[Expert Solution]: Evidence-Based Practice Models EBP is nothing…

Evidence-Based Practice Models EBP is nothing new to nurses. Florence Nightingale, through her use of meticulous record keeping and data analysis, was able to demonstrate that mortality rates decreased when sanitary methods were improved (Riddle, 2006). By using the data she had gathered, Nightingale developed interventions that, when applied to medical and surgical patients, reduced mortality rates caused by unsanitary conditions. In general, the term EBP describes a model of care whereby nurses, using current evidence or research knowledge, make decisions using clinical expertise and patient preferences to guide patient care (Melnyk & Fineout-Overholt, 2011). The University of Minnesota (n.d.) has on its website the following definition of evidence-based care: “Evidence-Based Practice is the thoughtful integration of the best available evidence coupled with clinical expertise.”CURN The CURN project was one of the earliest attempts to increase the use of research in practice by registered nurses (RNs). It was a 5-year project awarded to the Michigan Nurses’ Association by the Division of Nursing in the 1970s and focused on helping nurses transition research findings into their practice settings (Polit & Beck, 2011). An outcome of the CURN project was a realization that practicing nurses would use research only if it had been widely disseminated and was relevant to their practice (Horsely, Crane, & Bingle, 1978). The CURN project moved nursing practice from customs, opinions, and authority to searching for the best research available and integrating the evidence with a nurse’s clinical expertise, patient preferences, and existing resources (Polit & Beck, 2011). To appreciate the importance of the CURN project, consider that in the 1970s nurses engaged in practice behaviors solely because “we’ve always done it this way.” For example, consider the practice of restraining patients by tying them to their beds or chairs to prevent falls. It has only been through research studies examining this practice that nurses now know that although tying patients to beds or chairs may have prevented falls, it also predisposed patients to other injuries, such as strangling, as they tried to get out of the restraints. Because 70% of accidents among hospitalized patients are related to falls, the need to conduct research and disseminate the findings about the prevention of patient falls remains a priority (Agency for Healthcare Research and Quality, 2005). Without the work of the CURN project, an understanding of how nurses embrace and use research in their clinical practice might not have occurred. The Stetler Model Whereas the CURN project has given nurses insight about how and why nurses embrace research in clinical practice, the Stetler model (Stetler, 2001) focuses on how individual practitioners adopt research findings at the bedside. Originally developed in 1976 as the Stetler/Merram model for research utilization, this model can be used to systematically integrate research into practice. The model was updated to facilitate examination of both the product and process of research. Products of research are things such as research findings. An example is that 9 out of 10 dentists recommend a certain chewing gum for their patients who chew gum. The process of research tells how to go about solving a problem. For example, nurses on a busy medical-surgical unit want to explore why they have noticed an increase in patient falls. They begin to examine the problem by conducting a chart audit of all the patients who have fallen in the past year. Next they determine whether there are any common factors. When the common factors are identified, a list of risk factors is developed that can guide interventions to reduce the number of falls. These nurses are engaging in a process of research. As evidenced in these examples, both product and process are important to facilitate EBP. Because Stetler’s model (2001) is prescriptively designed, it provides practitioners with step-by-step instructions for integrating research into practice and is useful to help nurses deliver safe patient care. In the updated version of the model (see Figure 16-1), Stetler provides a traditional graphic accompanied by a narrative of the five phases of the model. Question: Choose two models outlined in your text and compare and contrast the two. Discuss which model would be most effective to use in nursing research and why. Using the models discussed in the text, describe how you would use one of the models to create a necessary and lasting change in the culture of your practice setting.