Module 6: Building and Sustaining an Evidence-Based Practice Clinical Environment
Original Discussion Question:
Describe components of a clinical based decision-making model impacted by clinical
expertise and explain how clinical expertise informs evidence-based practice.
Posted by Daniel Kim,
One evidence-based practice model that employs the use of clinical expertise is the
Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, which aids in
transforming evidence into clinical, educational, and administrative practices that is useful for
nurses, especially at the bedside. The goal of this practice model was to improve the
independence, leadership, and collaboration of nurses with multidisciplinary teams (Melnyk,
et. al., 2015). The components of the JHNEBP model include the “conceptual model, a
process, and tools to guide nurses through the critical steps of the process” (Melnyk, et. al.,
2015). The model makes use of internal and external evidence and fosters and supports
critical thinking. Some factors influencing nursing care are internal factors like organizational
culture, environment, equipment and supplies, staffing, and standards and external factors like
accreditation, legislation, quality measures, regulations, and standards. Nursing care which
integrates education, practice, and research includes at its core different types of research such
as experimental, quasi-experimental, non-experimental, and qualitative studies, and non-
research such as organizational experience (including quality improvement and financial
data), clinical expertise, and patient preference.
The JHNEBP employs the practice question-evidence-translation (PET) method. The
practice question phase is composed of five steps: 1.) Recruiting an interdisciplinary team, 2.)
Developing and refining the evidence-based practice (EBP) question, 3.) Defining the scope
of the EBP questions and identify the invested parties, 4.) Assign responsibilities for project
leadership, and 5.) Arrange team meetings. The evidence phase is composed of five steps: 6.)
Seeking internal and external evidence, 7.) Evaluate the quality of the evidence, 8.) sum up all
the evidence, 9.) Determine quality of evidence, and 10.) Advise on what changes are needed
based on established evidence. The translation phase involves: 11.) Determining fitness,
feasibility, and appropriateness of recommendations for translation path, 12.) Developing a
plan of action, 13.) Locking down backing and resources to put the plan into action, 14.)
Executing the plan of action, 15.) Evaluation of results, 16.) Communicate results to invested
parties, 17.) Determine the next set of plans, and 18.) Spread the news of the results.
Due to the nature of the nursing profession and practices, it is not always feasible to
conduct randomized control trials so clinical or bedside nurses rely on surveys that employ
rating scales to inform researchers of strength of evidence. Scala, et. al. (2016) describe
utilization of the JHNEBP model for their study on what it takes to get clinical nurses to
engage more in research because the model “provides a systematic approach to identify,
appraise, and synthesize the evidence” (Scala, et. al., 2016). Clinical expertise is an important
and valuable part of the body of internal evidence that clinicians use to inform critical
decision-making and should always be included in any nursing or healthcare investigation that
involve a human component. Without humanism, healthcare becomes an assembly line or
factory work with considerations only focusing on inputs and outputs which does not apply to
a social service of which healthcare is considered.
Posted by Amebille Gilay,
This discussion will explain the components of a clinically based decision-making model that
is impacted by clinical expertise. Then will explain clinical expertise informs evidence-based
practice (EBP).
Clinical decision making is a practice that encompasses knowledge-focused with
different pathological conditions, categorical patient information, and experimental by either
nursing or on medical practice. Clinical expertise refers to a person or group of clinicians who
accumulated experience in such areas, with extensive education and clinical skills. The EBP is
integrated with clinical expertise. The best-collected evidence is usually created from
clinically relevant research done and conducted methodologically (The Griffith University,
n.d.).
Describe components of a clinical based decision-making model impacted by clinical
expertise.
The components of the decision-making model as it relates to clinical which gives
patient values and professional medical and clinical expertise. EBP is used to integrate the
best research with combinations of clinical expertise and clinical skills. It will help more
clinicians gain experience and be educated over time (Melnyk & Fineout-Overholt, 2015).
Clinical expertise is vital because it involves clinical decisions in “examining, critiquing, and
synthesizing” any available research data, considering science along (Ginex, 2018).
One of the evidence-based practice models to promote quality care is the Iowa model.
