Introduction
Evidence-based practice (EBP) is an essential problem-solving approach in healthcare. Clinical providers must allocate the necessary resources to enable practitioners to access information promptly during care. Yet, using that information requires a systematic approach. To improve the efficacy and efficiency of practice, a systematic procedure is necessary that incorporates methods for integrating evidence into practice and precise criteria for evaluating it.
To structure and support nurses in posing clinical inquiries, assessing new information, and making adjustments in the clinical situation, numerous effective EBP models have been established. Each framework has benefits and drawbacks, and its applicability varies depending on the situation and context. Among the most well-known EBP models are the ACE Star Model of Knowledge Transformation, the Stetler Model of Evidence-Based Practice, and the Iowa Model. Although the three models are similar in their simplicity and emphasis on evidence, they differ in the level of detail and the number of steps.
Definition of EBP Models
When analyzing the EBP models, it is helpful to understand their backgrounds and steps. The first model, the ACE Star Model of Knowledge Transformation, is a methodological framework from the nursing-led research area that guides transformation, developed in 2004 and revised in 2012. The five stages are discovery research, summarizing the findings, translating them into guidelines, integrating practice, and evaluating the process and results (Polgar-Bailey et al., 2019).
The Star model can serve as a straightforward yet comprehensive framework for turning research into action and has been applied in educational institutions and clinical settings (Polgar-Bailey et al., 2019). Individual practitioners and organizations can apply the concept to guide improvements in practice across various contexts. Therefore, the Star model’s primary emphasis is on knowledge transformation.
The following model, which is similar to the previous one, is the Stetler Model of Evidence-Based Practice. It was first created in 1976, improved in 1994, and then revised in 2001 (Polgar-Bailey et al., 2019). The given model emphasizes analytical thinking and is practitioner-oriented. The five stages of Stetler’s model are preparation, validation, comparative evaluation/decision-making, translation/application, and evaluation. The paradigm encourages the use of internal and external sources of information (Polgar-Bailey et al., 2019). Beginning with the first step, it connects research utilization with the practice informed by the available evidence.
Lastly, an evidence-based model that applies research to daily practice is the Iowa Model of Evidence-Based Practice, a seven-step model introduced in the 1990s (Armstrong & Sables-Baus, 2019). To create the goal of the EBP initiative, the Iowa Model begins by identifying signs or triggers that focus on an issue or an urgent need for information or evidence, as well as accelerators for change. The next step is for stakeholders to decide whether the problem or topic they have chosen is a priority (Armstrong & Sables-Baus, 2019). This is crucial to securing the project’s backing from the organization’s leadership, staff, and management.
The Iowa Model suggests conducting a pilot study after assembling a team and conducting a literature search (Armstrong & Sables-Baus, 2019). When preparing for and carrying out the pilot study, it is crucial to involve patients and their families, as well as to consider the resources and obstacles that may exist. The Iowa Model’s final step is disseminating findings (Armstrong & Sables-Baus, 2019). Therefore, this framework provides a comprehensive and holistic approach for a clinical setting.
Comparison of the Three Models
When comparing all three models, some commonalities in terms of evidence can be identified. All three models emphasize the importance of using the best available evidence to guide healthcare decision-making. For this purpose, the ACE Star Model of Knowledge Transformation provides a systematic and valuable framework for integrating the best available research into medical practice (Polgar-Bailey et al., 2019). In Stetler’s model, each step is designed to encourage critical thinking about the practical applications of study findings and supporting evidence, leading to the use of evidence in everyday practice and reducing some human decision-making mistakes (Polgar-Bailey et al., 2019).
Ultimately, the Iowa Model has been commended for its focus on frontline practice issues that are crucial to both staff and patients (Duff et al., 2020). However, it is noteworthy that all models differ in the number of steps and the level of detail at each step. For instance, the Star model has only three steps, whereas the Iowa Model is more comprehensive, offering alternative approaches through its seven steps. Meanwhile, the Stetler model is a balance of two, offering four steps.
