and resources
This paper is a report of a study to describe nurses' practices, knowledge, and attitudes related to evidence-based nursing, and the relation of perceived barriers to and facilitators of evidence-based practice. Evidence-based practice has been recognized by the healthcare community as the gold standard for the provision of safe and compassionate healthcare. Barriers and facilitators for the adoption of evidence-based practice in nursing have been identified by researchers. Healthcare organizations have been challenged to foster an environment conducive to providing care based on evidence and not steeped in ritualized practice. A descriptive, cross-sectional research study was conducted in 2006-2007 with a convenience sample of 458 nurses at an academic medical center in California (response rate 44.68%). Two reliable and valid questionnaires were electronically formatted and administered using a secured website. Relationships between responses to the two instruments were examined and results compared with previously published data. Organizational barriers (lack of time and lack of nursing autonomy) were the top perceived barriers. Facilitators were learning opportunities, culture building, and availability and simplicity of resources. Statistically significant correlations were found between barriers and practice, knowledge and attitudes related to evidence-based practice. Similar barriers to the adoption of evidence-based practice have been identified internationally. Educators must work with managers to address organizational barriers and proactively support evidence-based practice.
The 84 subject-studies and 4,146 individual subjects in this meta-analysis were obtained from nurse-conducted experimental research over an 8-year period. The entire universe of accessible subject-studies that met criteria was included. Although both published and unpublished research were included to protect the study from publication bias, there was no statistically significant difference in findings. The mean effect size for the sample of comparisons from the 84 studies was .59. The associated U3 value of 72.2 and r of .28 indicate that patients who receive research-based nursing interventions can expect 28% better outcomes than 72% of the patients who receive standard nursing care.