EVIDENCE BASED

PRACTICE MODEL

By:- firoz qureshiDept. psychiatric nursing

WHY IS EVIDENCE BASED PRACTICE MODEL NEEDED?

To translate research findings into practice.

To provide framework for understanding the evidence based practice process.

MODELS OF EVIDENCE BASED PRACTICE

Stetler model

Iowa model

Rossworm and larrabee model

D.Censo model of evidence based practice

STETLER MODEL 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.

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

FIVE PROGRESSIVE CATEGORIES OF STETLER MODEL:-

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:-(Contd..)

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:-(Contd..)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.

Perform utilization focused critique & synopsis.Identify and record key study details accept

State decision

Consider use

State decisio

n

stopNot to use

CRITICAL ASSUMPTIONS 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

IOWA MODEL

It incorporates the use of research and other forms of evidence

Infrastructure to support research use might involve every level of the organization

Evidence based practice is linked to quality assurance.

Staff are given recognition for research work.

Clinicians are given time and resources for research work.

ROSSWORM AND LARRABEE MODEL Developed by Rossworm and Larabee in

1999. It is based on theoretical and research

literature It begins with the assessment of need

and integration of an evidence based protocol

STAGES OF ROSSWORM AND LARRABEE MODEL Assess needs of stakeholders Build bridges, make connections Synthesize the evidence and determine

relevancy Plan the practice change Implement and evaluate the practice

change Integrate and maintain the practice

change

Evidence Based Practice ModelAssess need for change

Link problem, interventions & outcomes

Synthesize best evidence

Design practice change

Implement and evaluate change in practice

Integrate and maintain change in practice

Link problem, interventions & outcomes

Select outcome indicators

Use standardized classification system and language

Identify potential interventions and activities

Implement and evaluate change in practice

Integrate and maintain change in practice

PROCESS OF EVIDENCE BASED PRACTICE Haynes and colleagues model(2002) of

evidence based practices involves the following processes:

Formulating a clinical question Systematically searching for relevant

research evidence Critically appraising the evidence Making an evidence based decision

regarding implementation Implementing of the practice change Evaluating the change in practice

D.CENSO’S MODEL OF EVIDENCE BASED DECISION MAKING

COMPONENTS: Patient preferences and actions will be

dominant element in their decision making

Patient’s clinical state and circumstances should be considered

Resources are considered before making a decision

Clinical expertise integrates the other model components

Clinical Expertise

STEPS IN EVIDENCE BASED DECISION MAKING

1. Compiling guidance: Search for relevant and high quality research studies that address the clinical question.

2. Planning a change: The administrators are consulted for planning a change.

3. Integrating skills and experiences: Clinical skills include the expertise

that develops from multiple observations of patients and the interventions carried on patients.

CLINICAL EXPERTISE It has a influence on: Quality of the initial assessment of the

client’s clinical state and circumstances Problem formulation. Decision about the best evidence Exploration of patient’s preference Delivery of the clinical intervention Evaluation of the outcome for that

particular patient

THANK YOU