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NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

NUR 590 Topic 3 DQ 2

Review the different models and frameworks that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale.

The Star Model explains how specific forms of knowledge, such as the systematic review and the clinical practice guideline, are solutions for moving research into practice. It is a model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various phases of EBP in moving evidence into clinical decision making.  NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

The clinical scholar model was developed and implemented 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. It began as an interactive, outcomes-oriented educational program for nurses but has evolved into an interdisciplinary educational program for direct care providers (Melnyk, 2019). In my evidence-based practice proposal, the Star Model would be most beneficial.

This model reviews current practice and applies knowledge for change. For my proposal, there is a lot of research on both patient and nurse dissatisfaction with the current bereavement process when a patient experiences a miscarriage in the ED. There is not a lot of research on implementation of better practice and protocols. Therefore, the Star Model will allow for me to take the knowledge of the subject and develop a change.

Resource:

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer Health.

Change facilitation requires forethought and intentional planning and execution if a well-supported, sustainable change is going to be made on a larger scale – especially in healthcare. Evidence-base practice models may include theoretical models grouped into evidence-based practice/research utilization and knowledge transformation processes, strategic organizational change theory or knowledge exchange and synthesis for application and inquiry (Melnyk & Fineout-Overholt, 2019).

 However, it is becoming more widely acknowledged that a formalized approach must be considered to successfully implement these evidence-based models. NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

Eight different models have been identified as key drivers for evidence-based integration and change management. These include: 1. The Stetler Model of Evidence-Based Practice, 2. The Iowa Model of Evidence-Based Practice, 3. The Model for Evidence-Based Practice Change, 4. The Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP, 6. The Clinical Scholar Model, 7. The Johns Hopkins Nursing Evidence-Based Practice Model, and 8. The Stevens Star Model of Knowledge Transformation (Melnyk & Fineout-Overholt, 2019).

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Upon comparing the Stetler Model and Johns Hopkins Model, the Stetler Model has been regularly revised, and involves integrating evidence-base practice information into practical, sustainable day to day standards for patient care. With critical thinking and utilization of both internal and external evidence to support practice change, the Stetler Model hinges on five phases, and multiple steps to identify and support use of evidence, determined by critical thinking (Melnyk & Fineout-Overholt, 2019). 

A “toolkit” of sorts has been developed to implement consensus guidelines and evidence-base practice change. Upon comparison, the Johns Hopkins Model supports its use by bedside registered nurses with aim to implement research results in an evidence-based practice format. The key objective is to make it easy for direct caregivers to make change at a grass-roots level, while positively impacting patient outcomes in a meaningful way. NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

 A problem-solving approach to address clinical questions, the 18-step process allows for non-randomized control trial designed evaluations and quality improvement initiatives to take place(Melnyk & Fineout-Overholt, 2019).. With mindfulness that registered nurses encounter challenges that require a fix “tomorrow”, with potential use of nonresearch evidence by use of four pathways.

For my PICOT with aim to reduce occurrence of CLABSIs in patients with a central line, I believe either model could be used to implement meaningful change. However, the Stetler model is better suited for a randomized control trial approach, which is the method I believe to be best suited to gain the most sound, valid and reliable results. By way of using critical thinking and various types of evidence (internal AND external), the Stetler model allows for easy implementation of evidence gathered by way of a toolkit and use of consensus guidelines and policy change.

References NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp

& Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017). Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research.

The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.

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It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).

References:

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing14(3), 175–182. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12223

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-Based practice in nursing and healthcare (4th ed.). p. 434-437. Wolters Kluwer Health.

Two models that facilitate change and are supported by evidence-based practice are Kotter’s Change Management Model and Kurt Lewin’s Change Model. Kotter’s Change Management Model is a standard theory used worldwide that consists of eight stages that focus on the employee’s responses when it comes to change (Kotter, 2019). These eight stages include increasing urgency, building the team, communicating, getting the vision correct, moving things, incorporating change, not giving up, and focusing on short-term goals.

Using Kotter’s method allows an organization to achieve successful quantitative and qualitative results while focusing on cost-efficient approaches towards health opportunities, demand for change, and barriers. Kurt Lewin’s Change Model is a standard method that has proven effective management models for change. Lewin’s model has three phases: unfreezing, changing, and refreezing (Hussain et al., 2018). The model aids organizations in better comprehending organizational and structural change.

The two different approaches provide valuable insights into how effective change management occurs. When used together, they tend to balance each other out when it comes to the weaknesses of each method one by one. In the evidence-based proposal, Kotter’s model is a better method when focusing on organizational detail.

