2. Searches, appraises and synthesises the literature
3. If literature is lacking, conduct research
EBP, evidence-based practice.
All 19 models and frameworks included a process for asking questions. Most focused on identifying problems that needed to be addressed on an organisational or hospital level. Five used the PICO (population, intervention, comparator, outcome) format to ask specific questions related to patient care. 19–25
The models and frameworks gave basic instructions on acquiring literature, such as ‘conduct systematic search’ or ‘acquire resource’. 20 Four recommended sources from previously generated evidence, such as guidelines and systematic reviews. 6 21 22 26 Although most models and frameworks did not provide specifics, others suggested this work be done through EBP mentors/experts. 20 21 25 27 Seven models included qualitative evidence in the use of evidence, 6 19 21 24 27–29 while only four models considered the use of patient preference and values as evidence. 21 22 24 27 Six models recommended internal data be used in acquiring information. 17 20–22 24 27
The models and frameworks varied greatly in the level of instruction provided in assessing the best evidence. All provided a general overview in assessing and grading the evidence. Four recommended this work be done by EBP mentors and experts. 20 25 27 30 Seven models developed specific tools to be used to assess the levels of evidence. 6 17 21 22 24 25 27
The application of evidence also varied greatly for the different models and frameworks. Seven models recommended pilot programmes to implement change. 6 21–25 31 Five recommended the use of EBP mentors and experts to assist in the implementation of evidence and quality improvement as a strategy of the models and frameworks. 20 24 25 27 Thirteen models and frameworks discussed patient values and preferences, 6 17–19 21–27 31 32 but only seven incorporated this topic into the model or framework, 21–27 and only five included tools and instructions. 21–25 Twelve of the 20 models discussed using clinical skill, but specifics of how this was incorporated was lacking in models and frameworks. 6 17–19 21–27 31
Evaluation varied among the models and frameworks, but most involved using implementation outcome measures to determine the project’s success. Five models and frameworks provide tools and in-depth instruction for evaluation. 21 22 24–26 Monash Partners Learning Health Systems provided detailed instruction on using internal institutional data to determine success of application. 26 This framework uses internal and external data along with evidence in decision making as a benchmark for successful implementation.
EBP models and frameworks provide a process for transforming evidence into clinical practice and allow organisations to determine readiness and willingness for change in a complex hospital system. 12 The large number of models and frameworks complicates the process by confusing what the best tool is for healthcare organisations. This review examined many models and frameworks and assessed the characteristics and gaps that can better assist healthcare organisations to determine the right tool for themselves. This review identified 19 EBP models and frameworks that included the five main steps of EBP as described by Sackett. 5 The results showed that the themes of the models and frameworks are as diverse as the models and frameworks themselves. Some are well developed and widely used, with supporting validation and updates. 21 22 24 27 One such model, the Iowa EBP model, has received over 3900 requests for permission to use it and has been updated from its initial development and publication. 24 Other models provided tools and contextual instruction such as the Johns Hopkin’s model which includes a large number of supporting tools for developing PICOs, instructions for grading literature and project implementation. 17 21 22 24 27 By contrast, the ACE Star model and the An Evidence Implementation Model for Public Health Systems only provide high level overview and general instructions compared with other models and frameworks. 19 29 33
A consistent finding in research of clinician experience with EBP is the lack of expertise that is needed to assess the literature. 24 34 35 The models and frameworks reviewed demonstrated that the user must possess the knowledge and related skills for this step in the process. The models and frameworks varied greatly in the level of instruction to assess the evidence. Most provided a general overview in assessing and grading the evidence, though a few recommended that this work be done by EBP mentors and experts. 20 25 27 ARCC, JBI and Johns Hopkins provided robust tools and resources that would require administrative time and financial support. 21 22 27 Some models and frameworks offered vital resources or pointed to other resources for assessing evidence, 24 but most did not. While a few used mentors and experts to assist with assessing the literature, a majority did not address this persistent issue.
