EBP Models/SWOT Analysis

Evidence Based Practice

By Joseph Chamness

Multiple Choice

Which of the following is NOT a component of evidence-based practice?

• Clinical Expertise

• Personal Opinions

• Best External Evidence

• Patient Preference

EBP is a lifelong, problem-solving approach that integrates the best external evidence, clinical expertise, and patient preferences to improve healthcare outcomes.

EBP = Experts, Best research, and Patient preferences – because we don't just medical decisions!

Multiple Choice

What is one reason EBP models are necessary?

• They make implementing EBP easier by providing structure

• They replace clinical judgment

• They guarantee perfect patient outcomes

• They eliminate the need for research

EBP Models

• EBP models provide a structured way to implement change in healthcare settings, overcoming barriers like lack of motivation and leadership support.

• “Without a model, EBP is like trying to assemble IKEA furniture without the instructions... chaotic and likely dangerous!”

Multiple Choice

What makes EBP different from research utilization?

• It only uses clinical expertise

• It includes multiple sources of evidence

• It relies on intuition

• It only applies to nurses

​Research Utilization

• Research utilization is about applying findings from a single study, while EBP incorporates multiple sources of evidence.

• Research utilization is like trusting one Yelp review. EBP is like reading 100 reviews, checking ratings, and asking your foodie friend for advice.

Steps of EBP

• Identifying problems, reviewing evidence, implementing changes, and evaluating results.

• Think of EBP steps like baking cookies:

  1. Find the recipe (Identify problem)

  2. Gather ingredients (Review evidence)

  3. Bake the cookies (Implement change)

  4. Taste test (Evaluate results)”

Iowa Model Steps

1. Identify a Trigger

   • Can be a problem-focused trigger (e.g., an increase in postoperative infections) or a knowledge-focused trigger (e.g., new research or guidelines).

2. Determine if the Topic is a Priority

   • Check alignment with organizational goals; if it’s a top concern, proceed.

3. Form an Interprofessional Team

   • Involve stakeholders who are directly affected and can champion the change.

4. Assemble, Appraise, and Synthesize Evidence

   • Gather relevant research; assess quality (best evidence) and applicability.

Iowa Model Steps

5. Decide if There is Sufficient Evidence

• If yes, move forward with a practice change; if no, consider conducting more research.

6. Pilot the Practice Change

• Implement on a small scale, track outcomes.

7. Evaluate and Roll Out

• Evaluate results, refine as needed, then expand organization-wide.

8. Disseminate Results

• Share findings to sustain changes and encourage ongoing improvement.

ARCC Model

1. Assess Organizational Readiness

   • Evaluate culture, leadership support, and readiness for EBP changes.

2. Identify and Train EBP Mentors

   • Mentors become “EBP champions,” guiding others through the process.

3. Implement EBP Projects Using a Chosen Framework

   • ARCC doesn’t dictate one specific project framework; you pick a project process (e.g., Iowa Model or Johns Hopkins) but rely on mentors to smooth adoption

ARCC Model

4. Address Barriers & Leverage Facilitators

• Mentors help remove practical, cultural, or educational obstacles.

5. Evaluate Outcomes

• Measure patient, staff, and system outcomes (e.g., reduced infections, increased satisfaction).

6. Sustain the Change

• Continued mentorship and leadership support to make EBP the “norm.”

The Johns Hopkins Model

1. Practice Question

   • Identify the problem or gap in practice.

   • Form an interprofessional team.

   • Define the scope and objectives of the inquiry.

2. Evidence

   • Search for internal (organizational data) and external evidence (research articles).

   • Appraise quality of research.

   • Summarize the evidence to determine best practices.

3. Translation

   • Adapt the findings for the local context.

   • Implement the practice change.

   • Evaluate outcomes and disseminate results.

EBP Models

• Iowa Model:

  • Focus: Stepwise, feedback loops, strong emphasis on identifying triggers and ongoing evaluation.

  • Use It If: You want a well-established, structured approach that explicitly ties in organizational priorities and has clear decision points (e.g., “Is this a priority? Do we have enough evidence?”).