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s Change model: a Critical Review of the Role of Leadership and Employee Involvement in Organizational Change. Journal of Innovation & Knowledge3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002

Kotter, J. (2019). John Kotter’s Eight Step Change Model. https://portal.ct.gov/-/media/SDE/Turnaround/School-Improvement-Resources/Kotters_model.pdf NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

The two models that I reviewed are the Iowa Model of Evidence-Based Practice and the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP). NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

The Iowa Model was developed by nurses in the 1990’s and then revised in 2015 due to dramatic changes in healthcare (Buckwalter et al., 2017). The revision included translation research and patient engagement (Buckwalter et al., 2017). This model is application oriented and provides a step-by-step guide to the EBP (Evidence Based Practice) process (Buckwalter et al., 2017). This model outlines a multiphase change process with feedback loops. It is widely recognized for its applicability and ease of use by interprofessional teams.

It can be used by novice to expert users and can be used in a variety of settings (Buckwalter et al., 2017). Since 2001 there have been over 3900 requests to use the Iowa Model from all 50 states and 130 countries (Buckwalter et al., 2017). It is focused on triggers both problem and knowledge focused. It consists of 11 categories/steps.

These categories/steps include: (Melnyk & Fineout-Overholt, 2019). NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

  1. Identify triggering issues/opportunities: Encourages clinicians to identify questions. Triggers may have data that highlights an area for improvement. Question current practice.
  2. Clinical applications: Nurses identify clinically relevant practice questions.
  3. State the question or purpose: Includes a clearly stated purpose. Using PPPICO (problem(patient), population, pilot area, intervention, comparison, and desired outcome)
  4. Topic Priority: Establish whether it aligns with organizational priorities.
  5. Form a team.
  6. Assemble and appraise evidence.
  7. Sufficient evidence.
  8. Design and pilot the practice change.
  9. Decide if the change is appropriate for practice.
  10. Integrate and sustain practice.
  11. Disseminate results

The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is also a model that guides bedside nurses in translating evidence into practice. It was developed by Hospital leadership to accelerate the transfer of new knowledge into practice (Melnyk & Fineout-Overholt, 2019). Bedside nurses evaluated and piloted the model. This model is an open system which can be influenced by both internal and external factors (Melnyk & Fineout-Overholt, 2019) 

The model starts with an inquiry (question) which leads to a PET (Practice, Question, Evidence and Translation) process (Melnyk & Fineout-Overholt, 2019). Within each phase there are 19 prescriptive steps (Melnyk & Fineout-Overholt, 2019). The process is linear and may be interactive as the process evolves (Melnyk & Fineout-Overholt, 2019) There are ten tools to support the critical steps and online learning modules. NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

The tools were developed by bedside nurses and contain check box formats, definition, and guidelines for use (Melnyk & Fineout-Overholt, 2019). It is simplified and easy to understand. This model may appeal to Nurse Educators as it has been applied in academic settings. The JHNEBP Model provides a structure for EBP education with mentoring, program planning, execution, and outcomes data collection (Friesen et al., 2017).

In comparing the two models both seem similar in many ways. Both seem widely used and easy to use.  The one that I would choose for my EBP project would be the Iowa Model of Evidence- Based Practice because it talks more about using a pilot unit. NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

For my project I would like to pilot two units to evaluate and then disseminate to the rest of the organization. A number of clinically important topics have been addressed using the Iowa Model, for example prevention of catheter associated urinary tract infections. This was appealing to me since my project goal is to reduce CAUTI (Catheter Associated Urinary Tract Infection) rates and use through patient/family education and empowerment. This model also talks about patient engagement which applies to my project as well (Melnyk & Fineout-Overholt, 2019).

References: NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

Buckwalter, K.C., Cullen, L., Hanraham, K., Kleiber, C., McCarthy, A.M., Rakel, B., Steelman, V., & Tripp, R.T. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldview on Evidence-Based Nursing, 14 (3), 175-182. https://doi-org.lopes.idm.oclc.org/10.111/wvn.12223.

Friesen, M.A., Brady, J.M., Milligan, R., & Christensen, P.(2017). Findings from a piot study bringing evidence-based practice to the bedside. Worldview on Evidence-Based Nursing, 14 (1), 22-34. https://doi-org.idm.oclc.org/10.111/wvn.12195. NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

Two models that can be used to facilitate evidence-based practice (EBP) change include the Iowa Model of Evidence-Based Practice to promote quality care and the Advancing Research and Clinical practice through close Collaboration (ARCC) model for implementation and sustainability of EBP. The Iowa Model guides clinicians through the process of identifying, implementing, and evaluating an EBP change with incorporated feedback loops (Buckwalter et al., 2017; Dang et al., 2019).

The feedback loops help to ensure that the project is moving forward and does not need to go back to a previous step.The model was designed for interprofessional teams and uses a basic problem-solving approach to simplify the process of implementing EBP change (Dang et al., 2019). The ARCC Model provides a framework that guides both individuals and organizations through implementation, evaluation, and sustainment of EBP changes. One unique feature of this model is the focus on EBP mentors who are developed within the healthcare system to help mitigate common barriers to the implementation of EBP (Dang et al., 2019).

