Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

358 Unit 3 / Steps 4 and 5: Moving From Evidence to Sustainable Practice Change

The ARCC© Model

Potential Strengths

• Philosophy of EBP (paradigm is system-wide) • A Critical Mass of EBP Mentors • Administrator/Leader Support • Culture supportive of EBP

Job Satisfaction Group Cohesion Intent to Leave Turnover

EBP knowledge* Beliefs about the Value of EBP and Ability to Implement the EBP Process*

Assessment of Organizational Culture and Readiness for EBP*

Decreased Healthcare System Costs

Identification of Strengths and Major

Use of EBP Mentors; Perceived EBP Mentorship*

EBP Competency* + and Implementation* +

Barriers to EBP Implementation

Implementation of ARCC Strategies, including Interactive EBP Education and Skills Building

Potential Barriers • Lack of EBP Mentors • Inadequate EBP Knowledge & Skills in Clinicians • Low Clinician Beliefs about the Value of EBP & the Ability to Implement it

Improved Healthcare Quality, Safety and Patient Outcomes

* Scale Developed + Based on the EBP paradigm and using the EBP process

© Melnyk & Fineout-Overholt 2005; Revised, 2017; Revised 2021 ARCC © = Advanced Research & Clinical practice through close Collaboration

Workshops EBP Journal Clubs EBP Change Projects

Figure 9.1: The advancing research and clinical practice through close collaboration (ARCC) model.

skills-building program. This program has been shown to signi cantly improve EBP attributes (beliefs, knowledge, and implementation) and competencies over time, up to 12 months after program completion (Gallagher-Ford et al., 2020). Mentors also assess and monitor outcomes of EBP changes. Findings from many studies have supported that when the ARCC model (Fig. 9.2) is implemented in healthcare systems, clinicians’ knowledge and beliefs about the value of EBP and their ability to implement it increase, which is associated with greater competency and implementation of evidence-based care and improved outcomes, both for patients and clinicians (Gorsuch et al., 2020; Levin et al., 2011; Melnyk et al., 2017; Wallen et al., 2010). Organizations can mix models as well. For instance, an organization could select the ARCC model as their organizational system-wide model to sustain EBP and select the Iowa Model as their EBP process model. The critical point is organizations that are serious about EBP need to adopt both an organizational model and an EBP process model unless they are using the ARCC model, which covers both dimensions. Implementation Toolkits and Resources There are a variety of methods available to address EBP implementation and sustainment barriers, which began emerging from the literature in the 1980s. Ultimately, this work led to the development of IS in the 1990s. Speci cally, toolkits were developed as a key strategy to assist in implementation of EBP in healthcare settings. The term “toolkit” was de ned as a bundle of interventions, such as checklists, educational and auditing materials, and implementation guidelines, used to facilitate practice change (Barac et al., 2014; Oster et al.,

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