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Selecting a Model for Evidence-BasedPractice ChangesA Practical Approach

AACN Advanced Critical Care

Volume 19, Number 3, pp.291–300

© 2008, AACN

Anna Gawlinski, DNSc, RN, FAAN

Dana Rutledge, PhD, RN

Evidence-based practice models have been

developed to help nurses move evidence into

practice. Use of these models leads to an organ-

ized approach to evidence-based practice, pre-

vents incomplete implementation, and can

maximize use of nursing time and resources.

No one model of evidence-based practice is

present that meets the needs of all nursing envi-

ronments. This article outlines a systematic

process that can be used by organizations to

select an evidence-based practice model that

best meets the needs of their institution.

Keywords: evidence-based practice models,

evidence-based practice, models

A B S T R A C T

Factors related to patient safety, quality, andevidence-based practice (EBP) are driving

changes in healthcare. Nurses are interested inhow to move good evidence into practice tooptimize patients’ outcomes; thus, nurses maybenefit from understanding more about EBPmodels. These models have been developed tohelp nurses conceptualize moving evidence intopractice. They can assist nurses in focusingefforts derived either from clinical problems orfrom “good ideas” toward actual implementa-tion in a specific practice setting. Use of EBPmodels leads to systematic approaches to EBP,prevents incomplete implementation, promotestimely evaluation, and maximizes use of timeand resources.

This article describes a systematic processfor organizations to use as a template forchoosing an EBP nursing model. Strategiesfor involving staff nurses and clinical andadministrative leaders are discussed. Finally,a summary of key EBP nursing models ispresented.

Creating Structures or Forums for DiscussionsThe first step in selecting a model is to estab-lish a structure or a forum in which presenta-

Anna Gawlinski is Director, Evidence-Based Practice, and

Adjunct Professor, Ronald Reagan University of California, Los

Angeles Medical Center & University of California, Los Angeles

School of Nursing, 757 Westwood Plaza, Los Angeles, CA

90095 (agawlinski@mednet.ucla.edu).

Dana Rutledge is Professor, Department of Nursing, California

State University Fullerton; and Nursing Research Facilitator,

Saint Joseph Hospital, Irvine, California.

tions and discussions can occur about variousEBP models, their advantages and disadvan-tages, and their applicability to organizationalneeds. Several possible strategies include:

• use of an existing nursing research commit-tee in which selection of an EBP model isadded to annual goals and activities;

• formation of an EBP council, with an initialtask of selecting an EBP model;

• appointment of a task force charged withselecting an EBP model;

• use of an educational event to increaseknowledge about EBP models while facili-tating the selection of a model appropriatefor the organization; and

• use of a focus group process to select an EBPmodel consistent with the philosophy,vision, and mission of the organization.1

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Any of these strategies could help “set thestage” for an organization to choose an EBPmodel. For example, the authors used anexisting nursing research committee/councilto begin the process of selecting an EBP modelin 2 different settings. In a third hospital, amultidisciplinary EBP council took on thetask of selecting an EBP model. Regardless ofthe structure or the forum used, a thoughtfuland systematic process is helpful.

Composition of the Committee or the GroupThe second step to identifying an EBP model isto carefully consider appropriate members ofthe committee or the group. Administrativeand clinical leaders such as nurse managers,clinical nurse specialists, and nurse educatorsshould be represented, as should interestedstaff nurses. Staff nurses who are clinicalresources in their units, share an interest inimproving patient care, or are curious aboutresearch are likely members. The educationallevel of the committee members should reflectthat of nurses within the department or theinstitution and will most commonly includenurses with associate, bachelor’s, and master’sdegrees. In addition, members should repre-sent the various clinical units/departments orspecialties within the institution.

Involvement of persons with special expert-ise in research or EBP, such as a nurse researcheror faculty member from a local unit, hospital,or school of nursing, may be especially helpful.These persons may be internal or external to theorganization and have valuable expertise inEBP nursing models. They can function asactive members or as consultants. A librarianmember may also be useful in retrieving neededpublications to evaluate selected models.

The evaluation process and the number ofEBP models that are considered can influencethe desirable number of committee members.For example, at one institution (a universityacademic hospital), the nursing researchcouncil selected 7 EBP nursing models forreview and evaluation. Table 1 lists the mod-els and shows the criteria used to evaluatethem. These 7 models were chosen for evalua-tion either because they were commonly men-tioned in publications about EBP nursingmodels or because they were identified bycommittee members. At another institution (acommunity hospital), the nursing researchcouncil selected 4 EBP nursing models to eval-

uate on the basis of council members’ knowl-edge of the models’ utility and potential fitwith the organization.

