MODELS FOR THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE IN HOSPITAL BASED NURSING: A NARRATIVE REVIEW1

Camargo, Fernanda Carolina; Iwamoto, Helena Hemiko; Galvão, Cristina Maria; Monteiro, Damiana Aparecida Trindade; Goulart, Mayla Borges; Garcia, Luan Augusto Alves

doi:10.1590/0104-07072017002070017

Brazil

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Literature Review • Texto contexto - enferm. 26 (4) • 2017 • https://doi.org/10.1590/0104-07072017002070017 linkcopy

MODELS FOR THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE IN HOSPITAL BASED NURSING: A NARRATIVE REVIEW¹

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to identify models for the implementation of evidence - based practice in hospital based nursing.

Method: this is a narrative review of the literature. After the identification of the models, a search of specific references on the topic of interest was carried out and the articles were published.

Results: 16 models are presented for the use of research in the practice of hospital nurses, published between 1970 and 2015. The stages for the implementation of the models were described with emphasis on the types of evidence and approaches for the use of the research.

Conclusion: in the analysis of the assumptions of the models described, it can be inferred that the use of research in the practice of hospital nurses requires knowledge and skills beyond the usual in the daily work. Thus, the challenge for the national scenario is the development of national models, specific to the reality experienced and, also, the elaboration of initiatives that portray the implementation and/or adaptation of the models proposed in an international scope.

DESCRIPTORS: Evidence-based nursing; Nursing research; Hospitals teaching; Nursing model; Evidence-based practice

