NUR 598 Week 2 Evidence-Based Practice Model Selection

Student Name

University of Phoenix

NUR 598 Research Utilization Project (capstone-style project)

Prof. Name

Date

Evidence-Based Practice Model Selection: 

Evidence-based practice (EBP) improves patient outcomes by integrating the best available research evidence, clinical expertise, and patient preferences into healthcare decision-making. Among the many EBP frameworks available, the Iowa Model of Evidence-Based Practice to Promote Quality Care is one of the most effective because it provides a structured, team-based approach for implementing evidence into clinical practice. It is particularly valuable for healthcare organizations seeking to improve emergency department (ED) patient flow through evidence-based triage systems.

Understanding Evidence-Based Practice

Evidence-based practice is the systematic process of translating the latest scientific evidence into routine clinical care. Rather than relying solely on tradition or individual experience, EBP enables healthcare professionals to make informed decisions that improve patient safety, healthcare quality, and cost-effectiveness.

Research consistently shows that organizations implementing EBP experience better clinical outcomes, improved patient satisfaction, and more efficient use of healthcare resources (Melnyk et al., 2012; Schaffer et al., 2013).

Despite these benefits, implementing EBP remains challenging across many healthcare settings.

Common Barriers to Evidence-Based Practice

Several factors limit successful EBP implementation, including:

• Limited funding and organizational resources

• Lack of time for reviewing and applying research

• Insufficient education and EBP training

• Poor access to research databases

• Limited computer and information literacy skills

• Inadequate leadership support

• Unclear organizational goals

• Resistance to change within healthcare teams

Studies also indicate that translating research findings into routine clinical practice can take nearly 17 years, highlighting the need for structured implementation frameworks (Institute of Medicine, 2001; Brown, 2014).

Why Healthcare Organizations Need Evidence-Based Practice Models

Evidence-based practice models provide healthcare professionals with a step-by-step framework for converting research into everyday clinical practice. Instead of approaching organizational change informally, these models simplify implementation by dividing complex processes into manageable stages.

Using an EBP model helps organizations:

• Standardize evidence implementation

• Improve interdisciplinary collaboration

• Allocate resources more effectively

• Reduce implementation errors

• Evaluate patient and organizational outcomes

• Sustain long-term quality improvement

These structured approaches significantly increase the likelihood of successful organizational change.

Why the Iowa Model Is the Preferred Evidence-Based Practice Framework

Among the available EBP frameworks, the Iowa Model of Evidence-Based Practice to Promote Quality Care has become one of the most widely adopted models in nursing and healthcare organizations.

Originally developed by Titler and colleagues (2002), the Iowa Model guides healthcare teams through identifying clinical problems, reviewing evidence, implementing practice changes, and evaluating outcomes.

Several characteristics make the Iowa Model particularly effective.

Organizational Change Focus

The Iowa Model is specifically designed to support healthcare organizations during clinical practice improvement initiatives. Rather than focusing solely on individual practitioners, it emphasizes system-wide change that aligns with organizational priorities.

Interdisciplinary Collaboration

Successful evidence implementation requires collaboration among multiple healthcare professionals. The Iowa Model promotes teamwork by involving nurses, physicians, administrators, educators, and support staff throughout the implementation process.

This collaborative approach is particularly beneficial in emergency departments, where patient care depends on coordinated efforts across multiple disciplines.

User-Friendly Design

The Iowa Model follows a logical algorithm with clearly defined decision points and feedback loops. Its structured design makes it accessible even for healthcare professionals with limited experience in evidence-based practice.

Pilot Testing Before Full Implementation

One of the model’s greatest strengths is its emphasis on pilot testing. Organizations can evaluate new clinical processes on a small scale before implementing them across the entire healthcare system, reducing risks and improving adoption rates.

Applying the Iowa Model to Improve Emergency Department Patient Flow

Emergency department overcrowding remains a significant challenge worldwide. Long waiting times, delayed physician assessment, and extended patient stays negatively affect both patient outcomes and staff efficiency.

The Iowa Model provides a structured process for implementing an evidence-based triage system that improves patient flow.

Step 1: Identify the Clinical Priority

The process begins by determining whether the issue represents an organizational priority.

Emergency department crowding clearly meets this criterion because it affects:

• Patient safety

• Treatment delays

• Staff workload

• Hospital efficiency

• Patient satisfaction

Once identified as a priority, an interdisciplinary implementation team is established.

Step 2: Build an Interdisciplinary Team

Effective implementation requires participation from professionals directly involved in emergency care.

A typical team may include:

• Emergency nurses

• Nurse managers

• Nurse educators

• Emergency physicians

• Nurse practitioners

• Patient registration staff

• Nursing assistants

• Hospital administrators

Research consistently shows that change initiatives are more successful when frontline healthcare professionals actively participate in planning and implementation (Doody & Doody, 2011).

Step 3: Search for the Best Available Evidence

The implementation team conducts a comprehensive literature review to identify:

• Systematic reviews

• Clinical practice guidelines

• Randomized controlled trials

• Quality improvement studies

• Professional organization recommendations

Healthcare databases and emergency medicine organizations provide substantial evidence regarding triage systems and patient flow improvement strategies.

Step 4: Critically Appraise the Evidence

After collecting relevant literature, the team evaluates:

• Study quality

• Strength of evidence

• Clinical relevance

• Consistency of findings

• Applicability to the organization

When team members lack experience in evidence appraisal, consultation with librarians, nurse researchers, or EBP specialists is recommended.

Step 5: Determine Whether Evidence Is Sufficient

The Iowa Model requires organizations to decide whether enough high-quality evidence exists to support practice change.