Involvement of all committee members inthe evaluation process is vital. Using a processwhere 2 or 3 persons volunteer to review andpresent 1 to 2 EBP nursing models can get allmembers involved. Staff nurses can be pairedwith administrative or clinical leaders in teamsof 2 to 3 persons. All committee members canthen participate in the process of evaluatingmodels by attending presentations about eachmodel and actively participating in discus-sions. By having small groups present eachmodel, the workload is divided among groupmembers. The more people involved in theprocess, the greater the need for coordinationand oversight by the chairperson.

Organizing the First MeetingOnce the group has been selected, the nextstep is to organize the first meeting so thatclear communication about the roles andresponsibilities of team members can occur.The chairperson or the leader can survey thegroup members to determine the optimal date,time, and comfortable location for this meet-ing. Because of the nature of the workinvolved in selecting a model, 2 hours is anoptimal duration for meetings. An agendashould accompany the meeting invitations andinitially will include items such as discussionsof the purpose and goals of the committee andthe roles and responsibilities of committeemembers (Table 2). Providing a brief readingassignment that gives an overview of EBPmodels and should be completed before thefirst meeting is advisable. The chairperson canrequest committee members who are alreadyknowledgeable about EBP models to highlightparts of the reading assignment at the firstmeeting to promote discussion. The chairper-son should also collaborate with unit leadersto ensure that staff nurses have appropriaterelease time for meetings.

Roles and Responsibilities ofCommittee or MembersAt the first meeting, roles and responsibilitiesof the members for reviewing, presenting, andevaluating each EBP model should beaddressed. Assignments and due dates aredetermined to ensure steady progress. Forexample, a member can elect to work in asmall group to review the literature on an EBP

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Table 1: Evaluation Criteria and Scoring for 7 Models of Evidence-Based PracticeChangesa

Evaluation Criteria for EBP Model

Purpose of Project: Evaluation and selection of an EBP model for the Nursing Department of Ronald

Reagan University of California, Los Angeles Medical Center.

1. Search, retrieve, and synthesize the current literature describing EBP models to help staff nurses use

EBP concepts and apply them in clinical practice.

2. Recommend the adoption of a specific EBP model for use by UCLA nurses.

Scoring system: 0 � not present; �1 � present/yes; �2 � highly present/yes

Criteria Models

1. Concepts and organization of model are

clear and concise

2. Diagrammatic representation of the

model allows quick assimilation of

concepts and organizes the steps in the

process of EBP changes

3. The model is comprehensive from

beginning stages through implementation

and evaluation of outcomes

4. The model is easy to use when

concepts are applied to direct EBP

changes and practice issues in clinical

settings

5. The model is general and can be applied

to various populations of patients,

EBP projects, and department initiatives

and programs

6. The model can be easily applied to

typical practice issues as evidenced

with practice scenario or in published

literature

Total

Comments

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

EBP Model: Strengths:

Weaknesses:

aUsed with permission from the Evidence-Based Practice Program, Nursing Department at Ronald Reagan University of California, Los

Angeles Medical Center, Los Angeles, California.

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model. Work teams should be assigned a pres-entation date to present details of the reviewedEBP model to committee members. Presenta-tions of each EBP model may take 30 to 45minutes and might include information on thehistory and development of the EBP model(who, what, when, where, and how), revisionof the model over time, overall concepts in theEBP model, the process and flow of the EBPmodel, and publications describing how themodel guided EBP changes in other facilities.

Each presentation of an EBP model can befollowed by 10 or 15 minutes for group mem-bers to raise questions and discuss specificaspects of the EBP model. After the presenta-tion and discussion, group members couldreview an example of how the EBP model mightbe applied in a realistic practice scenario thatrequires consideration of a practice change(Table 3). Group members could then use theEBP model under discussion to address thepractice issue. Depending on the group’s size,this work can be done in small groups, witheach small group slated to report back to thelarger group its opinion about how the model“worked.” It is recommended that groupsbreak into smaller groups of 2 or 3 persons to“rate” the models’ applicability on the basis ofpredetermined criteria (Table 4). Criteria forevaluating the applicability of the EBP model

should include clarity of the EBP model con-cepts and diagrammatic representation, appli-cability of the EBP model to clinical practiceissues for diverse patient care situations in theinstitution, ease and user-friendliness of the EBPmodel, and the ability of the EBP model to pro-vide direction for all phases of the EBP process.

