NURS 716 Week 4 Discussion Board Forum 2 on Choosing an Evidence-Based Practice Model Example

Discussion Board Forum 2: Models for Implementing Evidence-Based Practice

NURS 716 Applications of Evidence-Based Care, Discussion Board Forum 2

Thread by [Student Name]

The surgical department and the people replied to are composites written for a model discussion.

When our surgical services department agreed to tackle pressure injuries in long operations, someone asked which evidence-based practice model we would use, and the room went quiet. Most of us knew the names of several models but had never chosen one. Working through this week's reading, I have come to think the question should be asked differently. The useful question is not which model is best, but what our organization lacks. A model supplies structure for whatever is missing.

The revised Iowa Model is built around a sequence of steps and decision points: identifying a trigger, stating a purpose, judging the topic's priority, assembling the people who will do the work, assembling and synthesizing evidence, deciding whether the evidence is sufficient, piloting the change, deciding whether to adopt it, integrating and sustaining it, and disseminating results (Iowa Model Collaborative, 2017). Its strength is decision-making: it tells a team when to stop, when to pilot and when to spread. A 2026 project in Taiwan shows the model guiding a perioperative change. Tsai et al. (2026) used the Iowa Model to implement a safety protocol for managing postoperative thirst and evaluated it in 15,168 surgical patients using propensity score matching; mean thirst scores fell from 5.76 to 1.30, and although pain and recovery unit length of stay rose slightly, the changes were clinically marginal.

The ARCC model, described in our textbook by its developer, takes a different starting point. It emphasizes evidence-based practice mentors who build nurses' beliefs in their ability to use evidence and an organizational culture that supports it, on the premise that beliefs and culture drive implementation (Melnyk & Fineout-Overholt, 2015). A 2026 report describes a shared governance council at an academic medical center that used the ARCC model and the seven steps of evidence-based practice to carry out a year-long fall prevention initiative, with council members mentored by evidence-based practice experts as they developed a question, searched, appraised and synthesized evidence, leading to practice and policy change and high nurse engagement (Chignolli et al., 2026).

For our pressure injury project, I would choose the Iowa Model as the framework, because our department has motivated nurses but no process for deciding, piloting and adopting a change, which is exactly where we stalled before. But I would borrow ARCC's central idea and recruit two perioperative nurses as evidence-based practice mentors, because without nurses who believe they can lead change, the Iowa steps would be carried out by the project leader alone and would fade when the project ended. A model is a scaffold; the question is which part of the building is missing. Jesus spoke of the wise builder who digs deep and lays a foundation on rock (English Standard Version Bible, 2001/2016, Luke 6:48), and choosing a model with care is part of building a practice change that lasts.

Reply to the Instructor

Dr. Morgan, you asked whether the Iowa Model has been used for pressure injury prevention specifically. It has, and a pediatric project offers a useful parallel to the operating room. Saltzman et al. (2026) used the revised Iowa Model with an interprofessional team to develop a unit-specific bundle preventing pressure injuries from noninvasive ventilation masks in a pediatric intensive care unit, after finding that two-thirds of stage 2 or greater health care-associated pressure injuries on the unit were facial injuries from those masks. They tracked process measures, including staff knowledge, attitudes and behaviors, alongside injury outcomes. That design matches the Iowa Model's emphasis on piloting with both process and outcome data before deciding to adopt (Iowa Model Collaborative, 2017). For our project, it suggests measuring whether dressings were applied correctly in each case, not only whether injuries fell, since a disappointing result could reflect poor adherence rather than an ineffective dressing. It also reminds me that device-related injuries deserve their own attention, and that the project's audit should include a quick check under every positioning device at the end of surgery; just as masks caused most injuries in that unit, positioning devices and monitoring equipment may cause more of ours than we realize.

Reply to Danielle

Danielle, you chose the ARCC model for your medication reconciliation project because your hospital already has strong leadership support, and you suggested mentors are the missing piece. I agree, and there is evidence that investing in mentored programs pays off. Shever-Doletzky et al. (2026) evaluated a practicing nurse evidence-based practice fellowship for registered nurses and advanced practice nurses, describing its direct and indirect costs, the retention of fellows, the dissemination of their projects, applications for advanced degrees and the program's influence on the organization's evidence-based practice culture, with each project linked to the Quintuple Aim. That is close to the mentor-and-culture logic that Melnyk and Fineout-Overholt (2015) describe for ARCC. One question for your plan: who will mentor the mentors? A fellowship gave nurses in that program protected time and expert guidance. If your mentors are staff nurses without protected time, the ARCC structure may exist on paper but not in practice. The fellowship evaluation also tracked retention, which could help you make a business case: mentors who feel invested in may be less likely to leave. Could you propose a small fellowship for two mentors as part of your project?

Reply to Kevin

Kevin, you argued that shared governance councils are the best vehicle for evidence-based practice because they give nurses ownership. I think you are right, and two recent projects show councils using different models with good results. In one, a paranesthesia unit practice council used the Iowa Model to implement a standardized protocol of 20 minutes of preoperative forced-air warming for gynecologic surgery patients, comparing a post-implementation group of 30 patients with a historical group of 19 (Atwood et al., 2026). In another, a council used the ARCC model and mentoring to change fall prevention policy (Chignolli et al., 2026). The common element is not the model but the council: nurses who own the problem, meet regularly and have authority to change practice. The small samples in the warming project are a reminder that councils may need help with evaluation design, which is a natural role for a DNP-prepared nurse. Councils also change membership every year or two, so a project that depends on one council's energy needs a plan for handing it on. Does your council have access to someone who can help design its measures before the project starts rather than after?

References

Atwood, B., Romito, K., Garcia, J., Bernaola, M., & Kessinger, S. (2026). The impact of shared governance: Implementing preoperative warming to improve postanesthesia outcomes among gynecological patients. Journal of PeriAnesthesia Nursing. Advance online publication. https://doi.org/10.1016/j.jopan.2026.08.009

Chignolli, H., Frank-Scott, C., Gibson, J., Ring, L., Stromberg, K., & Zellefrow, C. (2026). Empowering nurses through shared governance: A council-led evidence-based initiative driving practice and policy advancement. Worldviews on Evidence-Based Nursing, 23(4), Article e70147. https://doi.org/10.1111/wvn.70147

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

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

Saltzman, B., Fayram, L., Houston, M., & Laures, E. (2026). Reducing pressure injuries due to noninvasive ventilation masks in the pediatric intensive care unit: An interprofessional approach. Critical Care Nurse, 46(3), 57-64. https://doi.org/10.4037/ccn2026322

Shever-Doletzky, L. L., Edick, P., Tschannen, D. J., Taylor, N., & Wenzel, L. (2026). The impacts of a practicing nurse evidence-based practice fellowship program on clinicians, patients, culture, and cost. Worldviews on Evidence-Based Nursing, 23(3), Article e70144. https://doi.org/10.1111/wvn.70144

Tsai, H. Y., Wang, M. L., Yeh, Y. C., Chao, A., & Hsiao, W. L. (2026). Implementing a safety protocol for thirst management to improve postoperative thirst using the Iowa Model of Evidence-Based Practice: A propensity score-matched evaluation. Journal of Clinical Nursing, 35(9), 3857-3866. https://doi.org/10.1111/jocn.70377