Regarding strengths and weaknesses, the ACE Star Model should be analyzed first. Regarding the model’s strengths, it is essential to highlight its simplicity and clarity, which make it easy to use and understand. However, one weakness of the frameworks is their lack of emphasis on stakeholder involvement, which may limit their effectiveness in complex healthcare settings (Grove & Gray, 2022).
Moreover, another framework, the Stetler model, shares similar shortcomings and strengths. For instance, its strengths include a balance between ease of use and comprehensiveness, as well as a focus on systematic and rigorous decision-making. Nevertheless, the model’s shortcoming is that it may not be suitable for complex healthcare problems that require a more detailed approach (Grove & Gray, 2022). Thus, both models share similar weaknesses and strengths due to their conceptual similarities.
Lastly, it is essential to consider the Iowa Model’s strengths. First, it supports change with a variety of evidence types, such as research studies, case studies, and EBP guidelines. Moreover, it highlights the implementation and incorporation of EBP into quality metrics and performance enhancement efforts to help sustain change (Armstrong & Sables-Baus, 2019). Ultimately, it views change from a systemic and organizational perspective.
However, the model has weaknesses that set it apart from the other two frameworks, such as requiring numerous stages, which can lead to inefficiency and inaccuracy. If there is insufficient research, a study should be conducted. Moreover, the team assembled might not be capable or devoted to the subject (Armstrong & Sables-Baus, 2019). Therefore, it is essential to consider stakeholder involvement and evidence-based efficiency.
Selection of EBP Models for Specialty Practice
As a registered nurse in the specialty practice of midwifery, EBP is essential to ensure positive patient outcomes. Of the three mentioned models, I would choose the Stetler Model for several reasons. First, the given model provides a well-structured and organized process for implementing EBP in a clinical setting. Second, the Stetler Model is flexible, allowing it to be applied in various contexts and areas of healthcare (Polgar-Bailey et al., 2019). Ultimately, this framework facilitates the integration of research evidence into medical decision-making, thereby enhancing patient outcomes.
Among the problems that could be addressed with the help of the Stetler Model is managing postpartum hemorrhage (PPH). PPH, which accounts for over 25 percent of annual deaths, is the leading cause of morbidity and mortality among mothers globally (Amanuel et al., 2021). However, the approach to managing the condition is currently not evidence-based, necessitating action.
Using the Stetler Model, I can prepare for implementing the new practice by reviewing the literature on the topic. During validation, I will synthesize and critically appraise the retrieved evidence. The comparative evaluation stage will review the research for gaps and develop the implementation plan. Translation and evaluation are the final steps, implying testing the initiative through training and assessing the results.
Conclusion
Hence, the simplicity and emphasis on the value of the evidence of the three models are similar, but their amount of detail and number of phases vary. The nursing-led field of research has developed a five-step methodology framework called the ACE Star Model of Knowledge Transformation to guide the transformation. The four-step Stetler Model of Evidence-Based Practice is the model that follows.
The paradigm promotes the utilization of both internal and external knowledge sources. The Iowa Model of Evidence-Based Practice was developed in the 1990s to integrate research into routine practice. All three models emphasize the importance of utilizing the most reliable data to inform healthcare decision-making. However, each model has a different number of steps and a different level of information in each step.
References
Amanuel, T., Dache, A., & Dona, A. (2021). Postpartum hemorrhage and its associated factors among women who gave birth at Yirgalem General Hospital, Sidama regional state, Ethiopia. Health Services Research and Managerial Epidemiology, 8, 1-7.
Armstrong, G., & Sables-Baus, S. (Eds.). (2019). Leadership and systems improvement for the DNP. Springer Publishing Company.
Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: An interpretive description. Implementation Science Communications, 1, 1-9.
Grove, S. K., & Gray, J. R. (2022). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.
Polgar-Bailey, P., Sandberg-Cook, J., Buttaro, T. M., & Trybulski, J. (2019). Primary care: A collaborative practice. Elsevier Health Sciences.