This model has been reviewed and revised to increase clinical decision-making and EBP to
process from both clinicians and system perspectives (The University of Iowa Hospital and
Clinics, 2017). The model is based on problem-solving steps that will scientifically help and
guide nurses and other clinicians. The model typically begins by encouraging clinicians to
pinpoint practice questions, called “triggers.” Problem-solving “triggers” are derived from
scientific knowledge such as; national guidelines and other new research leading clinical
experts to question specific practice standards.
The Iowa model has clinical applications that will help clinical expertise and nurses to
recognize significant and relevant practice questions to address through the EBP process.
Critical issues are addressed well following regulatory standards such as; falls, pain, or using
a urinary catheter by using EBP (Melnyk & Fineout-Overholt, 2015).
Clinical experts said that EBP changes need to be ongoing to evaluate with
incorporated information to improve the programs and promote the integration of practice in
nursing daily care. By following a basic-problem approach scientific process, many nurses
and healthcare organizations will attest that the Iowa Model is applicable in clinical-based
decision-making into clinical practice (Melnyk & Fineout-Overholt, 2015).
Explain how clinical expertise informs evidence-based practice.
Health care clinical expertise informs their clinical practice by referring to the best
EBP available, depending on the type of clinical questions finding “risk, diagnosis,
treatments, prevention, and more,” in such experts going through different studies, cohorts, or
trials at the highest level. Clinical knowledge of expertise, patient values, and the most
valuable research findings are included in all decision-making by healthcare providers or
clinicians (Melnyk & Fineout-Overholt, 2015) Expert Solution Preview
Module 6: Building and Sustaining an Evidence-Based Practice Clinical
Environment
Reply to Daniel Kim
Hi Daniel, that was great input on the usage of John Hopkins Nursing Evidence-Based Practice
(JHNEBP) Model in practice. I also find the model striking because it simpler and more
organized compared to other EBP models, which makes it easy to adopt within multidisciplinary
teams. For instance, the model relies on a three step procedure that include practice question,
evidence, and translation. The practice question is the question that can be used to explain the
problem that the model aims at solving and is suitably a PICO(T) type. The evidence is obtained
through literature review and this evidence is translated into practice by adopting it into practice.
However, I believe that a model such as the Iowa EBP model is more superior because it opens
an opportunity for including other clinical team members in synthesizing and critiquing evidence
before accepting it (Speroni et al., 2020), which is lacking in the JHNEBP model. Hence,
however simple JHNEBP model seems, the Iowa model will open more opportunities for strong
evidence development.
Reference
Speroni, K. G., McLaughlin, M. K., & Friesen, M. A. (2020). Use of Evidence‐based practice
models and research findings in Magnet‐Designated hospitals across the United States:
national survey results. Worldviews on Evidence‐Based Nursing, 17(2), 98-107.
https://doi.org/10.1111/wvn.12428
Reply to Amebille Gilay
Hello Amebille, you have put up some great argument about the suitability of the Iowa EBP
model. I share the same sentiments as yours because the Iowa EBP model is more effective in
applying evidence into practice, which makes it my favorite EBP model. The model is rigorous
in its steps and it opens many opportunities for making the chosen evidence stronger than those
of other models. For instance, the model allows the selection of a clinical team that handles the
EBP process, which means that expertise from different clinical backgrounds are involved in
creating the change process (Speroni et al., 2020). Furthermore, the process involves
synthesizing and critiquing evidence, which helps in determining the strength and level of
evidence found in the chosen data (Speroni et al., 2020). The multistep process makes the Iowa
model deliver stronger evidence for change in practice making it effective than other EBP
models. Therefore, I believe that the Iowa model stands a better chance of delivering changes in
practice that are sustainable and long lasting due to their strengths.
Reference
Speroni, K. G., McLaughlin, M. K., & Friesen, M. A. (2020). Use of Evidence‐based practice
models and research findings in Magnet‐Designated hospitals across the United States:
national survey results. Worldviews on Evidence‐Based Nursing, 17(2), 98-107.
https://doi.org/10.1111/wvn.12428
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