Table 1 shows an example of an evaluationtool that can be used by committee memberswhen reviewing each EBP model. After theevaluation instrument is administered andscored, committee members can compare andcontrast the ratings, strengths, and weaknessesfor addressing the practice scenarios, andpotential adoption by the institution for eachmodel is reviewed.

The use of a structured process providesmembers with little or no background in evalu-ating an EBP model to learn about EBP modelsand have greater participation and support inthe evaluation process. The link of the EBPmodel to practice is clear when the practice sce-nario is used. Members increase their knowl-edge and skills in using EBP models for practicechanges and become champions for the adop-tion of a model within the organization.

Finally, the ongoing work of the committeeshould be communicated through forums suchas mass e-mails, newsletters, posters, nursinggrand rounds, and other continuing educationprograms. Such communication helps dissemi-nate the process used in selecting a model forthe organization, while inviting others to par-ticipate via comments and feedback.

Summary of Selected EBP Nursing ModelsA number of EBP models have been devel-oped; many appear very different from eachother. Some of these models are more useful insome contexts than others, and each hasadvantages and disadvantages. The followingsteps or phases are common to most models:

• Identification of a clinical problem or poten-tial problem

• Gathering of best evidence• Critical appraisal and evaluation of evi-

dence; when appropriate, determination of apotential change in practice

• Implementation of the practice change• Evaluation of practice change outcomes,

both in terms of adherence to processesand planned outcomes (eg, clinical, fiscal,administrative)

Table 2: Example of Agenda Items for theFirst Evidence-Based PracticeCommittee or Group Meeting

Welcome and introduce members

Review agenda

Discuss the goals of the committee

Discuss roles and responsibilities of committee

members

Select models for evaluation

Discuss the process for presenting and evaluating

evidence-based practice models

Make assignments and schedule

Identify resources and forms

Identify strategies to communicate ongoing

committee work to the department

Open discussion of other items

Plan for next meeting

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Table 3: Sample Practice Scenario for Evaluating Applicability of Models for Evidence-Based Practice Changesa

Scenario for Application of Evidence-Based Practice Nursing Models

Note: The following scenario includes selected literature on the subject for the purpose of providing a

clinical practice issue for use when applying EBP models. The following does not include an extensive or

integrated review of the literature on the subject.

Clinical IssueSuctioning patients who have endotracheal and tracheal tubes is a frequent and important nursing intervention.

These tubes interrupt the normal mucociliary system and can result in a patient’s inability to mobilize and

expectorate secretions).13 Suctioning is an intervention that has beneficial effects such as removal of secretions,

maintenance of airway patency, and promotion of optimal ventilation and oxygenation.13

It is common practice for nurses and other healthcare providers to instill 3 to 10 mL of sodium chloride

in the endotracheal or tracheal tubes before suctioning.14 The action of sodium chloride is believed to

loosen and thin secretions, stimulate a cough, and lubricate the suction catheter.13,15,16

Research and Evidence-Based LiteratureResults of research on the benefits of sodium chloride instillation have been inconclusive.13,17–23 In fact,

studies indicate that this practice may result in the following adverse outcomes:

• Interferes with the alveolar-capillary oxygen exchange, causing a decrease in oxygen saturation,

• Increases rate of respiration,

• Increases the risk of infection by dislodging significantly more bacterial colonies, and

• Increases intracranial pressure.13,19,21,22

Furthermore, patients can panic or feel as though they are drowning during routine instillation of

sodium chloride via endotracheal or tracheal tubes.24

Research results indicate that mucus and sodium chloride solution are immiscible.13,17 Therefore, it is

unlikely that instillation of sodium chloride loosens secretions and aids in the expectoration of airway

secretions.13 The application of heat and humidification to the airway and the use of sodium chloride

nebulizers are effective in thinning secretions and promoting airway clearance.13,23

Nursing Staff and EBP ProcessThe nurses in your unit have recently heard a lecture presenting the lack of evidence supporting the

routine use of instillation of sodium chloride before suctioning patients with endotracheal and tracheal

tubes and the potential deleterious effects. They are questioning this practice and come to you as the unit

manager or the clinical nurse specialist to help them with considering a change in this practice.

Reflect on this EBP model to guide you through the steps to help your staff with this EBP change project.

aUsed with permission from the Evidence-Based Practice Program, Nursing Department, Ronald Reagan University of California, Los Angeles

Medical Center, Los Angeles, California.

