Evidence-Based Practice in the Clinical Setting

There is no doubt that organizational factors have a significant effect on the quality of care. In order to improve the quality of care, it is important to recognize the role evidence-based practice models play in today’s healthcare settings. An evidence-based practice model which fits the clinical settings will ensure the improvement of quality through evidence review and practice change (Schaffer, Sandau, & Diedrick, 2012, p. 1197).

Evidence-based practice means using best available clinical evidence to make informed diagnostic and treatment decisions. While evidence-based practice is the foundation of today’s healthcare, various evidence-based practice models have been created to accommodate a variety of different clinical settings. One such model is the Johns Hopkins Model which can be used to guide the process of applying research and non-research evidence into clinical practice (Newhouse, Dearholt, Poe, Pugh, & White, 2007).

This evidence-based practice model is based on three concepts: practice, education, and research (Buchko & Robinson, 2012, p. 260). According to the Johns Hopkins Model, evidence-based practice should be organized in three stages: outlining a question, searching for research and non-research evidence, using this evidence in a pilot study to measure the outcomes and determine its viability (Buchko & Robinson, 2012, p. 260).

This model is focused on the way evidence can be applied through research and views this process as an individual, rather than organizational issue. As such, this model emphasizes such approach to finding, reviewing, and synthesizing evidence which will be most appreciated by nursing educators (Schaffer, Sandau, & Diedrick, 2012, p. 1197).

Another model is the Promoting Action on Research Implementation in Health Services (PARiHS) framework. This model is relevant for “public health practitioners devising a knowledge translation strategy to implement research into practice” (National Collaborating Centre for Methods and Tools, 2011, par. 5The three concepts are making the foundation of this model: evidence, context, and facilitation (National Collaborating Centre for Methods and Tools, 2011, par. 5).

This evidence-based model emphasizes the need to consider the clinical setting where the new evidence is implemented and as such, will be more likely to work in my work environment, emergency department. An emergency department is a setting of high activity which accepts patients with unanticipated conditions. This unit provides medical care to patients with varying severity of medical conditions and as such, actions of practitioners prioritize securing available beds (Kirk & Nilsen, 2016, p. 555). Such organizational culture is described by researchers as “a flow culture” and it requires medical personnel not to do such activities which will stop patient flow (Kirk & Nilsen, 2016, p. 556).

This organizational culture necessitates a degree of flexibility in the implementation of evidence-based practices. Such practices should not be used if they stop patient flow (Kirk & Nilsen, 2016, p. 555). The PARiHS framework takes into account the context and as such, allows for a degree of flexibility not included in the Johns Hopkins Model. The emergency department necessitates applying evidence-based practice only in those cases when it will not interfere with the flow culture, putting patients’ health at risk.

Evidence-based practice models were created to describe the process of evaluating the evidence and implementing it in the clinical setting. The Johns Hopkins Model is focused on using evidence in a clinical trial to determine whether it can be applied in a clinical setting. The PARiHS framework takes into account evidence, context, and facilitation.

References

Buchko, B. & Robinson, L. (2012). An Evidence-based Approach to Decrease Early Post-operative Urinary Retention Following Urogynecologic Surgery. Urologic Nursing Journal, 32(5), 260-264. Web.

Kirk, J. & Nilsen, P. (2016). Implementing evidence‐based practices in an emergency department: contradictions exposed when prioritising a flow culture. Journal of Clinical Nursing, 25(3-4), 555-565. Web.

National Collaborating Centre for Methods and Tools (2011). PARiHS framework for implementing research into practice. Web.

Schaffer, m., Sandau, K., & Diedrick, L. (2012). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209. Web.