Role DNP in Evidence-Based Practice (EBP)

Evidence Based Practice  Model to use : IOWA Model Evidence based Practice
Practice Problem: VAP (Ventilator Associated Pneumonia)

Student: Wilmot-Carter, Sherian

Introduction to Evidenced Based Practice

Evidenced Based Practice (EBP) is defined as the use of scientific evidence as a guide for decision making that will evoke change in any organizational system (Hall & Roussel, 2017). This concept is continuously applied in nursing as it creates a medium for facilities to use best evidence to develop strategies that counter a particular clinical problem (Polit & Beck, 2017). This paper will discuss the Stetler Model of Research Utilization, the Advanced Practice Registered Nurse’s (APRN) role in each step and the steps of the model as it relates to managing catheter associated urinary tract infections (CAUTI).

The Stetler Model of Research Utilization

Since the introduction of EBP, researchers have developed and used numerous research models to guide their pursuit of problem solving. One such model that has been used for decades is the Stetler Model of Research Utilization. The Stetler Model is a tool that is used to transform research and best evidenced into clinical practice (Stetler, 2001). There are five steps to the Stetler Model, which all play and integral role in the process of problem solving. Each step enables critical thinking, alleviate some human errors made in decision making and uses evidence in daily practice (National Collaborating Centre for Methods and Tools, 2011).

1. Preparation: This step describes the purpose for consulting evidence and the needs to consider all other contextual factors that will influence the process. The APRN is necessary to facilitates this step. This is where the APRN will ensure that all aspect of the problem is considered, and the best and most effective evidence is chosen to complement the process.
2.  Validation: This step is all about the credibility and applicability of each research finding. The APRN is very important in this step as this is where expertise and knowledge of level of evidence is needed to critique and evaluate the research choses.
3.  Comparative Evaluation/Decision Making, Synthesis and Decisions/Recommendations per Criteria of Applicability: In this step the APRN will organized the choses research based on their similarities and differences. The APRN will determine if there is substantial evidence that is suited for the practice setting and targeted population. Based on this comparison the APRN will decide which research evidence to use and the ones to reject.
4.  Translation/Application, Operational Definition of Use/Actions for Change: This is where the APRN will use the evidence gathered to put into action. This step represents the implementation of a plan of action.
5. Evaluation: In this step the APRN will assess the implemented plan of action in terms of goals and potential outcomes that needed to be achieved.

The Stetler Model as it relates to CAUTI Prevention

CAUTIs have been a leading cause of infection in healthcare facilities, simply because healthcare workers are poorly educated on the need for a catheter (Carr, 2017).  This results in higher healthcare cost for patients, longer hospital stays and increased mortality rates (Ferguson, 2018), therefore prevention is key. The Stetler Model can be used as a tool to address CAUTIs and to implement a solution.

Using the first step of the Model, relevant evidence was gathered as it relates to CAUTIs in a hospital setting. It was important to consider all areas in the hospital that catheters are used as each department had a different reason.

Applying the second step of the model, literature was analyzed and validated to determine its efficacy as it related to CAUTIs. The credibility of these articles was determined by their level of evidence, whether they were experimental or non-experimental and whether the research yielded positive results or not.

In third step of the process a decision was made to use the research that provided the best results for the patient population and setting being examined. A number of the articles reviewed were literature reviews and non-experimental. After reviewing and choosing the best evident, a choice was made for a solution to the problem. In order to address this issue, the most feasible solutions that would be most cost effective in preventing CAUTIs in the hospital setting would be an algorithm that determines if a catheter is warranted and an alternative method if its use is not justified. This plan of action was used in multiple research study with positive results.

The fourth step of the model would allow for plan implementation, which would begin as soon as patients are admitted to the hospital. The algorithm would be place on each patient’s chart so it is available should there be a consideration for a catheter. The patients that qualify for a catheter will still be limited on the number of days they can have the catheter, along with strict guidelines for maintenance. Patients who do not qualify for a foley catheter would benefit from alternatives such as female external catheter or a male condom catheter as it applies per gender and scheduled toileting. Although these methods are less invasive than a foley catheter they still pose a risk for infection and require adequate management.

The fifth step of the model would allow for and evaluation of the process and whether it has generated positive results. Failure of the intervention does not mean it was an inappropriate option. Therefore, during the process of evaluation all aspect of the process would be critiqued to determine what areas can be improved.

References

Carr, A. N. (2017). CAUTI prevention: Streaming quality care in a progressive care unit. MEDSURG Nursing, 26(5), 306–323. https://search-ebscohost-com.libproxy.usouthal.edu/login.aspx?direct=true&db=a9h&AN=125833258&site=ehost-live

Ferguson, A. (2018). Implementing a CAUTI prevention program in an acute care hospital setting. Urologic Nursing, 38(6), 273–302. https://doi-org.libproxy.usouthal.edu/10.7257/1053-816X.2018.38.6.273

Hall, H. R., & Roussel, L. A. (2017). Evidenced-based practice, an integrated approach to research, administration and practice (2nd ed.). Burlington, MA: Jones and Bartlett Learning.

National Collaborating Centre for Methods and Tools (2011). Stetler model of evidence-based practice. Hamilton, ON: McMaster University. (Updated 18 September, 2017)                                                       http://www.nccmt.ca/resources/search/83.

Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Stetler, C. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49, 272-279. DOI: 10.1067/mno.2001.120517