Table 4: Criteria for Evaluation of Evidence-Based Practice Models to Meet Institutional Needs

Concepts and organization of the model are clear and concise

Diagrammatic representation of the model allows quick assimilation of concepts and organizes the steps

in the process of EBP changes

Model is comprehensive from beginning stages to implementation and evaluation of outcomes

Model is easy to use when concepts are applied to direct EBP changes and practice issues in clinical settings

Model is general and can be applied to various populations of patients, EBP projects, and department

initiatives and programs

Model can be easily applied to typical practice issues as evidenced with practice scenario or in the

published literature

Abbreviation: EBP, evidence-based practice.

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The following paragraphs describe severalEBP models that are often considered for usein hospitals (Tables 5 and 6). These modelswere selected on the basis of the followingcriteria: (1) they commonly appear in nurs-ing publications about EBP models; (2) pub-lished reports support their use to guide EBPchanges in the clinical setting; (3) institutions(hospitals or schools of nursing) use themodel; and (4) the models are intended to beused by nurses as they set out to find and useevidence to enhance patients’ or organiza-tions’ outcomes. Table 5 describes selectedEBP models that have specific steps or phasesto guide the EBP process. Table 6 identifieskey components of EBP models that do nothave specific steps or phases but help describeand conceptualize the many variables andinteractions that occur when making EBPpractice changes.

One of the oldest models that has recentlybeen revised to include EBP outcomes is Stetler’sEBP model.2 This model is one of the few thatdoes not focus entirely on formal changes led by

nurses in organizational settings, suggesting useby individual nurses as well. Developed as amodel for nurses within an East Coast hospital,Stetler’s model promotes use of both internal(eg, data from quality improvement, opera-tional, or evaluation projects) and external(primary research evidence and consensus ofnational experts) evidence. Stetler’s model con-sists of 5 phases, ranging from searching for evi-dence about a clinical problem to formal and/orinformal evaluations. Decision making aboutwhether a practice change should be madeincludes consideration of substantiating evi-dence, setting fit, feasibility, and current practice.

Developed as a model to promote qualitycare, the Iowa model of EBP has been used inmultiple academic and clinical settings.3 Thismodel melds quality improvement withresearch utilization in an algorithm that nursesfind intuitively understandable. Unique to theIowa model is the concept of “triggers” of EBP.Evidence-based practice may be spurred by aclinical problem or by knowledge coming from

Table 5: Selected Evidence-Based Practice Nursing Models and Key Components

Emphasis

Stages/

phases

Iowa Model3

Organizational

process

1 Trigger: Problem

or new knowledge

2 Organizational

priority?

3 Team formation

4 Evidence gathered

5 Research base

critiqued and

synthesized

6 Sufficient?

7 Pilot change

8 Decision?

9 Widespread

implementation

with continual

monitoring of

outcomes

10 Dissemination

of results

Stetler’s Model2

At individual nurse

or organizational

level

1 Preparation

2 Validation

3 Comparative

evaluation

4 Decision making

5 Translation/

application

6 Evaluation

Rosswurm and Larrabee’s Model4

Organizational process

1 Assess need for

change in practice

2 Link problem

interventions and

outcomes

3 Synthesize best

evidence

4 Design practice

change

5 Implement and

evaluate change

in practice

6 Integrate and

maintain

Johns Hopkins Nursing Model5

Organizational

process

1 Practice question

identified

2 Evidence gathered

3 Translation:

Plan, implement,

evaluate, and

communicate

ACE Star Model ofKnowledgeTransformation6

Knowledge

transformation

1 Knowledge

discovery

2 Evidence

summary

3 Translation into

practice

recommendations

4 Integration into

practice

5 Evaluation

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outside an organization. Either of these triggerscan set an EBP project into motion. Thereafter,the model delineates 3 key decision pointsduring the process of making a practice change:(1) Is there an institutional reason to focus onthis problem or use this knowledge? (2) Is therea sufficient research base? (3) Is the changeappropriate for adoption in practice? At 2 ofthese points, users must focus on the realitieswithin an organizational context; the thirdpoint infers the possibility that evidence is notsufficient and thus that a research study may beneeded or other evidence sought.

