Approaching the Nursing Shortage Through Comparison of the Iowa Model and the Star Model

Evidence-Based Practice and Nursing

A growing consensus has emerged within the field of modern nursing which holds that the most effective patient care is delivered through the use of evidence-based practice (EBP) by nurses and other health care providers. Although there are several distinct models of evidence-based practice, each typified by its varying approach to research utilization, EBP has been authoritatively defined as "the integration of the best research with clinical expertise and patient values" (Sackett et al., 2000). Two of the most prevalent models of EBP throughout the nursing profession are the Iowa Model and the Star Model, and each relies on a unique philosophy regarding the factors used to guide the implementation of academic research into clinical application. Conceived by Marita G. Titler, PhD, RN, FAAN and her colleagues, the model officially known as the Iowa Model of Research-Based Practice to Promote Quality Care was "developed and originally implemented at the University of Iowa Hospitals and Clinics (UIHC)" and "serves as a guide for nurses and other health care providers to use research findings for improvement of patient care" (Titler et al., 2001). In contrast, the Star Model of Knowledge Transformation® originated by The Academic Center for Evidence-Based Practice (ACE) is a "model for understanding the cycles, nature, and characteristics of knowledge that are utilized in various aspects of evidence-based practice (EBP)" which "organizes both old and new concepts of improving care into a whole and provides a framework with which to organize EBP processes and approaches" (Stevens, 2004). By exploring the similarities and contrasts between the Iowa and Star models of EBP, including a review of the processes utilized and the outcomes produced, I intend to address how EBP may ultimately provide solutions to the nursing shortage currently crippling America's health care system.

It has been consistently demonstrated that "a professional work environment that engages and optimizes the empirical and theoretical foundations of nursing can advance patient health and safety" (Pipe, 2007) and both the Iowa and Star models advocate a thorough review of existing empirical evidence by the nursing discipline. The Iowa model employs a rigorous standard of research utilization which strives "to identify areas of clinical inquiry (problem- and knowledge-focused triggers) that may be addressed through synthesis and application of research findings" (Titler et al., 2001), a system which encourages nurses to review, critique and adopt the work of their peers. Likewise, the 2nd point of the Star model's 5-point system is termed Evidence Summary and advises nurses "to synthesize the corpus of research knowledge into a single, meaningful statement of the state of the science" using "the most advanced EBP methods to date" (Stevens, 2004) in the realm of clinical practice. Both models share this strict adherence to the review of existing research because "nursing, medicine, and the allied health fields each possess a body of knowledge, which together inform evidence-based health care" (Spector, 2003), and this knowledge necessarily informs and enhances modern nursing's approach to existing cases. One of the critical components of the Iowa model is that it "facilitates the application of empirical evidence to clinical practice" (Taylor-Piliae, 1999) and this model is decidedly premised on clinical application of the lessons gleaned from prior research. Conversely, Star model holds that "knowledge transformation is necessary before research results are useable in clinical decision making" and is primarily concerned with the theoretical applications which may be developed by placing "nursing's previous scientific work within the context of EBP" (Stevens, 2004). When the totality of these models are fully considered it becomes apparent that, while the Iowa and Star models are focused on practice and theory respectively, both are linked by their effective implementation of evidence-based practices.