Sackett’s five-step model included another important consideration when implementing EBP: patient values and preferences. One criticism of EBP is that it ignores patient values and preferences. 36 Over half of the models and frameworks reported the need to include patient values and preferences, but the tools, instruction or resources for including them were limited. The ARCC model integrates patient preferences and values into the model, but it is up to the EBP mentor to accomplish this task. 37 There are many tools for assessing evidence, but few models and frameworks provide this level of guidance for incorporating patient preference and values. The inclusion of patient and family values and preferences can be misunderstood, insincere, and even tokenistic but without it there is reduced chance of success of implementation of EBP. 38 39
Similar to other well-designed scoping reviews, the strengths of this review include a rigorous search conducted by a skilled librarian, literature evaluation by more than one person, and the utilisation of an established methodological framework (PRISMA-ScR). 14 15 Additionally, utilising the EBP five-step models as a point of alignment allows for a more comprehensive breakdown and established reference points for the reviewed models and frameworks. While scoping reviews have been completed on implementation science and knowledge translation models and framework, to our knowledge, this is the first scoping review of EBP models and frameworks. 13 14 Limitations of the study include that well-developed models and frameworks may have been excluded for not including all five steps. 40 For example, the Promoting Action on Research Implementation in Health Services (PARIHS) framework is a well-developed and validated implementation framework but did not include all five steps of an EBP model. 40 Also, some models and frameworks have been studied and validated over many years. It was beyond the scope of the review to measure the quality of the models and frameworks based on these other validated studies.
Healthcare organisations can support EBP by choosing a model or framework that best suits their environment and providing clear guidance for implementing the best evidence. Some organisations may find the best fit with the ARCC and the Clinical Scholars Model because of the emphasis on mentors or the Johns Hopkins model for its tools for grading the level of evidence. 21 25 27 In contrast, other organisations may find the Iowa model useful with its feedback loops throughout its process. 24
Another implication of this study is the opportunity to better define and develop robust tools for patient and family values and preferences within EBP models and frameworks. Patient experiences are complex and require thorough exploration, so it is not overlooked, which is often the case. 39 41 The utilisation of EBP models and frameworks provide an opportunity to explore this area and provide the resources and understanding that are often lacking. 38 Though varying, models such as the Iowa Model, JBI and Johns Hopkins developed tools to incorporate patient and family values and preferences, but a majority of the models and frameworks did not. 21 22 24 An opportunity exists to create broad tools that can incorporate patient and family values and preferences into EBP to a similar extent as many of the models and frameworks used for developing tools for literature assessment and implementation. 21–25
Future research should consider appraising the quality and use of the different EBP models and frameworks to determine success. Additionally, greater clarification on what is considered patient and family values and preferences and how they can be integrated into the different models and frameworks is needed.
This scoping review of 19 models and frameworks shows considerable variation regarding how the EBP models and frameworks integrate the five steps of EBP. Most of the included models and frameworks provided a narrow description of the steps needed to assess and implement EBP, while a few provided robust instruction and tools. The reviewed models and frameworks provided diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models. Also, the issues of EBP expertise to assess evidence must be considered when selecting a model or framework.
Acknowledgments.
We thank Keri Swaggart for completing the database searches and the Medical Writing Center at Children's Mercy Kansas City for editing this manuscript.
Contributors: All authors have read and approved the final manuscript. JD conceptualised the study design, screened the articles for eligibility, extracted data from included studies and contributed to the writing and revision of the manuscript. LM-L conceptualised the study design, provided critical feedback on the manuscript and revised the manuscript. AM screened the articles for eligibility, extracted data from the studies, provided critical feedback on the manuscript and revised the manuscript. JD is the guarantor of this work.
Funding: The article processing charges related to the publication of this article were supported by The University of Kansas (KU) One University Open Access Author Fund sponsored jointly by the KU Provost, KU Vice Chancellor for Research, and KUMC Vice Chancellor for Research and managed jointly by the Libraries at the Medical Center and KU - Lawrence
Disclaimer: No funding agencies had input into the content of this manuscript.
Competing interests: None declared.
Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review: Not commissioned; externally peer reviewed.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Ethics statements, patient consent for publication.
Not applicable.
COMMENTS
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We have already explored as much as there is regarding evidence-based nursing in our comprehensive EBP paper-writing guide.A time comes in your nursing school journey, either at basic (ADN, LPN, or BSN) or advanced levels (MSN, DNP, or PhD), when you are required to select a suitable evidence-based practice nursing research topic, research, and write an evidence-based nursing paper, report, or ...