Rosswurm and Larrabee4 developed a 6-step model for change in EBP that aims forintegration of EBP into a care delivery sys-tem. The initial need for change is deter-mined by comparing internal data such asquality indicators with data from outside theorganization. When possible, this problem is

linked to standard interventions and out-comes. Research and contextual evidence aresought to solve the problem and combinedwith clinical judgment. With sufficient evi-dence, a practice protocol is developed and apilot test done to determine effects on out-comes. With widespread implementation,both processes (eg, staff adherence to thechange) and clinical outcomes are evaluated.The practice change is maintained by usingtheoretically derived diffusion strategies.

The Johns Hopkins Nursing EBP modelwas developed in collaboration with the JohnsHopkins Hospital and the Johns Hopkins Uni-versity School of Nursing.5 To ensure that cur-rent research findings were incorporated intopatient care, nursing administrative leadersfrom Johns Hopkins Hospital developed amodel for the department of nursing. Theresulting model addressed the following 3

Table 6: Select Evidence-Based Practice Frameworks

Abbreviations: ARCC, Advancing Research and Clinical Practice through Close Collaboration; EBP, evidence-based practice; PARIHS,Promoting Action on Research Implementation in Health Services.

Key focus

Key concepts

Major proposition

Utility—practical

implications

ARCC Model7–9

Organization of department or unit

EBP mentor—an individual who has

expert knowledge and skills in

EBP and the passion to help

others practice daily from an

evidence base

The development of APNs and other

nurses as EBP mentors facilitates

an organizational culture change

toward evidence-based care

Need to…

• assess and organize culture and

readiness for EBP

• identify strengths and major

barriers to EBP implementation

• implement ARCC strategies

• develop and use EBP mentors

• interactive EBP skill-building

workshop

• make EBP rounds and form

journal clubs

• implement EBP

• improve patient, nurse, and

system outcomes

PARIHS Framework10,11

Understanding key components of EBP

Evidence

Context

Facilitation

Practice changes are most likely when

they are based upon robust evidence,

conducted in a context “friendly” to

change, and facilitated well

Need to…

• critically appraise evidence

• thoroughly understand the

practice arena before implementing

a change

• make a strategic plan for

facilitation of any practice change—

from development to

implementation and evaluation

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domains of professional nursing: nursing prac-tice, education, and research. The modelincorporates use of available evidence as acore component for decision making withinthese domains. Guidelines for the modelreflect the “PET” process, an acronym thatstands for practice question, evidence, andtranslation. First, a team identifies an impor-tant practice question. The team gathersevidence by reviewing literature, rates the evi-dence, and makes recommendations forchanges in processes of care or systems. Thelast phase is the translation in which a plan ofaction is developed and implemented and out-comes are evaluated and communicated.5

The ACE Star Model of Knowledge Trans-formation aims to promote EBP by depictingknowledge types (from research to integrativereviews to translation) as necessary precursorsto practice integration.6 This model does notdiscuss use of nonresearch evidence. The 5major stages of knowledge transformation are(1) knowledge discovery, (2) evidence sum-mary, (3) translation into practice recommen-dations, (4) integration into practice, and (5)evaluation. The goal of the process is knowl-edge transformation, defined as “the conver-sion of research findings from primaryresearch results, through a series of stages andforms, to impact on health outcomes by wayof [evidence-based] care.”6

Another EBP model that is considered a“mentorship” model is the AdvancingResearch and Clinical Practice through CloseCollaboration model. This EBP model resem-bles an organizational plan for a departmentof EBP. The model focuses on establishingrelationships across systems to bring experi-enced researchers together with clinicians tointegrate research and clinical practice morefully.7 Originally an organizational model forlinkages between a college of nursing and amedical center, the model relies heavily onEBP mentors, ideally advanced practicenurses, with in-depth knowledge of EBP andexpert clinical and group facilitation skills.7–9

This model may be most useful in academicsettings with formal linkages between nursingeducation and practice in which APNs areabundant.

Out of the British system comes the Pro-moting Action on Research Implementationin Health Services framework,10,11 which is“useful as a heuristic device to help makesense of the many variables and interactions

that take place in practice.”12(pS1) This intu-itive model aids in understanding the keycomponents of EBP: evidence, context, andfacilitation. The model aims to represent thecomplexity of making practice changes onthe basis of evidence. The key proposition inthe model is that “the nature of the evidence,the quality of the context, and the type offacilitation all impact simultaneously onwhether implementation is successful.”11(p178)

Further understanding of the relationshipsamong evidence, context, and facilitation isneeded to maximize EBP. This model, thoughvery useful as a theoretical explanation, hasnot been documented as useful in drivingprojects within organizations.

