Practice Improvement Using Evidence Based Models
MSN Project Model Guidelines and Rubric
Evidence-based practice (EBP) dates back to the 1800’s when nurse Florence Nightingale used prior patient outcomes to make decisions regarding patient care. EBP was officially introduced to medicine in 1992 by a Scottish physician, Archibald Cochrane (Brower & Nemec, 2017). EBP uses high quality research, clinical knowledge, and patient choice for improving clinical practice and enhancing patient outcomes (Dugan & Gabuya, 2019) . Evidence-based practice models provide a framework for working through the decision process, starting with a clinical question. One such model is the Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (JHNEBP). The JHNEBP serves as a developmental guide to improve clinical quality and enhance patient outcomes.
Johns Hopkins Nursing Evidence Based Practice Model
The Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines assists with problem solving in clinical decision making. It is a 19-step process that consists of 3 phases identified by the acronym PET. The first phase of the process is the development of the practice question. The second phase is the search for evidence, and the third phase is translation. Together, the 3 phases of PET, practice, evidence, and translation, entail 19 steps .
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The first phase of PET is the development and modification of the practice question and consists of steps 1 through 6. It involves the assembly of a team to address a practice concern and create an EBP clinical question. The EBP team will need to identify the stakeholders for the project, choose a leader, and plan team meetings for further discussions (Dang & Dearholt, 2018).
The second phase of PET is the search and evaluation of evidence phase and consists of steps 7-11. Initially, the EBP team will determine who is going to complete the data search and what information will be searched for. The evidence will then be evaluated for quality using appendix H of the JHNEBP. Based on the level of evidence received, the team will decide on a recommendation for translation (Dang & Dearholt, 2018).
The third phase of PET is to determine if change is appropriate and consists of steps 12-19. The team will notify stakeholders and discuss the evidence found and the recommendations of whether to change or not. If change is approved, an action plan will be developed, executed, and appraised. The results of the plan are reported to the stakeholders. Thereafter, it will be determined if additional action is needed and the findings will be dispersed. If change is approved, the EBP team will develop an action plan, implement and evaluate the change, and communicate the results to appropriate individuals (Dang & Dearholt, 2018).
Clinical Practice Question
The clinical question is the start of an evidence based review to evaluate a need for change. The initial step of the change process is the development of a clinical question in PICOT format. PICOT is an acronym representing the 5 elements of a clinical question. Patient or population, intervention, comparison, outcome, and the optional element of time are represented by P-I-C-O-T. I have adjusted my PICOT question to reflect my practicum location. My PICOT question is: Are students (P) who have not received the annual influenza vaccine (I) compared to those students who have received the annual flu vaccination (C) at increased risk for absenteeism (O) during the school year (T)?
The Johns Hopkins Nursing Evidence Based Practice Model can be used as a guide for change. Following the PET process, the JHNEBP model will guide in the development of a PICOT question, the research process, and translation of the results. Appendix A, the project management guide, will assist me through the process, assuring all 19 steps are completed and recorded.
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The JHNEBP has multiple tools to assist in the completion of the evidence-based practice improvement. Appendix D is a guide to assist in determining the level of the evidence, and the quality of the evidence. Appendix E, the research evidence appraisal tool, will assist in the appraisal of the research, determining the type and quality, Using Appendix F, the same appraisal can be completed for nonresearch evidence. The use of appendix D, E, and F will assist me in determining if the research is of high quality and will provide the best evidence to support the proposed evidence based change.
Appendix I of the JHNEBP model is the action planning tool. This tool serves as a guide in the final steps of evaluating the information gathered and developing an action plan. Lastly is Appendix J, the dissemination tool. This tool is used to review the findings and plan the presentation of the results.
Evidence-based practice (EBP) combines high quality research, clinical knowledge, and patient values to provide quality patient outcomes. The Johns Hopkins Nursing Evidence-Based Practice model provides a framework and guidance through the research process to developing an evidence-based plan for change. When an evidence-based model is used to assist in the process of change, a framework is provided to assure the gathered research information is of the highest quality, and the necessary steps have been completed to plan an evidence based change. The EBP model will provide the framework to providing the highest quality of evidence-based patient care.
- Dang, D. & Dearholt, S. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines (3rd ed.). Indianapolis, IN: Sigma Theta Tau International.
- Dugan, K. & Gabuya, A. (2019). A “snippet” of evidence leads to practice change. Nursing Management 50(6), 16-18. doi: 10.1097/01.NUMA.0000558491.89888.f8
- Johns Hopkins Medicine. (2017). Johns Hopkins Nursing Evidence-Based Practice Model. Retrieved from https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html
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