If sufficient evidence is available, implementation proceeds.

If evidence remains limited, organizations may:

• Use expert consensus

• Apply scientific theory

• Review case studies

• Conduct additional research

This decision point prevents organizations from implementing unsupported interventions.

Step 6: Pilot the New Triage Process

Before organization-wide adoption, the proposed triage system is tested on a limited scale.

Important activities during the pilot include:

• Establishing measurable outcomes

• Collecting baseline performance data

• Developing standardized clinical protocols

• Training healthcare staff

• Testing the process over a defined period

• Comparing outcomes before and after implementation

Potential outcome measures include:

• Emergency department length of stay

• Time to physician assessment

• Patients leaving without being seen

• Patient satisfaction scores

• Staff workflow efficiency

Step 7: Evaluate Results and Refine the Process

Following the pilot, the implementation team compares post-intervention outcomes with baseline measurements.

If the intervention improves patient flow and quality indicators, the organization can expand implementation. If challenges remain, protocols are revised before broader adoption.

This continuous evaluation process is one of the Iowa Model’s defining strengths.

Benefits of Using the Iowa Model in Emergency Departments

Healthcare organizations using the Iowa Model for emergency department improvement can achieve several benefits, including:

• Faster patient assessment

• Reduced emergency department overcrowding

• Improved interdisciplinary communication

• Better use of healthcare resources

• Evidence-informed clinical decision-making

• Higher quality patient care

• Increased staff engagement

• Sustainable quality improvement initiatives

Key Takeaways

Evidence-based practice is essential for delivering safe, effective, and cost-efficient healthcare. However, successful implementation requires more than access to research—it requires a structured framework that guides organizational change.

The Iowa Model offers a practical, systematic approach that helps healthcare organizations identify clinical priorities, evaluate research, implement evidence-based interventions, and measure outcomes. Its emphasis on collaboration, pilot testing, and continuous evaluation makes it particularly effective for improving emergency department triage processes and patient flow.

Healthcare organizations seeking sustainable quality improvement can use the Iowa Model to bridge the gap between research evidence and everyday clinical practice.

Evidence consistently demonstrates that structured EBP models improve implementation success by providing clear decision pathways, interdisciplinary collaboration, and continuous evaluation of outcomes (Schaffer et al., 2013).

Research indicates that emergency department crowding contributes to treatment delays, longer patient stays, and reduced healthcare efficiency, making evidence-based triage systems an important organizational priority (Bernstein et al., 2009; Bellow & Gillespie, 2014).

Frequently Asked Questions

What is the Iowa Model of Evidence-Based Practice?

The Iowa Model is a structured framework that helps healthcare organizations translate research evidence into clinical practice through problem identification, evidence appraisal, pilot testing, implementation, and outcome evaluation.

Why is the Iowa Model widely used in nursing?

Nurses prefer the Iowa Model because it is practical, interdisciplinary, easy to follow, and supports organizational change through evidence-based decision-making.

How does the Iowa Model improve emergency department patient flow?

The model guides healthcare teams in evaluating evidence, testing new triage systems, measuring performance indicators, and refining processes to reduce delays and improve efficiency.

What are the main barriers to implementing evidence-based practice?

Common barriers include limited time, inadequate education, lack of leadership support, insufficient funding, poor access to research, and resistance to organizational change.

Why is pilot testing important in the Iowa Model?

Pilot testing allows healthcare organizations to evaluate new interventions on a small scale, identify potential issues, and refine processes before full implementation, reducing risks and improving long-term success.

References

Barish, R. A., McGaughey, P. L., & Arnold, T. C. (2012). Emergency room crowding: A marker of hospital health. Transactions of the American Clinical and Climatological Association, 123, 304–311. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540619/

Bellow, A. A., & Gillespie, G. L. (2014). The evolution of ED crowding. Journal of Emergency Nursing, 40(2), 153–160. https://doi.org/10.1016/j.jen.2013.01.013

Bernstein, S. L., Aronsky, D., Duszak, R., et al. (2009). The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1–10. https://doi.org/10.1111/j.1553-2712.2008.00295.x

Brown, C. G. (2014). The Iowa Model of evidence-based practice to promote quality care: An illustrated example in oncology nursing. Clinical Journal of Oncology Nursing, 18(2), 157–159. https://doi.org/10.1188/14.CJON.157-159

Doody, C. M., & Doody, O. (2011). Introducing evidence into practice: Using the Iowa Model. British Journal of Nursing, 20(11), 661–664. https://doi.org/10.12968/bjon.2011.20.11.661

Gawlinski, A., & Rutledge, D. (2008). Selecting a model for evidence-based practice changes: A practical approach. AACN Advanced Critical Care, 19(3), 291–300. https://doi.org/10.1097/01.AACN.0000330380.41766.63

NUR 598 Week 2 Evidence-Based Practice Model Selection

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press. https://nap.nationalacademies.org/catalog/10027/crossing-the-quality-chasm-a-new-health-system-for-the-21st-century

Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in U.S. nurses. Journal of Nursing Administration, 42(9), 410–417. https://doi.org/10.1097/NNA.0b013e3182664e0a

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence-based practice models for organizational change. Journal of Advanced Nursing, 69(5), 1197–1209. https://doi.org/10.1111/jan.12012

Titler, M. G., Kleiber, C., Steelman, V. J., et al. (2002). The Iowa Model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497–509. https://doi.org/10.1016/S0899-5885(18)30017-0

White, S., & Spruce, L. (2015). Perioperative nursing leaders implement clinical practice guidelines using the Iowa Model. AORN Journal, 102(1), 50–59. https://doi.org/10.1016/j.aorn.2015.04.001