Model (year/country), emphasis of approach and type of evidence	Synthesis of steps*
Stetler Model of Research Utilization²¹^-²² (1976, USA)	Establish purposes for literature review; to carefully evaluate the research findings; comparing the results of the studies with the practice of care; make a decision (use, expect to use, reject or not use); detail and justify the steps for the implementation of the new procedure and evaluate formally.
Individual Scientific evidence
Conduct and Utilization of Research in Nursing (CURN)²³^-²⁵ (1978, USA)	Concern about changes in Nursing practice; define and evaluate a problem in patient care; seek solutions; selecting a potential solution; perform experiments or test the proposed solution; evaluate satisfaction or dissatisfaction with the solution, therefore repeat the steps.
Individual Organizational Scientific evidence
Quality Assurance Model Using Research (QAMUR)²⁶ (1987, USA)	Ask questions or identify problems; seek solutions, review and evaluate literature (conducting research); plan to change; implement innovation (protocols, procedures and policies); evaluate the expected results; formulate care standards (ensure quality improvement).
Organizational Scientific evidence
Iowa Model²⁷^-²⁸ (1994, USA)	Identify practical problems and formulate research questions; determine how much of a problem the priority topic is for the organization; identify terms for searching for evidence, critically analyze and synthesize this evidence; determine if the evidence is sufficient - otherwise conduct a search; if evidence is sufficient and the changes are appropriate, conduct a pilot study to change the practice; evaluate pilot results, disseminate results and implement change.
Organizational Scientific evidence
Ottawa Model of Research Use (OMRU)²⁹^-³⁰ (1999, Canada)	Identify people with authority to legitimize the change process and the required resources; clearly specify what innovation need to be implemented; evaluate innovation: potential actors that can adopt it, barriers and facilities implementation; select strategies to sensitize those involved about the value of innovation, its diffusion in the organization until reaching the direct care to the patient; evaluate the impact and disseminate the results.
Individual Organizational Scientific evidences
Promoting Action on Research Implementation in Health Services Framework (PARIHS)³¹ (1998, United Kingdom)	Seek evidence from scientific research, clinical experience, patient experiences, institution data and reports; adopt innovation in order to influence organizational culture by supporting leadership and reviewing practices; incorporate people into the organization whose knowledge and skills can support change in practice according to the evidence.
Organizational Scientific evidence
The Rosswurm and Larrabee Model³² (1999, USA)	Identify the need to change practice; approximate the problem with outcome indicators; summarize the best scientific evidence (systematic review) considering feasibility, benefits and risks for its implementation; develop a plan for changing the practice, including the necessary resources; implement and evaluate change (inform if a pilot study is conducted); integrate and maintain change in practice (communicate results to strategic leaders); monitor implementation (evaluate process and results).
Individual Best scientific evidence
Advancing Research and Clinical Practice Through Close Collaboration (ARCC)³³^-³⁴ (1999, USA)	Understand organizational culture and readiness to change; identify strengths and barriers for the implantation of EBP in the organization; identify the professionals specialized in the organization to assist in the implementation of the EBP with the assistance teams in the clinical units; implement the evidence in practice and evaluate the results.
Organizational best evidence
The Tyler Collaborative Model³⁵ (2004, USA)	Breaking the ice: identifying forces in the organization that can affect change; building collaborative relationships among strategic leaders to adopt change; diagnose the problem: identify areas to implement EBP; acquiring resources: raising financial and human requirements for the implementation of change; move: engage nursing assistants to identify solutions to their demands based on EBP (organize working group); choose a solution: rigorous review of scientific production; gain acceptance and followers: implement the evidence through a pilot study, in which they can evaluate the care given to the adoption of the evidence regarding their non-adoption; Stabilize: include evidence in the organization's rules and routines; evaluate results in the organization against the incorporation of evidence into work routines, and prepare reports that evaluate the results.
Organizational Scientific and non scientific evidence
Johns Hopkins Nursing Evidencebased Practice Model (JHNEBP)³⁶^-³⁷ (2007, USA)	Identify a question of practice, formulate the research question using terms appropriate to the search for evidence; search, critically evaluate, summarize and classify levels of evidence; use "non-scientific" evidence (financial data, professional experience and patient preferences) for decision making; determine the feasibility of applying the evidence, draw up an action plan for its translation, implement the change, evaluate and communicate the results.
Individual Scientific and non scientific evidence
Academic Center for Evidence-Based Practice (ACE)³⁸^-³⁹ (2004, USA)	To seek new knowledge through research; to carry out a rigorous review of multiple primary studies (in view of the different designs) to formulate new knowledge; prepare a document or guide to translate the evidence into practice; integrate evidence into practice by influencing changes in people and organization; evaluate the impact of the change in practice and its increase in the quality of care provided.
Individual Scientific evidence
The Clinical Scholar Model⁴⁰ (2009, USA)	Identify opportunities to implement change in the organization; review internal evidence (information and service data) and external evidence (search results); determine the strength of the evidence and conduct a plan for its implementation. If they are not safe enough, conduct a search; to simulate its application with different means; apply them and obtain the results in context; disseminate the results to the internal and external community of the organization.
Individual Organizational Scientific and non scientific evidence
Model in an Academic Medical Center⁴¹ (2009, USA)	Formulate a clinical question; search for the best evidence (systematic review of primary experimental studies); critically review the evidence; integrate evidence into practice; communicate the results.
Individual Organizational Best evidence
The Colorado Model⁴² (2011, USA)	Identify factors that facilitate organizational change; elaborate a clinical question using the PICO strategy; identify the patient's needs; evaluate patient's values and preferences; seek scientific evidence according to a protocol (if the hospital has a protocol for EBP) or to carry out a rigorous review of the literature (in the absence of an institutional EBP protocol). In the absence of scientific evidence, use evidence from other sources: infection control data, cost-effectiveness analyzes, and clinical expertise; summarize the evidence considering their level of classification; use them according to the context and decisions of the patient; evaluate the results.
Individual Organizational Scientific and non scientific evidence
The Multisystem Model of Knowledge Integration and Translation (MKIT)⁴³ (2011, USA)	Induce the development of research that can be applied in practice; identify transformational leadership in organizations; perform a search, critical evaluation and synthesis of the evidence by the actions of nurses with specialty for the action; to promote the translation of evidence through meetings between nurse researchers and nursing assistants; prepare a pilot study and intervention plan with the support of specialized nurses; integrate evidence into the work process and organize normative documents (protocols and clinical guidelines); monitor the results achieved by the implementation; to disseminate implementation results.
Organizational Scientific and non scientific evidence
The Research Appreciation, Acessibility and Application Model (RAAAM)⁴⁴ (2015, Australia)	To value research in the hospital context (through partnerships between universities and hospitals); access research results that can support the improvement of the quality of practice (organization of committees or specific groups and inclusion of specialist tutors in the hospital context); apply research (the development of research is an integral activity of the role of nurses in the hospital context); ensure the sustainability of the model (the development of communication strategies for dissemination and reporting to evaluate EBP).
Organizational Scientific and non scientific evidence

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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