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EBP IN NURSING

The Importance of Evidence-Based Practice in Nursing

Patrick N. Ryan

College of Nursing, University of South Florida

Nursing is a profession that ties in hands-on skills and intellectual skills that draw on

learned knowledge in school. But nursing also leans on up-to-date research as none of these

things would be taught and learned effectively if it weren’t for the work that came before. Doing

things based on the most current and effective means for practicing medicine is known as

evidence-based practice (EBP); essentially, you are practicing nursing based off the medical

“evidence” which is tied to research. By book definition, EBP “incorporates what we have

learned across the years to provide resources and information that can facilitate clinicians’ ready

translation of research findings into practice, as well as their use of practice data to improve care

and document important outcomes, no matter the clinician’s healthcare role (Melnyk & Fineout-

Overholt, 2019).” It also “improves the patient experience through providing quality care,

enhances patient outcomes, reduces costs, and empowers clinicians, leading to higher job

satisfaction (Melnyk & Fineout-Overholt, 2019).” One thing of great importance within this

definition, is the word clinician. Clinician applies to all members of the healthcare team

involving doctors, midlevel’s, Pharmacists, and Nurses alike (of whom are also referred to as

stakeholders). The collaboration of this team leads to better patient outcomes, where the shared

knowledge each clinician has gained through research of best EBP, as well as “in the field”

practice, helps direct the focus towards using what is clinically proven for the betterment of the

patient. With each clinician focused on doing what is proven by research, the whole medical

team can operate more effectively together to meet patient goals. Within this paper, I will

demonstrate the importance of evidence-based practice in the clinical setting, the EBP models

used; and give examples of when I have seen it used most effectively, and at times alternatively,

in clinical practice.
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Clinical Experience

Despite the thorough nature of being in a nursing program, I recognize that there are new

things I will learn in the hospital from other nurses. One of the things that I have seen within the

VA healthcare system that made me re-think EBP, is MRSA contact precautions while working

on the Spinal Cord Injury unit in my first semester of nursing school. I was expected to don full

PPE, but the patient was allowed to leave their room. Because of their state, their immune,

cardiovascular, and pulmonary health was declined, so alternative ways to keep them active were

implemented like upper body physical therapy and breathing exercises up to their limitations.

Particularly for patients with complex medical conditions, I can understand why it is important

for them to keep moving so they avoid respiratory or immune collapse. The stakeholders

involved were the collaborative decisions made by physical therapists, doctors, nurses, the

patient, and their family. Naturally, I was concerned for the patient to acquire a separate

nosocomial infection while outside their room leading to further decline, but I was also

concerned for other patients. I don’t want to blame my nurse for going against her best judgment,

but I certainly could suggest brainstorming to come up with a better plan, such as having

physical therapy done in the patient room which would lead to physical therapy and nursing

collaboration. My concern is because studies show that 61.5% of hospitals report MRSA

infections at any given time (NCBI, 2016). MRSA infections also account for almost half of all

deaths caused by antibiotic resistant organisms (NCBI, 2016). But conversely, studies also show

that when proposing whether the removal of contact precautions for MRSA and VRE patients

change healthcare associated infection rate, no significant difference in rates were found (NCBI,

2021). Erring on the side of caution, I still feel isolation would be safest when referencing rates.
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Three Evidence Based Practice Models

There are several types of Evidence Based Practice Models used to help clinicians use the

most up to date methods to treat patients. Each of these models help guide clinicians to follow a

process where a situation arises, a solution needs to be made, a hypothesis of how to best solve it

is proposed, and naturally through collaboration and years of educated trial and error, better

practices are implemented for the betterment of the patient. I will be highlighting the Iowa Model

of Evidence Based Practice, the Stetler Model of Evidence Based Practice, and The Johns

Hopkins Nursing Evidence Based Practice Model. EBP studies show that patient outcomes

improve by 28-35% when EBP is used (SUNY Downstate, 2023).

Iowa Model of Evidence Based Practice

The Iowa Model is an application oriented guide for nurses to use research findings to

help improve patient care by being a pathway or method to EBP that identifies issues, researches

solutions and implements changes (Cabarrus College of Health Sciences, 2023). The 7 steps of

the Iowa model involve identifying an issue or opportunity, stating the purpose, forming a team,

assembling, appraising, and synthesizing the body of evidence, designing, and piloting the

practice change, integrating and sustaining the practice change, and dissemination (Cullen et al.,

2022). An example of the best way to implement the Iowa model is to identify the trigger where

an EBP change is warranted, such as the studies that show MRSA rates don’t change with the

use of contact precautions, see if the issue at hand is a priority for the department by seeing if no

longer using contact precautions would be better financially while weighing the health risks to

the staff and other patients, and eventually come to a solution via a team effort and implement

that change on a unit to unit basis or in some cases the whole hospital.
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EBP IN NURSING
Stetler Model of Evidence Based Practice

The Stetler Model focuses on a practitioner-oriented model (NP’s) that emphasizes

critical thinking and use of findings by the individual practitioner and dissemination of

information (Melnyk & Fineout-Overholt, 2019). The Stetler model does come from a different

angle in that it allows practitioners the opportunity to assess the effectiveness of research in

practice and gives strategies for how to best implement EBP into practice. The model also

consists of 5 phases: preparation, validation, comparative evaluation/decision making,

translation, and evaluation (McMaster University College of Nursing, 2001). To implement this

by using the MRSA example, a unit could recognize that donning PPE is costly, seeing that

research suggests it doesn’t change outcomes, no longer require PPE for MRSA patients, and see

the effectiveness of the change as well as it’s potentially negative consequences as it relates to

the priorities of the unit.

