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Ace star model of knowledge transformation

09/11/2021 Client: muhammad11 Deadline: 2 Day

Models to Guide Implementation and Sustainability of Evidence-Based Practice

Components That Need to Be Considered in the Clinical Decision-Making Model of EBP

Patient preferences and behaviors
Clinical state, setting, and circumstances
Availability of healthcare resources
High-quality research evidence
*

Factors That Are Impacted by the Practitioner’s Clinical Expertise

Quality of the initial assessment of the client’s clinical state and circumstances
Problem formulation
Decision about whether the best evidence and availability of healthcare resources support a new approach
Exploration of patient preferences
Delivery of the clinical intervention
Evaluation of the outcome for that particular patient
*

Commonalities Found in Models Used for Implementation of EBP

Identifying a problem that needs addressing
Identifying stakeholders or change agents who will help make the change happen in practice
Identifying a practice change shown to be effective through high-quality research that is designed to address the problem
Identifying and, if possible, addressing the potential barriers to the practice change
*

Commonalities Found in Models Used for Implementation of EBP—(cont.)

Using effective strategies to disseminate information about the practice change to those implementing it
Implementing the practice change
Evaluating the impact of the practice change on structure, process, and outcome measures
Identifying activities that will help sustain the change in practice
*

Commonly Used Models That Facilitate Integration of Evidence Into Practice

The Stetler Model of Evidence-Based Practice
The Iowa Model of Evidence-Based Practice to promote quality care
The Model for Evidence-Based Practice Change
The Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP
*

Commonly Used Models That Facilitate Integration of Evidence Into Practice— (cont.)

The Promoting Action on Research Implementation in Health Services (PARIHS) framework
The Clinical Scholar model
The Johns Hopkins Nursing Evidence-Based Practice model
The ACE Star Model of Knowledge Transformation
*

Fives Phases of the Stetler Model of EBP

Preparation: Identifying the purpose, context, and sources of evidence
Validation: Assessing the credibility of the evidence and its statistical and clinical significance
Comparative evaluation/decision making: Synthesizing evidence and making decisions/recommendations for use
Translation/application: Developing plan for implementation and measurement of processes/outcomes
Evaluation: Evaluation of processes and outcomes
*

The Iowa Model of EBP

Identifying problem- and knowledge-focused triggers
Determining whether the issue is an organizational priority
Forming a team
Selecting, reviewing, critiquing, and synthesizing available research evidence
Piloting the practice change
Evaluating the pilot and dissemination of results
Depending on pilot results, rollout and integration of the practice are facilitated with periodic evaluation
*

Steps in the Model for Evidence-Based Practice Change (Larrabee, 2009; Rosswurm & Larrabee, 1999)

Assess the need for change in practice: Stakeholders collect internal data and compare with external evidence/benchmarks to identify problems and link them with interventions and outcomes
Locate the best evidence: Determine the types and sources of evidence; plan and conduct the search
Critically analyze the evidence: Appraise, weigh, and synthesize evidence; assess feasibility, benefits, and risks
Design practice change: Define proposed change and resources needed; design pilot implementation and its evaluation
*

Steps in the Model for Evidence-Based Practice Change (Larrabee, 2009; Rosswurm & Larrabee, 1999)—(cont.)

Implement and evaluate change in practice: Implement pilot; evaluate processes, costs, and outcomes; develop conclusions and recommendations
Integrate and maintain change in practice: Communicate pilot results to stakeholders and make recommendations; integrate change into practice; routinely monitor process and outcomes; disseminate monitoring results and celebrate successes
*

The Advancing Research and Clinical Practice Through Close Collaboration Model (ARCC© Model)

Provides healthcare institutions and clinical settings with an organized conceptual framework that can guide system-wide implementation and sustainability of EBP to achieve quality outcomes
Model is a product of nurse input about barriers and facilitators of EBP, control theory (Carver & Scheier, 1982, 1998), and cognitive behavioral theory (Beck, Rush, Shaw, & Emery, 1979)
Use of mentors is a central mechanism for implementing and sustaining EBP
*

Control Theory as a Conceptual Guide for the ARCC Model

The ARCC Model

Promoting Action on Research Implementation in Health Services Framework (PARIHS) Framework

Framework is based on the formula:

SI = f(E,C,F)

where SI represents successful implementation; f, function of; E, evidence; C, context; and F, facilitation

The three elements (i.e., evidence, context, and facilitation) are each conceptualized on a high-to-low continuum; the focus is to move the elements in the formula toward “high” in order to optimize the chances of success
*

The PARIHS Framework—(cont.)

