1. Evidence-Based Nursing Part Two
Integrating EBP Knowledge into
Clinical Practice

2. Four Tools for Integration
Iowa Model for Evidence-Based Practice
Journal clubs
Critical Appraisal of Topics
Clinical Audit

3. Iowa Model for EBP

4. Highlights of the Model
Triggers: Problem-based and Knowledge-based
Organizational Priorities
Sufficiency of the Research Base
Appropriateness of change for the patient population/organization
Continuous feedback loops

6. Triggers

7. Triggers Problem focused Knowledge focused Risk management data
Process improvement data
Internal / external benchmarking data
Financial data
Identification of clinical problem
(first and last are original)
Knowledge focused
New research or other literature
Nat’l Agencies or Organizational standards
Philosophies of care
Questions from Institutional Standards Committee
(first is new)

8. Priorities of the Institution

9. If Yes then….
Form a team
Assemble relevant research & related literature
Critique and synthesize research for use in practice
Sufficient research to guide practice? (“no” is not a stopping point)
Develop a guideline or standard of practice
Pilot change in practice / is change appropriate?
Monitor process and outcome data / share results

10. Journal Clubs

11. Journal clubs
Teaching-based: emphasis on skill building, such as honing searching skills
Topic-based: often focused on critical appraisal
EBP skills-based: participants go through each step of EBP process
Can be nursing staff only or multidisciplinary
All clubs need a clinically meaningful context for their topics!

12. Critical Appraisal of Topics (CATS)
Assess the quality of a single study
Can results be applied to your patients?
Refer to handout from Evidence-Based Nursing
Click on CEBM site; show EBM tools link, refer to handout for Systematic Review

13. Critical Appraisal of Topics
National Guideline Clearinghouse
Journals such as Evidence Based Nursing
EBM Tools at Centre for Evidence-based Medicine site

14. Clinical Audit
Examine your care practices and compare your results with clinical guidelines or best practice statements
Define best practice
Measure and compare
Act to achieve change

15. Audit Cycle (simplified)
Defining quality
Take action to improve
Measuring and comparing

16. Reilly, L et al. “Reducing Foley Catheter Device Days in an Intensive Care Unit: Using the Evidence to Change Practice.” AACN Advanced Critical Care 17(3):272-83

17. Change: the final step

18. Method Smackdown
Discuss strengths and weaknesses of each method/approach to integrating EBP
Best area(s) for application of a method?
Image courtesy WWE

19. Method Review Iowa Model for Evidence-Based Practice Journal clubs
Critical Appraisal of Topics
Clinical Audit
Strengths and weaknesses
Best time/place for application

20. Good Luck!