Evidence to Action: A Model Analysis
Tera J. Gwaldis, RN
St. Johns River State College
July 8, 2015

Discussion
In order to understand evidence-based practice (EBP), it is important to recognize that EBP is detrimental to the quality improvement of patient outcomes while also helping to control the cost of health care. EBP is an approach to problem-solving and clinical decision- making that incorporates the best available evidence from well-designed studies based on clinician experiences and patients’ principles, values and preferences (Melnyk & Fineout-Overholt, 2015). The assessment of the effectiveness of EBP models can help to decide which models would be most practical and applicable to the actual practice setting. The Iowa Model of Evidence-Based Practice stands out as a model that will be carefully deliberated for the reason that it can be used successfully to initiate a practice change at the unit and organizational levels. The Iowa model is used throughout a multitude of clinical and academic settings. This model merges research utilization and quality improvement using processes that are innately clear and logical to nurses and is unique in that it uses the concept of “triggers” meaning that evidence-based practice may possibly be prompted by either facts or data from an outside organization, or by specific clinical problems (Brown, 2014).
The Ace model uses an interdisciplinary approach for conveying knowledge for use in healthcare and nursing practice to help meet quality improvement objectives. The Ace model focuses mutually on interpretation and execution of the EBP process. This model is arduous to most and consists of five steps: First, the pursuit of innovative information by means of traditional research. Next, a very thorough systematic review process of numerous studies occurs, that eventually forms the statement of evidence. Clinical practice guideline are then developed and interpreted. Practice changes that support EBP through influencing individual and organizational change are then implemented. The last step is evaluation. This step considers the effects of EBP practice modifications on quality improvements (Schaffer, Sandau, & Diedrick, 2013). In addition the ACE model places emphasis on discovery of nursing evidence (qualitative) for bedside practice; focuses on issues that impact the acceptance of innovation and change. A foremost focus of the ACE model is knowledge transformation that can be implemented at either individual or organizational levels.
Developed in 1976, the Stetler model of research utilization and evidence based practice was one of the original EBP models. This model helps nurses evolve from not only critiquing published findings, but to implement these findings into nursing practice. The Stetler model is made up of phases that assess and apply the research outcome while focusing on critical thinking and practical uses of the data. The phases of this model are dubbed preparation, validation, comparative evaluation/decision-making, translation/application, and evaluation (Bauer , 2010).
When bearing in mind the setting for the best fit evidence-based practice model, the amount of direction, applicability, and ease of translation for implementation of appraising and critiquing evidence was considered. Although, almost all the models cite clinical and patient experience, there remains a discrepancy on the importance and method for evaluating the actual experiences. A negative aspect of the Stetler model is that it is recognized for encouraging practice that is void of experience and therefore places less emphasis on procedural, and methodical clinical practices (Bauer , 2010), while the ACE model is often avoided for its arduous nature. Although it is thought that the ACEs arduous and time-consuming properties can be very beneficial in certain circumstances.

After consideration of all EBP models, the Iowa model was chosen for the reason that nurses tend find it innately logical, is intended to use interdisciplinary methods, and places and emphasis on organizational use. The PICOT format of developing clinical questions is recommended and visual charts that are easy to understand are easily integrated and used to guide decision-making. Problem-solving steps take advantage of feedback loops to direct the change process meaning that when there is a deficiency in evidence that more research is conducted. A provisional trial of the change is carried out before the actual implementation ensues throughout the organization.

References
Bauer , C. (2010). Oncology Nursing Society, 25(2), 1-3.
Brown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An illustrated example in oncology nursing. 18(2), 157-59. doi:10.1188/14.CJON.157-159
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Health; A Guide to Best Practices (3 ed.). Philadelphia: Wolters Kluwer Health.
Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209. doi:10.1111/j.1365-2648.2012.06122.x