Responding to evidence-informed practice change using frameworks and models. Use of frameworks and models to support EBP change.

In health care settings, the importance of frameworks and models in evidence-based practice (EBP) is that they offer a system or strategy for change. They assist health workers in identifying problems, creating intervention strategies, evaluating outcomes and monitor improvements. Change efforts can go awry, be inconsistent, and lack structure without a guiding framework. Additionally, models can enhance communication between health care teams and improve the odds of successful implementation of evidence-based interventions in health care practice (Brunt & Morris, 2023). Two “old” models that can be used to assist with change in EBP are the Evidence-Based Practice Iowa Model of Evidence-Based Practice and Lewin’s Change Theory.

Iowa Model of Evidence-Based Practice (Imedp2iowa.com)

The Iowa Model is a model specific to the healthcare environment and is used to discover clinical issues and/or knowledge-based triggers that require improvement. The model represents the various phases that practitioners are in with the implementation of a practice change – team formation, evidence review, piloting the change, the assessment of the change outcome, embedding the change. Team working, evidence appraisal and organizational support are strengths of the Iowa Model. The use of technology, especially in a systematic manner, to enhance patient outcomes based on research findings is of particular benefit.

Lewin’s Change Theory

Lewin’s Change Theory is a simpler and more general theory of change which includes the following three steps: unfreezing, changing and refreezing. The unfreezing stage is a process of getting people and/or groups ready for change. The change stage should be the time of introducing the new process or behavior, while the refreezing stage should be when the change is solidified and becomes the new habit. The advantage of Lewin’s model is that it emphasizes the human element of change and takes into account resistance that might arise when implementing change.

A great comparison site for the two popular models.

Both of these models could be applied as a means of implementing change, but they each have their own focus and application. The Iowa Model is more comprehensive and particularly oriented towards evidence-based healthcare practice. It gives comprehensive instructions for defining a clinical problem, searching for research evidence and for measuring a patient outcome. However, in contrast, Lewin’s Change Theory emphasizes behavioral and organizational change, rather than research per se. The Iowa Model also has its own way of thinking about how each member of the interdisciplinary team contributes to the work of the team and an emphasis on ongoing evaluation over emotional and psychological preparation for change, which seems to be the focus of Lewin’s. Lewin’s theory is easily applicable but might be less suitable for larger healthcare EBP initiatives, where a comprehensive examination of the evidence and an assessment of its effectiveness need to occur.

The most appropriate structure of my evidence-based practice proposal will be.

My evidence-based practice proposal would best fit the Iowa Model since it is meant to implement evidence-based changes in the health care environment. This model offers a structured approach to the identification of a healthcare problem, scientific evidence reviews, test of interventions, and evaluation of outcomes. In this organized framework, the chances of successful implementation as well as sustainable improvements in patient care are improved (Klaic et al., 2022). The Iowa Model is also suitable as it encourages teamwork amongst health care professionals that is crucial to EBP projects. In addition, it also considers measurable outcomes, to assess whether or not the intervention has been beneficial for the patient safety, quality of care, and/or clinical effectiveness. Lewin’s Change Theory gives more general guidance for incorporating research evidence in clinical practice; the Iowa Model has more specific guidance and is a better fit for evidence-based healthcare initiatives.

Conclusion

The important point to mention is that the frameworks and models are an integral part of supporting successful change of EP projects. Like Lewin’s Change Theory, the Iowa Model provides insightful advice for the implementation of change and is more appropriate for proposals of EBP in healthcare because of its focus on research evidence, interdisciplinary work, and the evaluation of outcomes. The framework that is being used is crucial to ensure that evidence-based interventions are in place and effective outcomes are being achieved.

References

Brunt, B. A., & Morris, M. M. (2023, March 4). Nursing Professional Development Evidence-Based Practice. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589676/

‌Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation Science Communications, 1(1). https://doi.org/10.1186/s43058-020-00070-0

Klaic, M., Kapp, S., Hudson, P., Chapman, W., Denehy, L., Story, D., & Francis, J. J. (2022). Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework. Implementation Science, 17(1). https://doi.org/10.1186/s13012-021-01171-7

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Assessment Description
Review the different frameworks/models that can be used to facilitate change. Compare two and explain which is best for your evidence-based practice proposal and why. Provide rationale. Discussion 2