Models of Evidence Based Practice in Nursing

Evidence-based practice is not incompatible with patient-centric care. Although evidence-based practice is concrete, there are different models and frameworks in use. One of the most important models for evidence-based practice is the ACE Star Model of Knowledge Transformation. The ACE Star Model of Knowledge Transformation incorporates research and evidence into the practice environment without sacrificing patient preferences.
Other models of evidence-based practice can be loosely grouped into three main categories: Research Utilization, and Knowledge Transformation Processes; Strategic/ Organizational Change Theory to Promote Uptake and Adoption of New Knowledge; and Knowledge Exchange and Synthesis for Application and Inquiry (Stevens, 2013, p. 3). Each of these models presents different angles or perspectives on how to use and implement evidence-based practice in the healthcare environment. Critical to a successful integration of evidence-based practice is accessibility of information. As Stevens (2013) points out, healthcare workers operating under strict time and resources constraints cannot pore over every research paper ever published on every given topic related to a healthcare decision. Yet healthcare workers also cannot risk the problems with oversimplifying knowledge. The best approach to evidence-based practice is to generate reliable peer-reviewed summary references for use in healthcare settings. The strength of any evidence determines how it is to be translated into practice.
The ACE Star model is ideal for integrating the needs for reliable, peer-reviewed information within the practice environment. Starting with a discovery phase, the healthcare worker is called upon to use the tools and technologies available for searching databases for meta-analyses or systematic reviews. Online databases can also be supplemented with national clearinghouse guidelines and information published by professional organizations. Stevens (2013) recommends using the AHRQ Health Care Innovations Exchange for further information on how to integrate research into practice, or how to translate experimental studies and meta-analyses into pragmatic guidelines for patient care. Essentially, evidence-based practice entails shifting abstract knowledge into hands-on practice.
Complicating evidence-based practice is patient diversity and communication. Working with patients may involve dissemination of information. The nurse has an ongoing responsibility to provide evidence-based practice, which can occasionally conflict with the equally important responsibility to provide patient-centric care. Patient autonomy may sometimes conflict with the duty to care. For example, a patient may refuse treatment. In situations like these, the nurse serves in the role of educator, helping to communicate evidence-based practice directly to the patient and family. Becoming informed empowers the patient and the family members, who can participate in the healthcare decision process.
Working with interdisciplinary teams also enhances the reliability of evidence-based practice. A team of nurses is preferable to an individual healthcare decision-maker. Teams can approach each clinical issue with the ability to solve problems using a number of different viewpoints. Similarly, each healthcare worker will have access to different sources of information. Evidence-based practice should always be collaborative, to prevent error and reduce bias. Moreover, the integration of evidence-based practice into the healthcare environment entails ongoing assessment and self-reflection. If improving patient outcomes is the ultimate goal of healthcare, then nurses need to address quality improvement by honestly addressing limitations in care delivery, and making adjustments accordingly. Evidence-based practice never needs to supplant a caring environment, in which the needs, preferences, and interests of patients are carefully integrated into healthcare decisions.



References

Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing 18(2), DOI: 10.3912/OJIN.Vol18No02Man04