The document discusses the importance of evidence-based practice (EBP) and the role of theory in guiding nursing practice, emphasizing that both EBP and practice-based evidence (PBE) are essential for effective decision-making. It outlines several models for implementing EBP in nursing, including the ACE Star Model, the ARCC Model, the Iowa Model, the Johns Hopkins Nursing EBP Model, and the Stetler Model, each with specific components and processes for integration into clinical practice. The document highlights the need for nursing practice to be both evidence-based and theory-based to improve patient outcomes and support continuous research validation.

1. Evidence Based Nursing
Practice Theory
Shraboni Roy
Teaching Assisstant
Department of Graduate Nursing

2. Introduction
• A theory is a set of concepts and propositions that provide an
orderly way to view phenomena.
• The purpose of a theory in scientific disciplines is to guide research
to enhance the science by supporting existing knowledge or
generating new knowledge”.
• A theory not only helps us to organize our thoughts and ideas, but
it may also help direct us in what to do and when and how to do it.

3. Evidence Based Practice
• Evidence based Practice is the conscientious, explicit, and
judicious use of current best evidence in making decisions
about the care of individual patients.

4. Practice Based Evidence
• “Practice-based evidence” (PBE)—was introduced into the
discussion of EBP a few years ago.
• PBE acknowledges the importance of the environment in
determining practice recommendations and recognizes that
knowledge can be generated from practice as well as from
research (Chinn & Kramer, 2015).

5. EBP in Nursing
• Walker and Avant (2011) pointed out that practice is the
central and core phenomenon and focus of nursing;
arguably, it is the reason for nursing’s existence.
• Thus, it is critical to remember that theory guides practice,
and it also generates models of testing in research through
both PBE and EBP.
• For nursing, therefore, practice must not only be evidence-
based but also be theory-based, for when research validates
a theory, it provides the evidence required for EBP.
• Finally, as more research is conduced about a specific
theory, more evidence is provided to support practice.

6. Components of a Theory
A theory has several components including
• Purpose
• concepts and definitions
• theoretical statements
• structure/linkages and ordering
• assumptions

7. Level of Nursing Theory
• Grand Nursing Theory
• Middle Range Theory
• Practice/ Evidence Based Practice Theory

8. Theoretical of Evidence Based Practice/ Practice
Theory
• Academic Center for Evidence-Based Practice Star Model (ACE Star
Model)
• Advancing Research and Clinical Practice Through Close Collaboration
(ARCC Model)
• Iowa Model
• Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model
• Stetler Model of Evidence-Based Practice

9. Academic Center for Evidence-Based Practice Star Model (ACE Star Model)
The Star Model is depicted by five points of knowledge
transformation.
• Discovery research
• Evidence summary
• Translation to guidelines
• Practice integration
• Process, outcome evaluation

10. ACE Star Model

11. Advancing Research and Clinical Practice Through
Close Collaboration (ARCC Model)
• The AARC Model relates best to clinical practice, and much
of the research supporting its development and
implementation was conducted in acute care, pediatric
settings.
• The central constructs are assessment of organizational
culture and readiness for EBP, identification of strengths and
major barriers to EBP, and development and use of EBP

12. Cont..
• These constructs are done sequentially and followed by EBP
implementation.
• Outcomes that should be evaluated include health care
provider satisfaction, cohesion, intent to leave, turnover,
improved patient outcomes, and hospital costs.

13. Iowa Model of Evidence-Based Practice to Promote Quality Care
• It incorporates starting points, which are nursing problems
that are termed “triggers.”
• It continues through multiple decision points and feedback
loops to provide for evaluation of any changes.
• When implemented, it will assist in providing quality care to
clients of clinics, home health agencies, and hospitals.
• The Iowa Model is very detailed and specific and has been
applied to address a number of clinical topics.
• It is also one of the best researched EBP models.

14. The Johns Hopkins Nursing Evidence-Based Practice Model
• The JHNEBP Model was designed as a problem-solving
approach to clinical decision making.
• It combines elements of the nursing process, the American
Nurses Association’s Standards of Practice, critical thinking,
and research utilization processes.

15. Steps of the Johns Hopkins Nursing Evidence-
Based Practice Model
• Practice Question
Recruit interprofessional team
Develop and refine the evidence-based practice (EBP)
question (Apply PICO elements.)
Define the scope of the EBP question and identify
stakeholders
Determine responsibility for project leadership
Schedule team meetings

16. Cont..
• Evidence
Conduct internal and external search for evidence
Appraise the level and quality of each piece of evidence
Summarize the individual evidence
Synthesize overall strength and quality of evidence
Develop recommendations for change based on evidence
synthesis

17. Cont..
• Translation
Determine fit, feasibility, and appropriateness of
recommendation for translation pathway
Create action plan
Secure support and resources to implement action plan
Implement action plan
Evaluate outcomes
Report outcomes to stakeholders
Identify next steps
Disseminate findings

18. Stetler Model of Evidence-Based Practice
• The current Stetler Model of EBP is similar to the nursing
process; therefore, it is easily assimilated by practicing
bedside nurses.
• The phases of the approach include
Preparation
Validation
comparative evaluation/decision making
translation/application, and evaluation.
• It provides practitioners with stepwise directions for
integrating research into practice.

19. Preparation (purpose, control, and sources of
research evidence)
• Define potential issues
• Seek sources of research evidence
• Perceive problems
• Focus on high-priority issues
• Decide on need for a team
• Consider other influential factors
• Define desired outcomes
• Seek systematic reviews
• Determine need for explicit research evidence
• Select research sources with conceptual fit

20. Validation (credibility of findings and potential
for/detailed qualifiers of application)
• Credibility of findings
• Critique and synthesize resources
• Critique systematic reviews
• Reassess fit of individual sources
• Rate the level and quality of evidence
• Differentiate statistical and clinical significance
• Eliminate noncredible sources
• End the process if there is no evidence or clearly insufficient
credible research evidence

21. Comparative evaluation/decision making (synthesis
and decisions/recommendations for criteria of
applicability)
• Synthesize the cumulative findings
• Evaluate the degree and nature of other criteria
• Make a decision whether/what to use
• If decide to “not use,” STOP use of the model
• If decide to use, determine recommendations for a specific
practice

22. Translation/application (operational definition of
use/actions for change)
• Types
• Methods
• Levels
• Direct instrumental use
• Cognitive use
• Symbolic use
• Caution: Assess whether translation/product or use goes beyond
actual findings/evidence
• Formal dissemination and change strategies should be planned
per relevant research
• Consider need for appropriate reasoned variation

23. Evaluation (alternative types of evaluation)
• Evaluation can be formal or informal, individual or
institutional
• Consider cost-benefit of evaluation efforts

24. Thank You..

25. Reference
• McEwen.M.(2018).Theoretical Basis for Nursing, 5th
Edition.Wolters Kluwer.