Remote Collaboration and Evidence-Based Care

CRITERIA

NON-PERFORMANCE

BASIC

PROFICIENT

DISTINGUISHED

Propose your evidence-based care plan to improve the safety and outcomes for the Vila Health patient with a discussion of new content for the care plan.

Does not propose an evidence-based care plan to improve the safety and outcomes for the Vila Health patient.

Describes an evidence-based care plan, but the relevance to the Vila Health patient or how the plan would improve outcomes is absent or unclear.

Proposes your own evidence-based care plan to improve the safety and outcomes for the Vila Health patient with a discussion of new content for the care plan.

Proposes your evidence-based care plan to improve the safety and outcomes for the Vila Health patient with new content added. Notes areas in which further information or data could have been useful in developing the plan.

Explain the ways in which you used the specific evidence-based practice model to help develop the care plan, identifying what interventions would be necessary. This requires a particular evidence-based model, such as the Johns Hopkins, Iowa, Stetler, or other.

Does not explain the ways in which you used the specific evidence-based practice model to help develop the care plan, identifying what interventions would be necessary.

Identifies an EBP model and lists the ways in which you use the specific evidence-based practice model to help develop the care plan.

Explains the ways in which you used the specific evidence-based practice model to help develop your care plan, identifying what interventions would be necessary. Uses a particular evidence-based model, such as the Johns Hopkins, Iowa, Stetler, or other.

Explains the ways in which you used the specific evidence-based practice model to help develop your care plan. Notes ideas for how to evaluate the positive benefits to patient outcomes.

Reflect on which evidence you collected that was most relevant and useful when making decisions regarding the care plan.

Does not reflect on which evidence you collected that was most relevant and useful when making decisions regarding the care plan.

Lists which evidence you collected that was most relevant and useful when making decisions regarding the care plan.

Reflects on which evidence you collected that was most relevant and useful when making decisions regarding the care plan.

Reflects on which evidence you collected that was most relevant and useful when making decisions regarding the care plan. Discusses the rationale or criteria that was used to determine relevance and usefulness.

Identify benefits and propose strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

Does not identify benefits or propose strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

Identifies benefits or proposes strategies to mitigate the challenges, but not both, of interdisciplinary collaboration to plan care within the context of a remote team.

Identifies benefits and proposes strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

Identifies benefits and proposes strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team. Discusses how interdisciplinary collaboration could be better leveraged to improve outcomes in future care situations.

Communicate via video with clear sound and light, and include a narrative of video content.

Does not communicate professionally in a well-organized presentation and does not include a narrative of video content.

Does not communicate via video or video is difficult to hear and see, but does include a narrative of video content.

Communicates via video with clear sound and light and does include a narrative of video content.

Communicates via video with clear sound and light. Content delivery is focused, smooth, and well-rehearsed. Includes a narrative of the video. Video presentation is between 5 to 10 minutes.

Provide a full reference list that is relevant and evidence-based (published within five years), exhibiting nearly flawless adherence to APA format.

Does not provide a reference list of relevant and/or evidence-based sources (published within five years).

Provides reference list that is not relevant and/or evidence-based with several APA errors.

Provides a reference list that is relevant and evidence-based (published within five years) sources, exhibiting nearly flawless adherence to APA format.

The reference list is from relevant and evidence-based (published within five years) sources, exhibiting flawless adherence to APA format.

Model Definition

Essential Steps

Salient Points to Consider

Iowa Model of EBP ( Titler et al., 2001 ). The Iowa Model focuses on the entire healthcare system (e.g., patient, practitioner, infrastructure) to implement and guide practice decisions based on best available research and evidence.

1. Identify either a “problem-focused trigger” or “knowledge-focused trigger” that will generate the need for a practice change.

2. Determine whether the “trigger” is a healthcare organization priority.

3. Reflect a team’s topic of interest and include interested stakeholders. The team will search, appraise, and synthesize literature related to the topic.

