Evidence-Based Practice: Models & Hierarchy

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  • 0:03 What Is Evidence-Based…
  • 1:09 Ace Star Model
  • 1:57 Johns Hopkins Nursing Model
  • 2:55 Evidence-Based…
  • 3:45 Quantitative & Qualitative
  • 5:18 Lesson Summary
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Lesson Transcript
Instructor: Heidi Howerton

Heidi has written education material for a well known hospital's pediatric neurosurgery unit and has her Bachelor's of Science degree in nursing.

In this lesson, we'll define what evidence-based practice is, then look at how evidence-based practice models and hierarchies are used to help healthcare team members determine the best patient care and treatment plans.

What Is Evidence-Based Practice?

A nursing student, Jenny, is assigned to write an evidence-based practice paper on medication errors. At the library, she searches medical journals and databases for nursing medication errors, and over 114 results pop up. She's overwhelmed. How will she know what problem to address on the topic, and how will she know which of the 114 studies to use in her paper? Jenny shares her stresses with her classmate Kim. Kim tells Jenny to review the evidence-based practice models and hierarchy and assures her that between the two topics, she'll be able to ask a clinical question and find the right research studies for her paper.

Evidence-based practice is a process that combines the best research evidence available, patient values, and the personal experiences of the healthcare team to ensure that each patient receives the best medical care and treatment possible. An evidence-based practice model is a guideline of steps that healthcare workers use to understand, create, and implement evidence-based practices in their areas of work. Numerous models exist, but we'll examine two key models.

Ace Star Model

The Ace Star Model of Knowledge Transformation lays out five steps a healthcare team member can follow to evaluate evidence-based practices. These steps include discovery of key research studies on the given topic, summary and review of research studies, translating the findings of the qualified studies into practical clinical application, integration of the evidence-based practical applications into clinical practice, and finally evaluation of whether the changes made in the healthcare setting were effective.

If Jenny uses this model to write her research paper, she'll begin with the discovery phase, by reading a variety of research articles on medication errors. She'll then narrow down her topic according to which research studies appear the most translatable into clinical practice and are best supported by evidence.

John Hopkins Nursing Model

The John Hopkins Nursing Evidence-Based Practice Model lays out three steps for nurses to use in implementing evidence-based research into the clinical setting. These steps include identifying a clinical question to answer, finding and evaluating evidence and research studies that pertain to the clinical question, and translating the best evidence-based practices found in the research into healthcare practice.

If Jenny uses this model to write her paper, she'll need to identify an evidence-based practice clinical question regarding medication errors. For example, she might ask if medication errors increase when the number of hours a nurse works per week increases. She would then visit medical databases to find the best available research studies on this topic. Lastly, based on her research findings, she might make a recommendation on how many hours it is safe for a nurse to work a week based on the correlation between medication errors made and hours worked by nurses.

Evidence-Based Practice Hierarchy

Now that Jenny knows how to narrow down her research topic, she needs to identify the strongest research studies to use in her paper. To do this, Jenny will use the evidence-based practice hierarchy. The evidence-based practice hierarchy is a pyramid (or scale) that ranks research studies and other types of evidence in order of their validity. The top of the pyramid, which corresponds to the lowest level number, represents the most reliable studies, and the bottom of the pyramid represents the least reliable studies.

The hierarchy is based on the method of conducting a research study. An evidence-based practice method describes how information in the study was collected and how patients were included into the study. One hierarchy exists to evaluate quantitative (or measurable data) studies, and a different hierarchy exists to evaluate qualitative (or descriptive data) studies.

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