Key Evidence-Based Practice Models

Why This Matters

Evidence-based practice (EBP) isn't just a buzzword you'll encounter on your nursing exams—it's the foundation of professional nursing practice and a core competency you'll be tested on repeatedly. These models represent the systematic frameworks that transform research from academic journals into real changes at the bedside. You're being tested on your ability to understand how knowledge moves from discovery to implementation, why some practice changes succeed while others fail, and what role nurses play in driving quality improvement.

Each model you'll study approaches the same fundamental challenge differently: How do we get the best available evidence into the hands of clinicians who can use it? Some models focus on the translation process itself, others emphasize organizational context and culture, and still others prioritize collaboration and stakeholder engagement. Don't just memorize model names and their creators—know what problem each model solves and when you'd choose one approach over another.

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Problem-Triggered Models

These models start with a clinical question or problem and work systematically toward a solution. The driving force is a gap between current practice and best evidence.

Iowa Model of Evidence-Based Practice

• Problem-focused triggers—this model begins when clinicians identify either a clinical problem or encounter new knowledge that challenges current practice
• Team-based implementation requires forming a multidisciplinary team to search, critique, and synthesize evidence before piloting changes
• Feedback loops built into the model ensure outcomes are evaluated and practices refined continuously after implementation

Rosswurm and Larrabee's Model for Evidence-Based Practice Change

• Six-step sequential process guides nurses from assessing the need for change through integrating and maintaining the practice change
• Emphasizes linking the problem to specific interventions and outcomes using standardized nursing language and classification systems
• Interdisciplinary collaboration is embedded throughout, making this model particularly useful for unit-based quality improvement projects

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Knowledge Transformation Models

These models focus on how evidence changes form as it moves from research to practice. Think of them as translation frameworks—they map the journey knowledge takes.

ACE Star Model of Knowledge Transformation

• Five-point star framework: discovery, summary, translation, integration, and evaluation—each point represents a distinct form knowledge takes
• Knowledge synthesis is central; the model emphasizes that single studies must be aggregated into systematic reviews before translation
• Evaluation completes the cycle by measuring impact on health outcomes, linking back to new discovery

Johns Hopkins Nursing Evidence-Based Practice Model

• PET process (Practice question, Evidence, Translation) provides a memorable three-phase structure for tackling clinical questions
• Evidence rating system teaches nurses to appraise and level evidence quality, building critical appraisal skills essential for professional practice
• Patient preferences are explicitly integrated alongside research and clinical expertise, honoring all three pillars of EBP

Knowledge-to-Action Framework

• Two-part structure separates knowledge creation (the funnel) from the action cycle, showing how synthesized knowledge feeds implementation
• Action cycle phases include adapting knowledge to local context, assessing barriers, and monitoring use—emphasizing context-specific adaptation
• Iterative feedback means the framework isn't linear; you continuously cycle through phases as new evidence emerges

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Implementation-Focused Models

These models prioritize what makes implementation succeed or fail. They're less about the evidence itself and more about the conditions needed for change to stick.

PARIHS Framework (Promoting Action on Research Implementation in Health Services)

• Three core elements: evidence, context, and facilitation must all be strong for successful implementation—weakness in any area undermines the whole effort
• Context includes culture, leadership, and evaluation capacity within the organization, not just physical resources
• Facilitation is the active ingredient—skilled facilitators bridge the gap between what research says and what clinicians do

Ottawa Model of Research Use

• Six key elements guide the process: evidence-based innovation, potential adopters, practice environment, implementation strategies, adoption, and outcomes
• Barrier assessment is built in, requiring systematic identification of obstacles before selecting implementation strategies
• Stakeholder engagement is continuous, recognizing that buy-in must be cultivated throughout the process, not just at the start

ARCC Model (Advancing Research and Clinical Practice Through Close Collaboration)

• EBP mentors are the cornerstone—this model trains advanced practice nurses to serve as unit-based champions who guide staff through EBP
• Organizational culture assessment using validated tools helps identify readiness and target interventions to build EBP capacity
• Sustainability focus makes this model particularly valuable for institutions building long-term EBP infrastructure

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Practitioner-Centered Models

These models put the individual nurse at the center, focusing on how clinicians appraise and apply evidence in their own practice.

Stetler Model of Evidence-Based Practice

• Critical appraisal emphasis makes this model ideal for individual practitioners evaluating whether specific research applies to their patients
• Five phases (preparation, validation, comparative evaluation, translation/application, evaluation) guide the nurse from question to outcome
• Internal evidence is valued alongside external research, recognizing that clinical expertise and quality improvement data matter

Evidence-Based Practice Model for Staff Nurses

• Bedside focus empowers direct-care nurses to engage in EBP without requiring advanced degrees or research expertise
• Practical tools and resources are central, providing templates and guides that make EBP accessible in busy clinical environments
• Culture of inquiry is the goal—this model aims to make questioning current practice a normal part of every nurse's workflow

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Quick Reference Table

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Self-Check Questions

1. Which two models both emphasize facilitation but differ in whether facilitators are one element among many (PARIHS) or the central implementation strategy (ARCC)?

2. You're a staff nurse who wants to evaluate whether a single research study applies to your patient population. Which model provides the most detailed guidance for individual critical appraisal?

3. Compare and contrast the ACE Star Model and the Knowledge-to-Action Framework. How do their approaches to knowledge transformation differ, and when might you choose one over the other?

4. An FRQ asks you to explain why an evidence-based intervention failed despite strong research support. Which model's framework would best help you analyze the failure, and what elements would you assess?

5. Your unit wants to build sustainable EBP capacity over the next three years. Which model specifically addresses training mentors and assessing organizational culture, and what makes it suited for long-term infrastructure building?