Supervisor:

Madam Mrs Manpreet Kaur

Associate Professor
Presenter:
Jasmeet kaur
MSc Nsg 1st year
WHY IS EVIDENCE BASED PRACTICE
MODEL NEEDED?

 To translate research findings into

practice.
 To provide framework for understanding
the evidence based practice process.
MODELS OF EVIDENCE BASED
PRACTICE

 Stetler model

 Iowa model

 Rossworm and larrabee model

 D.Censo model of evidence based practice

STETLER MODEL
 Developed as ‘practitioner oriented’ model
in 1994
 Revised in 2001 without a change in its focus
on critical thinking.
 Deemphasized unsystematic clinical
experiences.
 Raised awareness about the importance of
applying research findings in nursing
practice.
MEANING OF ‘EVIDENCE’ AS PER
STETLER MODEL
 ‘Evidence’ is defined as information or facts
that are obtained systematically.
 ‘Evidence’ comes from two different
sources-external and internal evidence

External evidence: Derived from opinions of

experts.
Internal evidence: It comes from
systematically obtained facts or information
STETLER MODEL
FIVE PROGRESSIVE CATEGORIES
OF STETLER MODEL:-

1.Preparation:
• Identify a priority need
• Review the content in which research
utilization would occur
• Organize the work
• Initiate the research systematically.
FIVE PROGRESSIVE CATEGORIES
OF STETLER MODEL:-(Contd..)

2.Validation:
• Critique each study systematically.
• Choose and summarize the collected
research that relates to the identified
need.
3.Decision making:
Make decisions about use after synthesizing
body of summarized evidence.
FIVE PROGRESSIVE CATEGORIES
OF STETLER MODEL:-(Contd..)
4.Translation:
Converting findings, planning their
application, putting the plan to use and then
implementing use with an evidence based
practice.

5. Evaluation:
Evaluate the plan in terms of goals.
Prepration
Perform utilization
focused critique &
synopsis.
Identify and record
key study details acce
pt
State
decision
 e
stop
t o us
Not
State
decision

Consider use
CRITICAL ASSUMPTIONS
 Both formal and informal use of research findings can
occur in the practice setting.
 Individual, research utilization competent
practitioners also can use the model’s process and
interaction with others.
 Skills are required for effective use of findings
 Research findings may be used in multiple ways
 Contextual and personal factors can influence
research evidence
 The data provides probabilistic information about
individuals for whom the evidence is generally
believed to fit
IOWA MODEL

 It incorporates the use of research and other

forms of evidence
 Infrastructure to support research use might
involve every level of the organization
 Evidence based practice is linked to quality
assurance.
 Staff are given recognition for research work.
 Clinicians are given time and resources for
research work.
ROSSWORM AND LARRABEE MODEL
 Developed by Rossworm and Larabee in
1999.
 It is based on theoretical and research
literature
 It begins with the assessment of need and
integration of an evidence based protocol
STAGES OF ROSSWORM AND
LARRABEE MODEL
 Assess needs of stakeholders
 Build bridges, make connections
 Synthesize the evidence and determine
relevancy
 Plan the practice change
 Implement and evaluate the practice change
 Integrate and maintain the practice change
Implement and evaluate change in
practice
Integrate and maintain change in
practice
PROCESS OF EVIDENCE BASED
PRACTICE
Haynes and colleagues model(2002) of
evidence based practices involves the
following processes:
 Formulating a clinical question
 Systematically searching for relevant
research evidence
 Critically appraising the evidence
 Making an evidence based decision regarding
implementation
 Implementing of the practice change
 Evaluating the change in practice
D.CENSO’S MODEL OF EVIDENCE BASED
DECISION MAKING

COMPONENTS:
 Patient preferences and actions will be
dominant element in their decision making
 Patient’s clinical state and circumstances
should be considered
 Resources are considered before making a
decision
 Clinical expertise integrates the other model
components
Clinical
Expertise
STEPS IN EVIDENCE BASED
DECISION MAKING

1. Compiling guidance: Search for relevant

and high quality research studies that
address the clinical question.
2. Planning a change: The administrators
are consulted for planning a change.
3. Integrating skills and experiences:
Clinical skills include the expertise that
develops from multiple observations of
patients and the interventions carried on
patients.
CLINICAL EXPERTISE
It has a influence on:
 Quality of the initial assessment of the
client’s clinical state and circumstances
 Problem formulation.
 Decision about the best evidence
 Exploration of patient’s preference
 Delivery of the clinical intervention
 Evaluation of the outcome for that particular
patient
REFERENCES:
 Melynk and Fineout-Overholt “Evidence
based practice in nursing and health care”
Pages:187-205
 Kozier and Erb’s “Fundamentals of Nursing”
Pages:30-31
 Nursing outlook,Vol-49,issue-6
 GailJ;Nursing Science quarterly,Introduction
to nursing research;April.2008,21:2;page
no,180-182
THANK YOU