Chapter 1 of Evidence-Based Practice in Action, published by Sigma, discusses the first step in the Iowa Model—identification of triggering issues or opportunities for improvement.
High-quality healthcare for patients and families, as well as clinicians, demands a culture of inquiry and continuous improvement. This mindset leads to identification of many practice questions that can be addressed through evidence-based practice (EBP). EBP is the process of shared decision-making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996; Sigma Theta Tau International 2005–2007 Research and Scholarship Advisory Committee [STTI], 2008).
Point-of-care clinicians are in a key position to ask and answer clinical questions to promote quality and safety. Shared governance committee members and organizational leaders also generate clinical or operational questions (Cullen, Wagner, Matthews, & Farrington, 2017). Identifying a question initiates or triggers the EBP process (Iowa Model Collaborative, 2017). Questioning practice creates a culture of inquiry and is the foundation to developing a learning healthcare system (Wilson, Sleutel et al., 2015). Identifying triggering issues or opportunities for improvement is the first step in the Iowa Model and EBP process, which is described in the remaining chapters.
The triggering issue or opportunity for improvement may be generated in a variety of ways. Potential sources are:
- Clinical or patient identified issue
- Organization, state, or national initiative
- Data or new evidence
- Accrediting agency requirements or regulations
- Philosophy of care
Click here to read the rest of Chapter 1 from Evidence-Based Practice in Action: Comprehensive Strategies, Tools, and Tips From the University of Iowa Hospitals and Clinics in the Virginia Henderson Global Nursing e-Repository of Sigma Theta Tau International Honor Society of Nursing (Sigma).
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Laura Cullen, DNP, RN, FAAN, is an evidence-based practice scientist at University of Iowa (UI) Hospitals and Clinics.
Kirsten Hanrahan, DNP, ARNP, CPNP-PC, is interim director of nursing research, evidence-based practice, and quality at UI Hospitals and Clinics and a pediatric nurse practitioner.
Michele Farrington, BSN, RN, CPHON, is a clinical healthcare research associate at UI Hospitals and Clinics.
Sharon Tucker, PhD, RN, PMHCNS-BC, FAAN, is the Grayce Sills endowed professor in psychiatric-mental health nursing and director of the Translational Research Core of the new Helene Fuld Health Trust National Institute for Evidence-Based Practice at The Ohio State University College of Nursing.
Charmaine Kleiber, PhD, RN, FAAN, is an associate research scientist at UI Hospitals and Clinics and associate professor emeritus at UI College of Nursing.