Evidence-Based Practice Models

The Iowa Model Revised (2017) is one of the most widely used EBP models in nursing. It provides a systematic approach to clinical decision-making that promotes quality care through the integration of best available evidence.

The model begins with identifying triggering issues or opportunities—either problem-focused triggers (risk management data, quality improvement data, clinical problems) or knowledge-focused triggers (new research, guidelines, or standards).

Key steps include forming a team, assembling and appraising the evidence, determining if the evidence is sufficient to guide practice change, piloting the practice change, and evaluating outcomes. A distinguishing feature is the emphasis on organizational context and the involvement of key stakeholders throughout the process.

The Iowa Model is particularly suited for DNP capstone projects because it provides a clear, step-by-step process that can be implemented within a single clinical setting.

The Johns Hopkins Nursing Evidence-Based Practice Model emphasizes the translation of best evidence into clinical practice. It uses a three-step process known as PET: Practice question, Evidence, and Translation.

The Practice question step involves identifying an EBP question using a structured format. The Evidence step includes searching for, appraising, and synthesizing the best available evidence using the Johns Hopkins evidence appraisal tools.

The Translation step involves creating an action plan, implementing the practice change, and evaluating outcomes. The model includes specific tools for evidence rating (strength and quality) that many nursing programs require.

This model is favored in many DNP programs because of its comprehensive toolkit and structured approach to evidence appraisal and translation.

The Stetler Model provides a comprehensive approach to evidence-based practice that can be applied by individual practitioners and organizations. It consists of five phases: Preparation, Validation, Comparative Evaluation/Decision Making, Translation/Application, and Evaluation.

A unique feature of the Stetler Model is its emphasis on critical thinking at each phase. The model acknowledges that not all evidence should be applied and provides decision points where practitioners evaluate whether the evidence is applicable to their specific context.

The model distinguishes between conceptual utilization (using evidence to change thinking) and instrumental utilization (using evidence to change practice). This distinction is valuable for understanding the different ways research can inform nursing care.

The Stetler Model is particularly useful for experienced nurse researchers and clinicians who need a sophisticated framework for evaluating and applying research evidence.

The Promoting Action on Research Implementation in Health Services (PARIHS) framework proposes that successful implementation of evidence into practice is a function of the relationship between evidence, context, and facilitation.

Evidence encompasses research evidence, clinical experience, and patient preferences. The framework recognizes that evidence is not just about research findings but includes multiple sources of knowledge.

Context refers to the environment in which the change is implemented, including culture, leadership, and evaluation mechanisms. A receptive context is characterized by a learning culture, transformational leadership, and routine evaluation practices.

Facilitation describes the process of enabling implementation through appropriate support, guidance, and intervention. Facilitators can range from task-oriented (providing practical support) to holistic (addressing individual and organizational development).

PARIHS is particularly valuable for implementation science research and for understanding why evidence-based interventions succeed or fail in different clinical settings.

Selecting an EBP model depends on your specific context, level of evidence, organizational support, and project scope. Consider these factors when making your choice.

For clinical practice changes in a single unit or department, the Iowa Model provides the clearest step-by-step guidance. For projects emphasizing evidence appraisal and rating, the Johns Hopkins model offers the most structured tools.

For individual practitioner-level evidence application, the Stetler Model provides the most nuanced approach. For understanding implementation in complex organizational settings, PARIHS offers the most comprehensive framework.

Many DNP programs have preferences or requirements for specific models. Always check with your program guidelines before selecting your EBP model. Regardless of which model you choose, clearly articulate why it is the best fit for your specific project and how you will apply its components.