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357 Chapter 9 / Key Strategies for Implementing Evidence in Real-World Clinical Settings

their EBP skills and competence. It promotes the use of EBP tools (i.e., establishment of a PICOT question, searching the evidence, ranking the evidence, and understanding how the literature can inform and in uence the clinicians’ practice and the environments) in which care is delivered. Adding EBP components into existing structures and processes does not always have to require nancial resources. Many times, what is available can be used and ampli ed. Doing so ultimately strengthens the EBP foundation and allows it to ourish. Organizational Infrastructure and Resources to Support Implementation of EBP An Organizational Model for EBP Implementation There are several models of EBP in the literature, and although each have unique attributes, there are essential tenets that run through all of them (see Chapter 14). Every EBP model includes at least the following: clinical inquiry; writing a searchable question; compre hensive searching for evidence; critical appraisal of evidence; synthesis of the current best evidence; rendering EBP change recommendations; integrating the evidence with clinician expertise and patient preference and values; implementing change; evaluating, measuring, and sustaining outcomes; and disseminating results. The availability of so many EBP models and frameworks should be a great accelerator for uptake of EBP as any organization can look for a model or framework that is the best t for them. Research has demonstrated that when organizations use a model or framework to underpin their EBP journey, it is far more likely that the results of evidence-based care will be actual ized, patient care and outcomes will be improved, and the workforce will be healthier (Gorsuch et al., 2020). Among the EBP models, there are two types of models: (1) EBP process models that focus on the speci c steps of EBP (e.g., Iowa Model [Iowa Model Collaborative et al., 2017] and the Johns Hopkins Model [Dang & Dearholt, 2017]), and (2) organizational models that focus on system-wide implementation of EBP (e.g., the ARCC model and the Integrated Promoting Action on Research Implementation in Health Services model [Harvey & Kitson, 2016; Kitson & Harvey, 2016]). It is helpful for organizations to select both an organizational model and a process model in order to ensure success in their EBP journey. The organizational model serves as the roadmap and guide for creating an evidence-based enterprise and the process model serves as the roadmap and guide for conducting EBP work and implementing EBP projects and initiatives. The ARCC model (Fig. 9.1) is one of the three most frequently used organizational frameworks for EBP (Speroni et al., 2020). ARCC was created in 1999 to integrate research with clinical practice within an academic medical center to ultimately improve healthcare quality and safety, population health outcomes, and costs (Melnyk & Fineout-Overholt, 2019, 2002). Early in the model’s development, research with advanced practice nurses and point-of-care nurses identi ed several barriers and facilitators to evidence-based care, includ ing mentorship in EBP, which emerged as a critical facilitator in the ARCC model (Tucker et al., 2021). The ARCC model includes an EBP process model within it (the seven steps of EBP) and, as such, can serve as a model that targets both the EBP process and system-wide implementation.

The initial step in the ARCC model is an organizational assessment of culture and readiness for EBP. Facilitators and barriers to EBP are identi ed with a plan to overcome the barriers and leverage the strengths. A critical mass of EBP mentors who work with point-of- care clinicians on the implementation of evidence-based care in hospitals and healthcare systems is then developed. These mentors acquire expanded knowledge and skills in EBP as well as how to foster strong cultures that support it through an intensive 5-day educational Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.