Simplifying the EBP Process:
An example of the Iowa Model
Evidence-based care is the cornerstone for optimizing health performance and evidence-based practice (EBP) frameworks are an effective and efficient tool to demystify and guide the process of translating research into practice. Many EBP frameworks have been developed to serve as a guide to promote successful and sustainable changes within an organization. At Duke, the Iowa model guides EBP efforts within the organization, and this blog will walk through how to use the Iowa model for your EBP project.
The Iowa Model is most notable for its use of “triggers” to initiate an EBP inquiry. These triggers can be problem-focused or new-knowledge focused. The example below identifies both a problem-focused trigger (healthcare providers are experiencing alarming rates of burnout and compassion fatigue) and a new-knowledge-focused trigger (storytelling can help promote resiliency in the healthcare setting).
These triggers initiate the EBP process and a PICO question should be formulated. The nurse must then determine if the topic is a priority for the organization and in alignment with its strategic goals. If so, the next step is to form a team and assemble, appraise, and synthesize the body of evidence. The following questions should be addressed prior to changing practice:
1. Is there sufficient evidence to change practice?
2. Are the findings consistent across studies?
3. Are the type and quality of findings sufficient?
4. Is there clinical relevance?
5. Are these findings appropriate for your patient population?
6. Is the clinical change feasible?
7. Is there an appropriate risk-benefit ratio to make the practice change?
If you determine that the evidence does support a practice change, it will then be time for you to design and pilot the change. The Iowa model is unique in that it emphasizes the use of pilot testing prior to full-scale change implementation. Pilot testing will allow the team to refine the intervention or process to ensure successful and sustainable translation. Once the change has been integrated into the organization, it is important to disseminate the results.
