DQ: Review the different models and frameworks that can be used to facilitate change

DQ: Review the different models and frameworks that can be used to facilitate change

Upon comparing the Stetler Model and Johns Hopkins Model, the Stetler Model has been regularly revised, and involves integrating evidence-base practice information into practical, sustainable day to day standards for patient care. With critical thinking and utilization of both internal and external evidence to support practice change, the Stetler Model hinges on five phases, and multiple steps to identify and support use of evidence, determined by critical thinking (Melnyk & Fineout-Overholt, 2019). A “toolkit” of sorts has been developed to implement consensus guidelines and evidence-base practice change. Upon comparison, the Johns Hopkins Model supports its use by bedside registered nurses with aim to implement research results in an evidence-based practice format. The key objective is to make it easy for direct caregivers to make change at a grass-roots level, while positively impacting patient outcomes in a meaningful way. A problem-solving approach to address clinical questions, the 18-step process allows for non-randomized control trial designed evaluations and quality improvement initiatives to take place(Melnyk & Fineout-Overholt, 2019).. With mindfulness that registered nurses encounter challenges that require a fix “tomorrow”, with potential use of nonresearch evidence by use of four pathways.

For my PICOT with aim to reduce occurrence of CLABSIs in patients with a central line, I believe either model could be used to implement meaningful change. However, the Stetler model is better suited for a randomized control trial approach, which is the method I believe to be best suited to gain the most sound, valid and reliable results. By way of using critical thinking and various types of evidence (internal AND external), the Stetler model allows for easy implementation of evidence gathered by way of a toolkit and use of consensus guidelines and policy change.

References

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer. ISBN-13:9781496384539

The Iowa Model for Evidence-based practice (IMEBP) implementation has been used effectively to implement hundreds of evidence-based research projects as it provides direction through decision points for priority, resources, amount of supporting evidence, research designing, piloting then integration and sustaining (Buckwater, Cullen, Hanrahan, Kleiber, McCarthy, Rakel, Steelman, Tripp & Tycker, 2017). This model thoroughly considers the creation and lifespan of implementation of EBP which is why it can commonly be seen and used in a research setting (Buckwater et al., 2017). Compared to the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBPM), there is similarity in the process of implementing and evaluating EBP research. The JHNEBPM however is more specific in applying to the nursing perspective as well as increasing the understanding that an initial exploratory inquiry is a separate step from the PET (practice question, evidence, translation) process (Melnyk & Fineout-Overholt, 2018). This model appears more organized for clinical decision making for EBP in nursing as it can be similar to the nursing process in both clinical and research settings.

It is more appropriate to use the JHNEBPM as a framework to my EBP research project as the goal is to provide change in education from nursing to a population. Since the model provides more considerations for critical thinking, more health outcomes or more types of education can be produced to achieve research goals (Melnyk & Fineout-Overholt, 2018).

Upon reviewing the different frameworks and models for organizational change two were identified that are helpful to my EBP project. The first one is Lewin’s Change Management Model. This model is referred to as the 3-Stage Model of Change, which are Unfreeze-Change-Refreeze. In other words, 1) unfreeze is the stage in which there is an understanding that a change is needed, 2) Change is when the process of initiating the change starts, and finally, 3) refreeze is when the change is fully established and put into the organization’s daily practices (Barrow et al., 2023). Considered by many a very effective framework model.

The second framework is the ADKAR Change Management Model. This model is a bottom-up model that Jeffrey Hiatt created. This model focuses on the people behind the change (“10 Proven Change Management Models (2023),” 2022). In this model, each letter represents a goal that the organizations must reach. 1) A-awareness of the need to change, 2) D-desire to participate in and support the change, 3) K-knowledge of how to change, 4) A-ability to implement required skills and behaviors for the chan