The Iowa Model of Evidenced Based Practice to Promote Qualit

Reflection

Provides Intuitive Guidelines for implementing EBP change.

Personally, I found this model easy to understand. Also, a with a similar PICOT question used this model with success.

Implementation of a practice change can be difficult. I was pleased when I found the White and Spruce (2015) article, as it provided many implementation strategies to build support among key stakeholders and the organizational system.

What I enjoyed most about this project, is that I learned one of the many ways clinicians can lead the way in implementation of best practice, and continue to decrease the gap between research and practice.

The Iowa Model of Evidenced Based Practice to Promote Quality Care applied to the use of CO2 for insufflation during colonoscopy

References

McCommons, R., Wheeler, M., & Houston, S. (2016). Colonoscopy Comfort: An Evidence-Based Practice Project. Gastroenterology Nursing: The Official Journal Of The Society Of Gastroenterology Nurses And Associates, 39(3), 212-215. doi:10.1097/SGA.0000000000000213

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. (3rd ed.). Philidelphia, PA: Wolters Kluwer

White, Shawna, and Lisa Spruce. 2015. "Perioperative Nursing Leaders Implement Clinical Practice Guidelines Using the Iowa Model of Evidence-Based Practice 1.3." AORN Journal 102, no. 1: 50-59. CINAHL with Full Text, EBSCOhost (accessed July 11, 2017).

Problem Focused "triggers"

Knowledge Focused Triggers

• Often stem from new research or national guidelines that leads to the questioning of the current standard of practice.

• Often top-down change

Data may demonstrate an opportunity for improvement....

Data sources: risk management, benchmarking, financial, risk management

Or it could simply stem from the identification of a clinical problem.

(Melnyk &neout-Overholt, 2015)

(Melnyk & Fineout-Overholt, 2015).

Ex: Application of the Model

Key Components

An Evidence-Based Practice Project on colonoscopy comfort conducted by McCommons, Wheeler, and Houston (2016).

Iowa Model Background

1. Develop Clinical Question: from problem or knowledge focused triggers.

Iowa Model Guided Project Development

Disseminate Results & Continue to Evaluate

2. Form a Team

Made up of stakeholders: nurses, doctors, unit managers, etc.

Study developed from knowledge focused trigger, leading to the questioning of current practice standards :

Emerging literature demonstrating that carbon dioxide insufflation decreases postoperative flatus and discomfort (McCommons et al., 2016).

• A clinical decision making tool based on problem-solving steps in the scientific process.
• Begins by identifying an area to improve care based on evidence, can be problem-focused or knowledge focused
• Benefits: easy to use, multiphase change process with feedback loops
• Has been reviewed & updated

4. Conduct Research/Develop Practice Change

3. Literature Review

... if the practice change is in alignment with organizational goals and is supported by the literature

Evaluate the existing evidence for the practice change.

Applying the Iowa Model to my PICOT Question

(Melnyk & Fineout-Overholt, 2015).

PICOT Question

"In the general adult population undergoing colonoscopy, how does carbon dioxide (CO2) insufflation affect postoperative pain when compared to air insufflation?" (McCommons et al., 2016, p. 313).

Team Members

My Question: In patients undergoing a screening colonoscopy, what is the effect of the use of CO2 versus room air for insufflation on post-operative pain and patient satisfaction?

• Staff nurses, surgeons, nurse manager, advance practice registered nurse (APRN), surgical technicians, surgical services director.

Another example: How Perioperative nurse leaders can use the Iowa Model to apply best evidence into clinical practice using the Iowa Model (White & Spruce, 2015).

How I would use the Model

Organizational Approach

Steps Completed by the study

This article gives a detailed example on how to use the Iowa model as a framework for a pilot study on surgical site infections.

I would apply the Iowa Model to my research question in a similar fashion to the McCommons et al., (2016) study. Application of this framework would facilitate generation of data to validate a recent practice change on my unit from the use of room air to CO2 for insufflation.

Ex: My team members would include: the endoscopy department chair, unit manager, unit education committee, surgical services director, recovery room nurses, and patients

Taking an organizational approach, and involving interdisciplinary stakeholders will theoretically build wider support for the practice change. This will be helpful in building support for the change on a larger scale, since there are no existing practice guidelines specifically on the use of CO2 for insufflation during colonoscopy in the United States.

Study Details

• Form a team
• Critique evidence
• Based on evidence decided to make a practice change
• Implementation of practice change
• Evaluate outcomes

• CO2 machinery donated by manufacturer.
• Education of all staff by vendor on CO2 equipment.
• Conducted randomized trials using analog scale to evaluate post-operative pain after using O2 or CO2.
• 8 month trial of practice change with pre and post data evaluation.
• Findings were consistent with literature, patients experienced less post-operative discomfort and flatus in the CO2 group.
• Findings were disseminated to all employees.

Implementation Strategies (White & Spruce, 2015)

Based on Iowa Model's Implementation Guide

(McCommons et al., 2016)

Promote integration and sustained use of practice change

Create awareness & interest across the organization

Ex: report to senior leaders

Ex: staff meeting

Build knowledge & commitment regarding practice change

Promote action & adoption of practice change

Ex: pocket guides

Ex: change champion