Implementing the Iowa Model Paper
The Iowa Model was developed and presented in 1994 by the University of Iowa Hospitals and Clinical as a guide for nurses to apply research findings in efforts to improve patient care. It is an action oriented simulation that originates from nursing-led research utilization fields, and applies theoretical approaches to nursing with the intention of achieving three objectives. Firstly, the model describes and guides the process of translating evidence that is collected from research into nursing practice. Secondly, it explains an understanding of what factors influence patient care outcomes when evidence is applied. Thirdly, it evaluates and assesses the implementation of evidence. The model has been continually referenced in nursing publications and extensively applied in research activities with multiple reporting demonstrating that it is success in a variety of settings to guide decisions and practice change implementation. Regardless of prior evidence-based practice (EBP) experience, Iowa Model can help medical personnel to translate research findings into clinical practice while improving patient outcomes (Butts & Rich, 2018). Implementing the Iowa Model Paper
It is undeniable that the implementation of evidence in nursing has progressed towards applying theoretical approaches to offer a better awareness of nursing practice failures and successes, especially when new approaches and technologies are being applied. Besides that, it is clear that nursing theoretical approaches are the result of aspirations to address problems linked with research to realize more EBP. Eventually, the theoretical approaches signify the strength of the evidence by explaining why and how they either succeed or fail thereby laying the stage for research to be translated into practice. Still, it is important to note that even as Iowa Model is applied, it must be considered as basically an overarching guide for theoretical approaches and their tailored application in each case (Fawcett, 2016). It is clear that EBP in nursing focuses on integrating the best available evidence of nursing expertise with the values and preferences of the patients, families and communities. This is based on the assumption that nursing care can only be personalized if the nurse – as a decision-maker – has access to the current evidence that is drawn from consensus expert opinion and research, and makes use of the evidence to influence decisions concerning care provision and planning even as cultural and personal values and preferences are considered. This implies that in making use of Iowa Model, the nurse has the responsibility of acting in the patient’s best interest even when EBP, patient and family practice are misaligned (Fawcett, 2016).
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The application of Iowa Model occurs through a five-step process as discussed. The steps are presented as part of a flowchart that guides decision-making, offers defined decision points and presents feedback loops for the nursing care process. They are intuitively understandable for nurses with a concise, clear and simple implementation approach that even novices can understand the process. In applying the steps, nurses are able to gain more knowledge and information on EBP and see the benefits of implementing the mode even as their confidence in EBP is enhanced (Masters, 2015). The first step is to identify the problem. In the present case, the problem is that treatment protocols for patients with serious mental illness (SMI) receiving care in the acute care setting applies ineffective triage, identification and treatment protocols. The identified problem stems from a problem-focused trigger, particularly process improvement data. The problem is a priority for the organization since it has implications for the opinions of patients and their care outcomes. The problem is a trigger indicating that EBP change is warranted. The second step is forming a team that is responsible for developing, implementing and evaluating the solution. The composition of the team would be directed at addressing the problem and including interested stakeholders with representatives from both inside and outside the nursing unit. The inclusion of all stakeholders allows for interdisciplinary input while allowing for the better evaluation and implementation of the change (McKenna, Pajnkihar & Murphy, 2015). Implementing the Iowa Model Paper
The third step is critiquing the relevant research in terms of brainstorming with the team members to identify the key terms and available sources that would present the relevant current evidence. This step helps with searching for and retrieving studies that aid in choosing an appropriate intervention to the problem. In addition, the studies are critiqued to determine whether they are scientifically sound in terms of the tested intervention. Not all published studies apply a scientifically sound approach, and some of them may use a tool lacking validity or reliability, or a small sample size. In essence, critiquing the studies prior to considering the results for implementation in EBP helps with the decision about whether sufficient research exists to implement practice change. The critique criteria for determining the sufficiency of the research will focus on evaluating the existence of consistent findings that support the change, quality and type of studies, clinical relevance of the findings, feasibility of findings in practice, and risk-benefit ratio. The change is only applied into practice if the critique criteria is met (McKenna, Pajnkihar & Murphy, 2015).
The fourth step is implementing the practice change. This involves piloting the identified change in trial run in a small department within the organization then evaluating its results before making the decision to implement the change in the whole organization. The evaluation is intended to see whether the change is feasible and if it achieves the intended outcomes without unacceptable negative effects. It involves identifying the outcomes to be achieved, collecting baseline data, developing a written guideline for the EBP, testing the guideline in a trial run in a small department, evaluating the trial’s process and outcomes, and modifying the EBP guideline based on the evaluation. The final step is disseminating the findings. Once the trial run in the small department has proven successful, then it would be extended to the whole organization as a practice change even as the team continues to evaluate results and make improvements (McKenna, Pajnkihar & Murphy, 2015).
The Iowa Model is considered suitable for the present study because it supports the use of expert opinions and case reports as evidence. Research evidence is the most trustworthy and reliable source of evidence. Useful and effective clinical protocols should be based on research evidence to the extent possible. The model notes that if there is no sufficient research base to support change, then other types of evidence can be adopted to include theory, scientific principles, expert opinion and case reports. If the research evidence does not sufficiently address the clinical problem or is not available, then other forms of evidence can be used. Unlike other models that devalue and ignore evidence with low qualities, Iowa Model allow researchers and clinicians to use all types of evidence when making clinical decisions. These are particularly important principles for the present case since the problem/topic has not been extensively researched. There could be effective solutions that lack a scientific base as they are unconfirmed through high quality research (Ellis, 2016).
Besides that, care for patients with SMI involve a combination of various interventions thus making it difficult to conduct a high quality trial to evaluate the complexity of the intervention. The psychological nature of SMI emphasizes the profound effects of humanistic factors like relationship, spirit and emotion. These factors are difficult to evaluate using classic research approaches as they entail the involvement of qualitative research aspects that may be difficult to apply in evaluating the intervention. This is a deficit that Iowa Model does not share. While high quality evidence is scarce on the topic/problem, expert opinions and case reports can also be used as available current evidence that can be used to develop EBP protocols, practice in line with the protocol in providing daily care, and be confident that the nursing care being delivered is based on the best available evidence (Melnyk & Fineout-Overholt, 2015). Implementing the Iowa Model Paper
References
Butts, J., & Rich, K. (Eds.) (2018). Philosophies and Theories for Advanced Nursing Practice (3rd ed.). Jones & Bartlett Learning, LLC.
Ellis, P. (2016). Evidence-based Practice in Nursing (3rd ed.). Learning Matter/SAGE Publications Ltd.
Fawcett, J. (2016). Applying Conceptual Models of Nursing: Quality Improvement, Research, and Practice. Springer Publishing Company.
Masters, K. (2015). Nursing Theories: A Framework for Professional Practice (2nd ed.). Jones & Bartlett Learning, LLC.
McKenna, H., Pajnkihar, M., & Murphy, F. (2015). Fundamentals of Nursing Models, Theories and Practice. John Wiley & Sons.
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice (3rd ed.). Wolters Kluwer Health. Implementing the Iowa Model Paper