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    Nurses and other healthcare professionals have developed several evidence-based practice (EBP) models that aid in implementing EBP. These models serve as organizing guides that integrate the most current research to create the best patient care practices. In addition to helping nurses integrate credible evidence into practice, EBP models help assure complete implementation of EBP projects and optimize the use of nurses’ time and healthcare resources. No single EBP model can meet the needs of every organization and patient.

    Below you will find model definitions, essential steps, salient points, and information resources for the models to help identify the EBP model that best fits current, specific EBP needs (Christenbery, 2017).

    Stetler

    Stetler Model (Ciliska et al., 2011; Stetler, 2001). The Stetler Model enables practitioners to assess how research findings and other pertinent evidence are implemented in clinical practice. The model examines how to use evidence to create change that fosters patient-centered care.

    Essential Steps (Steps in this model are referred to as phases):

    • Phase I. Preparation: Identify a priority need. Identify the purpose of the EBP project, the context in which the project will occur, and relevant sources of evidence.
    • Phase II. Validation: Assess sources of evidence for level and overall quality. Determine whether the source has merit and goodness of fit and whether to accept or reject the evidence in relation to the project purpose.
    • Phase III. Comparative Evaluation/Decision Making: Evidence findings are logically summarized and similarities and differences among sources of evidence are evaluated. Determine whether it is acceptable and feasible to apply summation of findings to practice.
    • Phase IV. Translation/Application: Develop the “how to’s” for implementation of summarized findings. Identify practice implications that justify application of findings for change.
    • Phase V. Evaluation: Identify expected outcomes of the project and determine whether the goals of EBP were successfully achieved.

    Salient Points to Consider:

    • Designed to encourage critical thinking about the integration of research findings
    • Promotes use of best evidence as an ongoing practice
    • Helps lessen errors in critical decision-making activity
    • Allows for categorization of evidence as external (e.g., research) or internal (e.g., organization outcome data)
    • Emphasizes use by single practitioner but may include groups of practitioners or other stakeholders

    Ottawa Model of Research Use

    Ottawa Model of Research Use (Graham & Logan, 2004 Graham et al., 2006). The Ottawa Model is an interactive model that depicts research as a dynamic process of interconnected decisions and actions taken by stakeholders.

    Essential Steps:

    I. Assess barriers and supports:

    1. Evidence-based innovation: Identify what the innovation is and what the implementation will involve.
    2. Potential adopters: Identify potential adopters with characteristics that could influence the adoption of the innovation (see Rogers’ Change Theory in Chapter 7).
    3. The practice environment: Identify formal and informal leaders who can inspire change. Assess the environment for needed resources.

    II. Monitor intervention and extent of use:

    1. Implementation of intervention strategies: Select appropriate strategies to increase implementation awareness and provide necessary education and training for conducting the implementation.
    2. Adoption of innovation: Determine the extent of adoption of implementation.

    III. Evaluate outcomes:

    1. Evaluate the impact of innovation on patients, practitioners, stakeholders, and healthcare organizations.

    Salient Points to Consider:

    • Patients are central to the model’s process, and their health outcomes are the primary focus.
    • The model focuses on the unit-level environment instead of the entire healthcare organization.
    • The prescriptive aim of the model is to assess, monitor, and evaluate.

    PARiHS

    Promoting Action on Research Implementation in Health Services (PARiHS) Framework (Rycroft-Malone, 2004). The PARiHS Framework provides a method to implement research into practice by exploring the interactions among three key elements: (a) evidence, (b) context, and (c) facilitation.    
    Essential Steps:

    1. Evidence: Search for and identify the best available evidence from research, clinician experience, patient values, organization data, and information.
    2. Context: This is the local environment where the practice change will occur. Adoption of practice change depends on contextual features such as organizational culture and level of acceptance, leadership investment, and evaluation of desired outcomes.
    3. Facilitation: Organizational participants use their knowledge and skills to foster the implementation of practice change.

    Salient Points to Consider:

    • Explicitly uses facilitation as a factor impacting the integration of research findings into practice
    • Does not address the generation of new knowledge
    • Focus is on unit settings more than the system-wide environment
    • Codified (e.g., research data) and noncodified (e.g., practitioner experience) sources of evidence used

    ACE Star or Knowledge to Action Process

    ACE (Academic Center for Evidence-Based Practice) Star Model of Knowledge Transformation© (Kring, 2008; Stevens, 2004). The ACE Star Model aids in systematically integrating best evidence into practice as a framework. The model has five major stages that depict forms of knowledge in relative sequence. Research moves through the cycles to combine with other forms of knowledge before integration into practice occurs.

    Essential Steps:

    1. Discovery: This stage involves searching for new knowledge in traditional quantitative and qualitative methodologies.
    2. Evidence Summary: The primary task is to synthesize the body of research knowledge into a meaningful statement of evidence for a given topic. This is a knowledge-generating stage, which occurs simultaneously with new findings that may arise from the synthesis.
    3. Translation: Translation aims to provide clinicians with a practice document (e.g., clinical practice guideline) derived from the synthesis and summation of research findings.
    4. Integration: Practitioner and healthcare organization practices are changed through formal and informal channels.
    5. Evaluation: An array of EBP outcomes are evaluated on impact, quality, and satisfaction.

    Salient Points to Consider:

    • Focus on promoting the use of EBP for direct care nurses
    • Includes use of qualitative evidence
    • The primary goal of the model is knowledge transformation
    • Does not incorporate nonresearch evidence (patient values, practitioner’s experience)
    • Identifies factors that impact the adoption of innovation

    References

    Christenbery, T. L., PhD. (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles (1st ed.). Springer Publishing Company. 

    Ciliska D., DiCenso, A., Melynk, B. M., Fineout-Overholt, E., Stettler, C. B., Cullent, L., … Dang, D. (2011) Models to guide implementation of evidence-based practice. In B. M. Melnyk & E. Finout-Overholt (Eds.), Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed., pp. 241–275). Philadelphia, PA: Wolters-Kluwer.Google Scholar

    Graham, I. D., & Logan, J. (2004). Innovations in knowledge transfer and continuity of care. Canadian Journal of Nursing Research, 36(2), 89–103.Google Scholar

    Kring, D. L. (2008). Clinical nurse specialist practice domains and evidence-based practice competencies: A matrix of influence. Clinical Nurse Specialist. 22(4), 179–183.Google Scholar

    Rycroft-Malone, J. (2004). The PARIHS framework: A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304. Google Scholar

    Stetler, C. B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nursing Outlook. 49, 272–279.Google Scholar