• ARCC Model:

  • Focus: Changing organizational culture via EBP mentors; strategic approach to removing barriers.

  • Use It If: Your biggest challenge is staff buy-in or if you need mentorship roles to drive EBP changes.

• Johns Hopkins Model:

  • Focus: The PET process (Practice Question, Evidence, Translation), especially easy to use at the bedside.

  • Use It If: You want a bedside-friendly tool that clearly outlines how to move from identifying a clinical question to implementing solutions.

SWOT Analysis

​SCOT Analysis

SCOT stands for Strengths, Weakness, Opportunities, and Threats – a powerful tool for strategic planning and decision-making.

Think of SWOT like a superhero briefing:

• Strengths = Superpowers

• Weakness = Kryptonite

• Opportunities = Doors Ready to Be Opened

• Threats = Villains or Obstacles"

​SCOT Analysis

Main Point:

• Strengths & Weaknesses = Internal factors (within your organization or team’s control)

• Opportunities & Threats = External factors (outside forces you react to)

SW = Stuff We own, OT = Outside Things.

​SCOT Analysis

• Main Point:

  • Strengths: Talents, resources, or assets that help you succeed.

  • Weaknesses: Limitations or gaps that can hinder success.

• Fun Way To Remember:

  • Strengths: “What makes you stand out?”

  • Weaknesses: “Where could the wheels fall off?”

​Strengths & Weaknesses (Internal)

• Main Point:

  • Strengths: Talents, resources, or assets that help you succeed.

  • Weaknesses: Limitations or gaps that can hinder success.

• Fun Way To Remember:

  • Strengths: “What makes you stand out?”

  • Weaknesses: “Where could the wheels fall off?”

Opportunities & Threats (External)

• Opportunities: Favorable external conditions you could leverage.

• Threats: Potential challenges or risks outside your immediate control.

• Fun Way To Remember:

  • Opportunities: “Doors you can open”

  • Threats: “Dark clouds that could rain on your parade”

SWOT Analysis

• Main Point:

  • Offers a clear snapshot of where you stand and where you can go.

  • Helps you build on strengths and reduce weaknesses.

  • Lets you seize opportunities and neutralize threats.

• Fun Way To Remember: “SWOT is your GPS for planning: it shows you the best route and the roadblocks ahead.

Multiple Choice

A hospital wants to implement an EBP initiative but is struggling with staff resistance. What would be the best first step based on EBP models?

• Mandate all staff follow the new EBP approach immediately

• Identify key stakeholders and involve them in discussions

• Replace all staff who resist change

• Skip straight to implementation

Multiple Choice

A nurse wants to implement a new protocol but finds conflicting evidence. According to EBP models, what should be done?

• Use the study that supports the nurse’s opinion

• Choose the study with the largest sample size

• Synthesize the evidence from multiple high-quality studies

• Ignore research and rely on clinical intuition

Multiple Choice

A nurse leader using the Iowa Model is in the evaluation phase. What should they focus on?

• Whether stakeholders feel like the change was fair

• Finding another research study to implement immediately

• Patient outcomes and staff adherence to the new practice

• How many nurses participated in training

Multiple Choice

Which scenario best represents the ARCC Model in action?

• A nurse makes a change without consulting anyone

• An EBP mentor helps guide staff through implementing an intervention

• A hospital bans outdated research from practice

• A doctor forces staff to follow EBP without feedback

Multiple Choice

A hospital implements an EBP intervention, but adoption is low. What is the BEST action according to EBP models?

• Identify barriers and adjust strategies to improve adoption

• Abandon the change altogether

• Ignore the issue and move on

• Punish staff who refuse to comply

Multiple Choice

Which of the following is an example of a Strength in a project team?

• A new competitor entering the market

• Decreasing budget for the department

• Strict government regulations

• Skilled team members in relevant areas

Multiple Choice

Which step should you take FIRST when applying a SWOT to your project?

• Identify external threats

• Create a marketing campaign

• Identify internal factors

• Identify Threats