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The “John Hopkins Nursing Evidence-Based Practice Model” uses a process called PET (Dang & Dearholt, 2017). This stands for practice question, evidence, and translation. With the Institute of Medicine publication calling for higher educated nurses working at the full extent of their license (Campaign for Action, 2017), this involves understanding how to implement evidence-based practice. However, barriers exist, including, the demands of patient care which limits their time to implement these practices. With the John Hopkins approach the process is simplified and easy to understand, reducing the cost of entry. With the PICO framework, the nurse is able to better identify the problem in the form of a tangible question. Through the evidence phase, research is conducted and critiqued in order to determine strengths and weakness of articles before committing to a practice. Lastly, through the translation phase, nurses are able to determine if the practice is feasible and pilot a project (Parkosewich, 2013).
I am working on rolling out new psychotropic review for my company. This form is used by the nurses to identify psychotropic and spark conversation with the provider in order to reduce the amount of psychotropic medications used in the facilities. Through this course I have developed a PICO statement and completed a lot of research. By using the John Hopkins model, I would be able to further identify key items such as stakeholder analysis. Additionally, by using this model I would want to identify a project leader and change champions to push the new review forward. Milestones will need to be identified and pre and post measurements taken. Also, barriers would need to be identified with a plan to overcome them. Eventually this form will be added to the EMR but initially it will be a paper form and would not be financially impactful on the company as we do have a form and process already. Barriers may include nurses who are used to the old form and resistant to change. However, with proper dissemination on the evidence of using the new form this could be overcome. Additionally, providers may not be on board when a higher questioning of psychotropic medications is presented. However, as part of the role out process infographics and information on why this is important and what our companies views are will help nurses to have meaningful conversations to overcome this barrier.
Campaign for Action. (2017). Infographic – the future of nursing. The National Academies of Sciences, , 1. Retrieved fromhttp://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Infographic.aspx
Dang, D., & Dearholt, S. (2017). Center for evidence-based practice. Retrieved from https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html
Parkosewich, J. A. (2013). An infrastructure to advance the scholarly work of staff
nurses. The Yale Journal of Biology and Medicine, 86(1), 63-77. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584497/
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The Iowa model is an Evidence-Based Practice (EBP) model whose foundational concepts revolve around problem-focused triggers and knowledge-focused triggers. The nurse identifies the area of interest from these two triggers. Problem-focused triggers include issues related to patient care such as increased rate of nosocomial infections and patient falls whereas knowledge-focused triggers focus on identifying new research findings can be applicable in clinical practice (Brown, 2014). Once the nurse has recognized the potential triggers, the next step is to prioritize the identified problems. This ensures that the nurse selects the most important issues that require prompt attention.
Following prioritization, team comprising of members from different disciplines such as nursing, medicine, pharmacy, epidemiology, and infection control is created. The purpose of the team is to oversee the successful implementation of evidence-based practice. The team members will then formulate a research question using the PICOT format (population, intervention, comparison, outcome, and time) (Brown, 2014). The research question will guide the team members during the selection of relevant research articles. Evaluating the significance and relevance of these research articles is mandatory. The findings are then implemented in a pilot study that involves one or two units in the hospital. If the pilot study is successful, the research findings can be applied to the whole organization (Brown, 2014).
Time is a significant barrier that can impede the successful adoption of EBP in any organization. Nurses are often overworked, and they do not have time to go to the databases and look for research evidence. The organization should ensure that the nurses have adequate schedules that support the use of EBP (Tacia, Biskupski, Pheley & Lehto, 2015).
Brown, C. G. (2014). The Iowa Model of Evidence-Based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing. Clinical Journal of Oncology Nursing, 18(2).
Tacia, L., Biskupski, K., Pheley, A., & Lehto, R. H. (2015). Identifying barriers to evidence-based practice adoption: A focus group study. Clinical Nursing Studies, 3(2), 90.