The Iowa Model of Evidence-Based Practice to Promote Quality Care

So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas

“…7,8 EBP is the integration of the best evidence with clinical expertise and patients' values to facilitate clinical decision making. [9][10][11][12][13][14][15][16] Philosophically Paula Lusardi, RN, PhD So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas Evidence-Based Practice nursing research to guide nursing care allows practitioners to provide safe, high-quality care. 2 Yet studies continue to suggest that nurses at the bedside lack the resources and knowledge necessary to change the traditional nursing culture to a culture of inquiry with the daily application of the best evidence.…”

“…13,14,17,[22][23][24][25] The institution's or unit's choice of an EBP model must "fit" with the work to be accomplished and the context of the clinical area. 22 Although many of these models appear different from each other, all models have a number of common elements.…”

“…[12][13][14] However, little guidance is available to assist staff nurses in critically analyzing the specifics of an issue at hand or in recognizing unit processes that are helpful to clarify potential clinical issues. We developed 4 questions to help our practitioners focus on a problem and reflect upon the clinical significance of the issue (Table 2).…”

“…We developed 4 questions to help our practitioners focus on a problem and reflect upon the clinical significance of the issue (Table 2). Titler 13 describes problem-and knowledge-focused triggers as catalysts for nurses to think critically about practice issues and to seek scientific evidence for changing practice. Problem-focused triggers include risk management data, quality assessment and improvement data, total quality management and continuous quality improvement data, and importantly, nursegenerated identification of clinical problems at the bedside.…”

“…Knowledge-focused triggers are generated by national standards and guidelines, questions from institutional standards committees, and new research. 13 Problem identification emerges from multiple sources. However, meaningful questions are driven by the practitioner's curiosity and a need to find answers to these questions and to improve practice, 12,21 rather than from organizational mandates.…”