The three PARIHS elements and their subelements:

Evidence: Propositional and nonpropositional knowledge from the subelements of research, clinical experience, patient experience, and local data/information
Context: The environment in which the proposed change is to be implemented. Subelements include culture, leadership, and evaluation.
Facilitation: The process of enabling or making easier the implementation of evidence into practice. Subelements include role, skills, and attributes.
*

The Clinical Scholar (CS) Model

Developed to promote the spirit of inquiry, educate direct care providers, and guide a mentorship program for EBP and the conduct of research at the point of care
Clinical scholars are described as individuals with a high degree of curiosity that possess advanced critical thinking skills and continuously seek new knowledge through learning opportunities
Clinical scholar mentors play a central role in the model
The Clinical Scholar Program was developed to actualize the Clinical Scholar Model
*

The Clinical Scholar (CS) Model—(cont.)

Four central goals of the model include that the CS should be able to:

Challenge current direct care practices
Speak and understand research language, making day-to-day dialog about new research findings a common occurrence
Critique and synthesize current research as the core of evidence
Serve as mentors to other staff and to teams who question their clinical practices and seek to improve clinical outcomes
*

The Johns Hopkins Nursing Evidence- Based Practice (JHNEBP) Model

Facilitates bedside nurses in translating evidence to clinical, administrative, and educational nursing practice
Sets a goal of building a culture of nursing practice based on evidence
Aims to demystify the EBP process for bedside nurses and embed EBP into the fabric of nursing practice
Desired outcomes include enhancing nurse autonomy, leadership, and engagement with interdisciplinary colleagues
*

The JHNEBP Conceptual Model

(From Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau International. Used with permission.)

The JHNEBP Process for EBP:
The PET Process

Practice question: Identify an EBP question and define its scope; leadership responsibility assigned and interdisciplinary stakeholders recruited for team; team meetings scheduled
Evidence: Internal and external evidence search conducted; evidence critiqued, summarized, and rated; recommendations developed depending on the evidence strength and need for change
Translation: Determine appropriateness of recommendation in specific settings; develop action and evaluation plan; implement plan; evaluate and report outcomes; secure support for widespread change; identify next steps
*

The ACE Star Model

Development of the ACE Star Model was prompted through the work of the Academic Center for Evidence-Based Practice (ACE) at the University of Texas Health Science Center San Antonio during the early phases of the EBP movement in the United States
The ACE Star Model explains how to overcome the challenges of the volume of research evidence; the misfit between form and use of knowledge; and integration of expertise and patient preference into best practice
The ACE Star Model is a model of knowledge transformation, to which quality improvement of healthcare processes and outcomes is the goal
*

The ACE Star Model—(cont.)

Star Point 1: Discovery—represents conduction of primary research studies
Star Point 2: Evidence summary—represents the synthesis of all available knowledge compiled into a single harmonious statement/document, such as a systematic review
Star Point 3: Translation into action—combining the existing evidential base with expertise to extend recommendations into evidence-based clinical practice guidelines
*

The ACE Star Model—(cont.)

Star Point 4: Integration into practice—practice is aligned to reflect the best evidence
Star Point 5: Evaluation—an inclusive view of the impact that the evidence-based practice has on patient health outcomes, satisfaction, efficacy and efficiency of care, and health policy
*

Question

The use of EBP mentors is a major component of which model for evidence-based practice change?

The Model for Evidence-Based Practice Change
The ARCC© model
The Stetler model
The Iowa model
*

Answer

b. The ARCC© model

Rationale: The ARCC model is the only model of those listed that considers the lack of EBP mentors to be a major barrier to the implementation of EBP and uses training of a cadre of EBP mentors as a step in implementing the model.

Question

Is the following statement true or false?

Both the Model for Evidence-Based Practice Change and the Iowa model include the use of a small-scale pilot study during the process of introducing an evidence-based change in practice.

Answer

True

Rationale: Pilot studies are explicit components of both the Model for Evidence-Based Practice Change and the Iowa model.

Question

Feedback loops are a central component of which of the following models for evidence-based practice change?

The Model for Evidence-Based Practice Change
The Clinical Scholar model
The ARCC model
The Iowa model
*

Answer

d. The Iowa model

Rationale: The Iowa model includes multiple feedback loops that refer the user back to earlier points in the process. This is not a central feature of the Model for Evidence-Based Practice Change, the Clinical Scholar model, or the ARCC model.

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