Here are some of the latest evidence-based practice nursing research topics that you can use in your essay or explore further in your own research: ... The nursing evidence-based practice topics listed above provide a starting point for further exploration and investigation. By studying the effectiveness of various nursing interventions and ...
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2. Mental Health Nursing Research Articles Topics. Research papers focusing on mental health are still one of the most read and referred papers. And there's still more scope for research on topics such as: Evaluating the concept of Integrated Mental and Physical Health Care. Psychiatric Nursing and Mental Health.
5 min read • June, 01 2023. Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs. Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing ...
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The purpose of this paper is to present the Mayo Clinic Nursing Research (MCNR) model (Figure (Figure1)—a 1)—a model developed to guide and focus nursing science generation in a practice‐based setting with an emphasis on promoting the health and well‐being of patients and caregivers with complex needs. The components of the model are ...
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Qualitative Research Topics in Nursing. Evidence-Based Practice Nursing Research Topics. Pediatric Nursing Research Topics. Nurses are at the front of patient care, and as such, their work can have a profound impact on public health. While nursing constantly evolves, some nurses dedicate themselves to research to advance the profession.
Evidence-based practice is now widely recognized as the key to improving healthcare quality and patient outcomes. Although the purposes of nursing research (conducting research to generate new knowledge) and evidence-based nursing practice (utilizing best evidence as basis of nursing practice) seem quite different, an increasing number of research studies have been conducted with the goal of ...
A nurse who practices evidence-based practice can earn $53,000 annually. In the United States, this is the average wage for nurses, according to the Bureau of Labor Statistics. A registered nurse's average salary in 2014 was $58,790. According to the Bureau of Labor Statistics, registered nurses have earned an average of $51,230 over the past ...
EBN perspectives bring together key issues from the commentaries in one of our nursing topic themes. This article is part of Evidence Based Nursing ( EBN ) Perspective series. In this series, published commentaries related to a specific nursing theme are collated and highlights are discussed. The topic for this edition is 'nursing issues', covering 21 commentaries published from October ...
Evidence-based practice (EBP) is a decision-making approach that uses the best evidence from research and clinical expertise to improve healthcare delivery. Our examples of evidence-based practice nursing topics let you explore the significance, challenges, and ethical aspects of EBP. Read the best evidence-based practice research topics below!
It is defined as "The nursing professional development (NPD) practitioner integrates scholarship, evidence, and research findings into practice" (p. 104). There is often confusion between quality improvement, evidence-based practice, and research. A seminal article by Shirey and colleagues. [2] differentiated these three topics.
Systems - integration of evidence with patient records. Summaries - practice guidelines found via Clinical Key & UpToDate. Synopses of Syntheses - focused journals: Evidence-Based Nursing, Evidence-Based Medicine, ACP Journal Club. Syntheses - m eta-analyses, systematic reviews and other evidence syntheses found through Cochrane, CINAHL, PubMed.
Top 5 Benefits To The Nurse. 1. Evidence-based practice in nursing provides nurses with scientifically supported research to help them make well-educated decisions. 2. EBP in nursing helps nurses stay up-to-date about new nursing interventions and protocols used in patient care. 3.
EBP is a process used to review, analyze, and translate the latest scientific evidence. The goal is to quickly incorporate the best available research, along with clinical experience and patient preference, into clinical practice, so nurses can make informed patient-care decisions (Dang et al., 2022). EBP is the cornerstone of clinical practice.
Practice: Topics for researchers and practitioners. Vanessa Antunes 1. Associate Editor. Keywords: nursing research, evidence-based healthcare, nurses, developing nursing. skills, evidence-based ...
Background. Evidence-based practice (EBP) integrates the clinical expertise, the latest and best available research evidence, as well as the patient's unique values and circumstances [].This form of practice is essential for nurses as well as the nursing profession as it offers a wide variety of benefits: It helps nurses to build their own body of knowledge, minimize the gap between nursing ...
Part B: Finding the Evidence. EBP Search Assignment Part B: Finding the Evidence; Workshops: Literature Searching ; Research Databases ; STEP 1: PICOT, Search Terms, & Search Strategy ; STEP 2: Conduct Searches in 3 Databases ; STEP 3: Search History Screen Captures ; STEP 4a: Add Research Articles to Folder ; STEP 4b: Save PDF List of Articles
Objectives. The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the ...