This model also uses cognitive behavior therapy (CBT) to change behaviors and emotions related to EBP.  NUR 590 Topic 3 DQ 2 Review the different models and frameworks that can be used to facilitate change

Both of these models include the steps of identifying a relevant clinical issue, synthesizing current research on the issue, developing and implementing a plan for EBP change, and evaluating the results of the EBP change. Both of these models also incorporate interprofessional teams in the EBP change process.

In contrast, the Iowa Model includes feedback loops that allow for checking in with the team throughout the process and pivoting or adjusting as needed to ensure the best plan is developed and implemented, which the ARCC Model does not. The ARCC Model places a strong emphasis on the development and utilization of EBP mentors to promote the success and sustainability of the practice change, which the Iowa Model does not. 

The Iowa Model fits the needs of my EBP proposal best. This model has been widely used since the 1990s and has been revised in response to feedback from use of the model by numerous healthcare organizations, thus showing it is a valid and reliable model (Buckwalter et al., 2017).

This model is simple and was developed specifically for use by clinicians who wanted to incorporate EBP into patient care, which is appropriate for the practice change I am proposing in the intensive care unit. This model also allows for reflection and adjustment at each step, which is essential when working in a hospital setting where change is constant. In addition, this model utilizes an interprofessional team, which will be an essential part of my EBP proposal. 

References

Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp, R. T., & Tucker, S. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223

Dang, D., MeInyk, B. M., Fineout-Overholt, E., Yost, J. Cullen, L., Cvach, M., Larabee, J. H., Rycroft-Malone, J., Schultz, A. A., Stetler, C. B, & Stevens, K. R. (2019). Models to guide implementation and sustainability of evidence-based practice. In B. M. MeInyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice. (4th ed., pp. 378-427). Wolters Kluwer.

The Transtheoretical Model (TTM) is the selected framework for change in an evidence-based practice proposal project. The TTM is a well-established and widely used model that focuses on individual behavior change across various domains, making it relevant and suitable for guiding the efforts of our proposed project. The Transtheoretical Model (TTM) is highly relevant to our project as it provides a comprehensive framework for understanding and facilitating behavior change (Khani Jeihooni et al., 2019). The TTM offers a structured approach to address the different stages individuals go through when modifying their behavior, making it an ideal model for our project. The Transtheoretical Model consists of five key stages. The first stage is called precontemplation. It represents individuals who are not yet considering change and may be unaware or under-aware of the need for change (Taher & Younis, 2023). In our project, this stage involves identifying sedentary adults who do not perceive physical activity as a priority or are unaware of its benefits. The second stage is referred to as contemplation.

Individuals in this stage know the need for change but have not yet committed to taking action. Our project will focus on providing information and education about the benefits of physical activity, aiming to help sedentary adults move from contemplation to the next stage. The third stage, preparation, involves individuals who are actively preparing to make a change in their behavior. Our project will provide resources and tools to support sedentary adults in developing a plan for incorporating physical activity into their daily lives. The fourth stage is called action. At this stage, individuals have started implementing the desired behavior change. In our study, we will assist sedentary adults in initiating regular physical activity by providing access to exercise programs, guidance, and ongoing support. The last stage is maintenance. It focuses on sustaining the behavior change over time. Our project will emphasize the development of strategies to overcome barriers and provide continued support to help sedentary adults maintain regular physical activity.

To apply each stage of the Transtheoretical Model to our proposed implementation, we will conduct targeted outreach and awareness campaigns to reach our target groups, such as community events, social media, and healthcare settings. Secondly, we will offer educational materials, workshops, and counseling sessions to address misconceptions and encourage them to consider incorporating new practices into their lives. Thirdly, we will provide personalized goal-setting assistance, develop action plans, and offer resources in preparing for their behavior change. The fourth step will facilitate access and provide personalized coaching and feedback to enhance their motivation and adherence. The fifth step will involve implementing strategies to prevent relapses and foster long-term commitment, such as offering ongoing support, reminders, social incentives, and maintenance resources.

The JHNEBP model supports nursing leadership’s unique role in translational research into EBP by assessing the need, motivation, and readiness and formulating the change engine for sustainability (Melnyk & Fineout-Overholt, 2019). 

References

 

Khani Jeihooni, A., Gholampour, Y., & Shokrpour, N. (2019). Application of trans-theoretical model for smoking cessation in a sample of Iranian men. Journal of Substance Use 24(4), 414-419.

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13: 9781496384539

Taher, A. K. M., & Younis, N. M. (2023). Effect of a trans theoretical model in improving behaviors of health care workers related to electronic hookah in Mosul, Iraq. Rawal Medical Journal48(1), 228-228.