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Which results in being more capable of keeping patients stay in the hospital to be shorter.

by | Nov 22, 2022 | Nursing | 0 comments

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Two popular evidence-based practice (EBP) models are the Iowa Model and the Advancing Research & Clinical practice through close Collaboration (ARCC) Model. The Iowa Model is based on Rogers innovation theory and is a straight forward tool that is geared toward bedside nursing staff (Tucker et al., 2021). The Iowa Model has been updated frequently since 1987 and has been used globally to solve triggering issues with an interprofessional team to develop and implement interventions (Tucker et al., 2021). Once a project has been deemed supported by evidence and a pilot has been initiated, the Iowa Model uses a feedback loop to fine tune the intervention until the practice is adopted and sustainable or abandoned (Tucker et al., 2021).
The ARCC Model was developed in 1999 and begins with an assessment of the healthcare organization’s readiness for EBP to identify barriers and strengthen EBP mentors with a five-day research seminar (Melnyk, 2021). An interdisciplinary team is created to develop EBP projects with help from the mentors to identify barriers and facilitators, collect data, share data, and create education (Tucker et al., 2021). Data from the project is used as a guide to evaluate and adjust initiatives based on new evidence (Tucker et al., 2021). The Iowa and ARCC models are similar in their approach of an interdisciplinary team to develop and evaluation EBP projects and initiatives.
Population: In adult oncology patients
Intervention: does a Columbia Suicide Severity Rating Scale (CSSRS) at each encounter
Control: compared to no suicide screen questions at each encounter
Outcome: affect number of patients identified with suicide risk
Time: over a three-month period
EBP supports inter-professional collaboration naturally when representatives from various disciplines form work groups to develop projects based on improvement or problem inquiry. Health care organizations are complex and depend on collaboration and teamwork to function successfully. All parts of an organization interact in some way and effect each other’s work.
When using evidence-based practice (EBP), it helps to have some models to represent or initiate a plan to change the organization. One particular EBP model is the Iowa Model. This model focuses on the entire healthcare system and infrastructure to implement a new practice based on the available resources, research, and evidence. This model identifies a problem and determines if it is an issue of high priority that needs to be addressed within the organization (Christenbery, 2017) (Cullen, et al 2022). It’s a model that requires the attention of stakeholders and will require levels of research to aid it. The availability and merit of the evidence is evaluated. If it is lacking, then more research is required. If the pilot run of the project is effective, then the findings are disseminated, and the program is evaluated for change.
With Stetler’s model, the process of the program is similar, but it is centered more on patient care and not with an organization. The steps are similar. There is the identification of a problem, the validity of the problem and the evidence it provides. All of these reviews help determine if addressing the problem would be a good fit for the current situation (Christenbery, 2017) (Indra, 2018). Once all of the evidence and relevance to the problem have been reviewed, then the program is transitioned and implemented. Education and demonstrations are performed here to provide information on why changes are required. Finally, once the program is implemented, then the goals are identified, then it is reviewed whether or not any additional changes are required, along with whether or not the goals have been met. All in all, these two models are similar, but the differences lie in the platform of change (Christenbery, 2017).
In our unit, a neuro and telemetry floor, I implemented a MSN project on educating COPD patients and following-up with them with the use of telehealth, to achieve a result in lowering the rate of readmissions. My PICOT at the time was: On every unit in the hospital, will the implementation of educating staff of COPD discharge planning with teach back and a detailed questionnaire with routine telehealth follow-up appointments reduce COPD readmission rates to at least the national average in 10 weeks? With the use of EBP models mentioned, I was able to make a plan not just with the patient, but within the organization as well. It was cost effective, since such a program was already in place, it just needed finessing. It allowed the patients to have immediate access to care if needed from their homes and to have a quick consult on whether or not this patient truly needs to visit the ER. Doing research around the facility, and in nearby hospitals helped me improve the process further, which led to the goal of our organization being successful in reducing readmissions below the national average. Telehealth has been known to be effective in helping staff and patients apply what is required for them to feel better and not spend more of their time in the hospital. The quick and accessible care is effective in achieving several healthcare goals (Abshire, et al 2020). Taking advantage of the technological opportunities that we have, we were able to have a successful COPD program.
EBPs help support interprofessional collaboration by sharing the same goals and by conducting similar research. EBP doesn’t have to fall within nursing only. It can be used by anyone that is focused on the task at hand. A nurse researching COPD from a respiratory therapist’s article on EBP can provide insight for the nurse to make a finessed plan that benefits both groups. The same concept applies to physical, occupational therapists, and physicians too. EBP comes from all sides of the spectrum. By understanding what other professions are doing and how they approach healthcare with the patient, a more finessed plan of care can be developed (Nandiwada & Kormos, 2018). Individually, one person can only do so much, but by coming together as a team and mixing different mindsets together, a stronger force in providing care gets achieved. Which results in being more capable of keeping patients stay in the hospital to be shorter.

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