The Johns Hopkins Nursing Evidence Based Practice Model

The Johns Hopkins Nursing Evidence Based Practice Model is unique in that it is geared

towards the needs of the practicing nurse. It uses a three-step process called “PET,” which is

“practice question, evidence, and translation (SUNY Downstate, 2023).” The ultimate goal of

this model is to ensure that the latest research findings and best practices are quickly and

appropriately incorporated into patient care (SUNY Downstate, 2023). One way that we can use

this model in practice is to be presented with a patient with perhaps a resistant strain of MRSA,

when then come up with the question of how to treat this organism and how to prevent this from

happening again, we go to the current research, find the answer, and implement it.
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EBP IN NURSING
Model Similarities and Differences

In each of these models, they require clinicians to see a problem, look to research, or

create new practices that will later become the new EBP, and implement it for the betterment of

the patient experience and outcome. These models do have differences, however. The John

Hopkins model uses a PET method to try to quickly propose questions and solutions into care.

The Stetler Model asks mainly practitioners to implement EBP and evaluate the effectiveness of

EBP for the potential for organizational changes if the EBP is ineffective or potentially for things

to stay the same. Lastly, the Iowa model is essentially the step by step process or identification of

how to create new EBP, create a team for it, test its effectiveness, and implement it.

Conclusion

In summary, EBP is imperative for the betterment of patients and clinicians at all levels

should be trained in its application so that outcomes can improve. EBP allows clinicians to think

critically, look in the best interest of patients by motivating themselves to look towards best

practice, evaluate the effectiveness of current EBP, and even become the creators of new EBP

themselves. EBP is especially critical to be used by nurses, physicians, pharmacists, and

midlevels with even more emphasis on collaboration between the disciplines via sharing of

knowledge and EBP that they rely on to perform as a clinican so that the whole team can best

serve patients. Through various models such as the Iowa Model for EBP, Stetler Model for EBP,

and the Johns Hopkins Model for EBP, among others, clinicians have a clear guideline for how

to best implement EBP into practice. Such examples as the one I provided about research of

MRSA rates when using or deciding not to use PPE and contact precautions with MRSA

patients, is a clear example of the analysis of EBP and then potential application if an

organization so chooses to use that research to change their practice. One recommendation I have
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for future practice using EBP is to assess the effectiveness of certain practices such as long term

catheter use is more or less helpful to patients, particularly as it pertains to CAUTI’s. Via

collaboration between doctors and nurses, as well as the educational bodies that teach them, if

the information is consistent between the two disciplines then orders written by doctors and

practices by nurses can hopefully change for the better, but only if EBP is at the forefront of this

movement.
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References

Cabarrus College of Health Sciences. (2023, April 18). Libguides: Cabarrus College of Health

Sciences Library: Iowa model. IOWA Model - Cabarrus College of Health Sciences

Library - LibGuides at Cabarrus College of Health Sciences.

https://cabarruscollege.libguides.com/c.php?g=465666&p=5283295

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa

Implementation for Sustainability Framework. Implementation science : IS, 17(1), 1.

https://doi.org/10.1186/s13012-021-01157-5

Fukunaga, B. T., Sumida, W. K., Taira, D. A., Davis, J. W., & Seto, T. B. (2016). Hospital-

Acquired Methicillin-resistant Staphylococcus aureus Bacteremia Related to Medicare

Antibiotic Prescriptions: A State-Level Analysis. Hawai'i journal of medicine & public

health : a journal of Asia Pacific Medicine & Public Health, 75(10), 303–309.

Kleyman, R., Cupril-Nilson, S., Robinson, K., Thakore, S., Haq, F., Chen, L., Oyesanmi, O.,

Browning, K., Pino, J., & Mhaskar, R. (2021). Does the removal of contact precautions

for MRSA and VRE infected patients change health care-associated infection rate?: A

systematic review and meta-analysis. American journal of infection control, 49(6), 784–

791. https://doi.org/10.1016/j.ajic.2020.11.020Barrett Values Centre. (2021, September

22). Personal values assessment (PVA). Barrett Values Centre. Retrieved November 20,

2022, from https://www.valuescentre.com/tools-assessments/pva/

McMaster University College of Nursing National Collaborating Centre for Methods and Tools.

(2001). Stetler model of evidence-based practice. NCCMT.

https://www.nccmt.ca/knowledge-repositories/search/83
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Melnyk, B. M., & Fineout-Overholt, E. (2019a). Evidence-based practice in Nursing &

Healthcare: A guide to best practice. Wolters Kluwer.

SUNY Downstate Health Sciences University. (2023, May 9). Help guides: Evidence-based

Nursing Practice Guide: EPN models and Ebn Processes. EPN Models and EBN Processes

- Evidence-Based Nursing Practice Guide - Help Guides at SUNY Downstate Health

Sciences University. https://guides.downstate.edu/c.php?g=868154&p=6230033#s-lg-

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