Selection of EBP Model for the InstitutionAfter evaluation of each of the EBP models, com-mittee members should be able to narrow theselection of these models to 1 or 2 models. Thiscan be done by selecting the top 2 models withthe highest scores on the evaluation tool and bydiscussions that facilitate group consensus.

If 2 models score similarly on the evalua-tion tool, having members discuss generaladvantages and disadvantages of each of themodels can help delineate the model that“fits” the needs of the organization best. Forexample, the group members might discussadvantages and disadvantages of the modelsreviewed and make the final selection on thebasis of (1) how easy the EBP model was tounderstand and whether it would guide usersin the EBP process; (2) appropriate directionby the model for the conduct of research whenevidence is insufficient to support a practicechange; (3) the flow of steps in the model issimilar to the flow of practice algorithms forstaff; and (4) decision points in the EBP modelwould provide users with opportunities forthoughtful reflection and decision making.

To maximize leadership buy-in, nurse man-agers, administrators, and clinical leaders who arenot part of the selection committee should also beincluded in the evaluation and selection process.This can be accomplished by having members ofthe nursing research committee attend leadershipmeetings to present either the final model or thefinal 2 models determined by the selection com-mittee. Leadership members can then participatein the exercise of evaluating and scoring the finalmodel(s) by using the practice scenario. The man-agement group can then discuss the results,

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advantages, and disadvantages, and make finalrecommendation for adoption. Including broadernursing leadership representation in the selectionof an EBP model would build consensus and pro-mote support of the adopted model. If the initialcommittee is having trouble making a decision,leadership input can help break a tie or may resultin new insights as to why one model might fitbetter than another.

Dissemination and Integration of the Selected ModelOnce the model is chosen, the committee canbrainstorm strategies to promote its dissemina-tion and use. Educational sessions that areplanned should use active participation oflearners to enable participants to increase theirknowledge and skills in using the model toanswer clinically important questions thatrequire evidence-based solutions. Several strate-gies can be used for dissemination and integra-tion of the selected model:

• Incorporating a class about EBP and theselected model into the new graduate orien-tation or residency program. This ensuresthat each new employee has basic knowl-edge about the use of the selected model.

• Add content about use of the EBP model inpreceptor development programs. Precep-tors are often clinical leaders in their respec-tive units. Enhancing their knowledge andskills about EBP models can increase thelikelihood that preceptors will serve asagents of change and champions of EBPwithin their clinical areas.

• Incorporate education and skill building onuse of the selected EBP model into theannual skills laboratories or competencyforums. This strategy ensures widerdissemination of the selected model and aidsin establishing baseline knowledge and skillsfor all nurses throughout the organization.

• Conduct nursing grand rounds on theselected model, with examples of use of themodel in clinical practice. Grand rounds canprovide a forum for more in-depth knowl-edge and skill building with respect to use ofthe model. Examples of how the model canbe used to answer important clinical prac-tice questions can also be presented and dis-cussed. Feedback can be obtained from thegrand rounds participants about the clarityand feasibility of using the model for theEBP process. Ideas can be elicited from the

participants about strategies to overcomechallenges to using the model.

• Provide EBP programs for the nursing lead-ership group. The program should introducethis group to more extensive concepts of themodel, involve them in several examples ofhow to use the model for both administrativeand clinical changes, and discuss their role inincreasing use of the model in their respectiveareas. The infrastructures available tofacilitate use of the model should also bediscussed.

• Implement special “train-the-trainer” EBPdevelopment programs. Content aboutvarious innovative methods to teach othersabout the model should be included, alongwith a general discussion of the structure,concepts, and processes of the model.

• Include content in institution-sponsoredresearch and EBP conferences by selectingprograms that increase participants’ knowl-edge and skill building relative to the use ofthe model for EBP practice changes.

• Integrate the selected EBP model into the cur-riculum of any existing EBP immersion pro-grams, such as an EBP internship orfellowship programs.

• Encourage members of the nursing researchcommittee/council to brainstorm additionalideas that work best in their respective units,institution, and nursing culture. Memberscan examine what educational programsand forums already exist that could be usedto disseminate and integrate the model inthe organization.

SummaryUsing a model for EBP change will assist nurs-ing departments to better focus their limitedfiscal and personnel resources on critical EBPactivities. This article described structures andprocesses that institutions could use to facili-tate choosing a model for EBP change that fitstheir practice setting and guides efforts inmaking EBP changes.

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