4. Evaluate the availability and merit (e.g., level of evidence, quality of evidence) of evidence. If evidence availability and merit are lacking, conduct research.

5. If credible and reliable evidence is available, pilot the practice change.

6. Appraise pilot for level of success. If pilot is successful, disseminate findings within the organization and implement recommended change into practice.

· Recommended for use at organizational systems level

· Uses pragmatic problem-solving approach to EBP implementation

· Detailed flowchart (see  Chapter 11 ) guides decision-making process

· Clearly identified decision points and feedback loops throughout the model

· Emphasizes necessity of pilot project before initiating system-wide project

· Designed for interprofessional collaboration

· Has sustained test of time

Stetler Model ( Ciliska et al., 2011 ;  Stetler, 2001 ). The Stetler Model enables practitioners to assess how research findings and other pertinent evidence are implemented in clinical practice. The model examines how to use evidence to create change that fosters patient-centered care.

Steps in this model are referred to as phases. Phase I. Preparation: Identify a priority need. Identify the purpose of the EBP project, context in which the project will occur, and relevant sources of evidence. Phase II. Validation: Assess sources of evidence for level and overall quality. Determine whether source has merit and goodness of fit and whether to accept or reject the evidence in relation to project purpose. Phase III. Comparative Evaluation/Decision Making: Evidence findings are logically summarized and similarities and differences among sources of evidence are evaluated. Determine whether it is acceptable and feasible to apply summation of findings to practice. Phase IV. Translation/Application: Develop the “how to’s” for implementation of summarized findings. Identify practice implications that justify application of findings for change. Phase V. Evaluation: Identify expected outcomes of the project and determine whether the goals of EBP were successfully achieved.

· Designed to encourage critical thinking about the integration of research findings

· Promotes use of best evidence as an ongoing practice

· Helps lessen errors in critical decision-making activity

· Allows for categorization of evidence as external (e.g., research) or internal (e.g., organization outcome data)

· Emphasizes use by single practitioner but may include groups of practitioners or other stakeholders

Ottawa Model of Research Use ( Graham & Logan, 2004   Graham et al., 2006 ). The Ottawa Model is an interactive model that depicts research as a dynamic process of interconnected decisions made and actions taken by stakeholders.

The model is composed of three phases: (a) Assess barriers and supports. (b) Monitor intervention and extent of use. (c) Evaluate outcomes. Subsumed under the three phases are six designated primary elements that must be considered when integrating research into practice:

I. Assess barriers and supports:

1. Evidence-based innovation: Clearly identify what the innovation is and what the implementation will involve.

2. Potential adopters: Identify potential adopters with characteristics that could influence the adoption of the innovation (see Rogers’ Change Theory in  Chapter 7 ).

3. The practice environment: Identify leaders, formal and informal, who can inspire change. Assess environment for needed resources.

II. Monitor intervention and extent of use:

1. Implementation of intervention strategies: Select appropriate strategies to increase awareness of implementation and provide necessary education and training for conducting the implementation.

2. Adoption of innovation: Determine the extent of adoption of implementation.

III. Evaluate outcomes:

1. Evaluate the impact of innovation on patients, practitioners, stakeholders, and healthcare organization.

· Patients are central to the model’s process and their health outcomes are the primary focus.

· The model focuses on the unit-level environment instead of the entire healthcare organization.

· The prescriptive aim of the model is to assess, monitor, and evaluate.

Promoting Action on Research Implementation in Health Services (PARiHS) Framework ( Rycroft-Malone, 2004 ). The PARiHS Framework provides a method to implement research into practice by exploring the interactions among three key elements: (a) evidence, (b) context, and (c) facilitation.

1. Evidence: Search for and identify the best available evidence from research, clinician experience, patient values, organization data, and information.

2. Context: This is the local environment where the practice change will occur. Adoption of practice change is dependent on contextual features such as organizational culture and level of acceptance, leadership investment, and evaluation of desired outcomes.

3. Facilitation: Organizational participants use their knowledge and skills to foster implementation of practice change.

· Explicitly uses facilitation as a factor impacting integration of research findings into practice

· Does not address generation of new knowledge

· Focus is on unit settings more than system-wide environment

· Codified (e.g., research data) and noncodified (e.g., practitioner experience) sources of evidence used

ACE (Academic Center for Evidence-Based Practice) Star Model of Knowledge Transformation© ( Kring, 2008 ; Stevens, 2004). As a framework, the ACE Star Model aids in systematically integrating best evidence into practice. The model has five major stages that depict forms of knowledge in relative sequence. Research moves through the cycles to combine with other forms of knowledge before integration into practice occurs.

Five Stages:

1. Discovery: This stage involves searching for new knowledge found in traditional quantitative and qualitative methodologies.

2. Evidence Summary: The primary task is to synthesize the body of research knowledge into a meaningful statement of evidence for a given topic. This is a knowledge-generating stage, which occurs simultaneously with new findings that may arise from the synthesis.

3. Translation: The aim of translation is to provide clinicians with a practice document (e.g., clinical practice guideline) derived from the synthesis and summation of research findings.

4. Integration: Practitioner and healthcare organization practices are changed through formal and informal channels.

5. Evaluation: An array of EBP outcomes are evaluated on impact, quality, and satisfaction.

· Focus on promoting use of EBP for direct care nurses

· Includes use of qualitative evidence

· Primary goal of model is knowledge transformation

· Does not incorporate nonresearch evidence (patient values, practitioner’s experience)

· Identifies factors that impact adoption of innovation

Advancing Research and Clinical Practice Through Close Collaboration (ARCC) ( Melnyk & Fineout-Overholt, 2015 ).

1. Assess the healthcare organization for readiness for change and implantation of EBP project.

2. Identify potential and actual barriers to and facilitators of EBP project.

3. Identify EBP champions to work with direct care nurses or specific clinical units.

4. Implement evidence into practice.

5. Evaluate EBP outcomes.

· Promotes use of EBP among advanced practice nurses and direct care nurses

· Identifies a network of stakeholders who are supportive of the EBP project

· Cognitive behavioral theory underpinnings

· Emphasis on healthcare organizational readiness and identification of facilities and barriers

· Encompasses research, patient values, and clinical expertise as evidence.

Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) ( Newhouse, Dearholt, Poe, Pugh, & White, 2007 ). The JHNEBP Model applies a problem-solving approach to clinical decision making. The model is designed to meet the EBP needs of direct care nurses using an uncomplicated three-step process referred to as PET: (a) Practice Question, (b) Evidence, and (c) Translation.

1. Practice Question: Using a team approach, the EBP question is identified.

2. Evidence: The team searches, appraises, rates the strength of evidence, describes quality of evidence, and makes a practice recommendation on the strength of evidence.

3. Translation: In this stage, feasibility is determined, an action plan is created, and change is implemented and evaluated. Findings are presented to the healthcare organization and broader nursing community.

· Emphasizes individual use

· Well-developed tool kit that provides nurses with guide for question development, evidence-rating scale, and appraisal guide for various forms of evidence

Knowledge-to-Action (KTA) Process Framework ( Graham et al., 2006 ). The KTA is a model of knowledge creation and knowledge integration.

Phases:

1. Identify problems that need to be addressed and begin searching for evidence and research about the identified problem.

2. Adapt the knowledge use to a local context.

3. Identify barriers to use of knowledge.

4. Select, adapt, and implement interventions.

5. Monitor the use of implanted knowledge.

6. Evaluate outcomes related to knowledge use.

7. Sustain appropriate knowledge use.

· Adapts well for use with individuals, teams, and healthcare organizations

· Is grounded in planned action theory, which makes the model adaptable to a variety of settings

· Breaks knowledge-to-action process into manageable sections.