Updating the Stetler Model of research utilization to facilitate evidence-based practice.

The evidence-based practice movement raises questions about the continuing viability of research utilization models. This manuscript describes the updated, practitioner-oriented Stetler Model. First developed in 1976 with Marram, it was refined in 1994 with conceptual underpinnings and a set of assumptions. The model has been further refined on the basis of a related utilization-focused integrative review methodology, targeted evidence concepts, and continuing experience through use of the model with clinical nurse specialists. The revised model continues to focus on a series of judgmental activities about the appropriateness, desirability, feasibility, and manner of using research findings in an individual's or group's practice.

Developing an evidence-based procedure: maintenance of central venous catheters.

This article describes the creation of an evidence-based guideline as part of a learning experience of a group of clinical nurse specialists. The guideline was the product of a utilization-focused integrated review of the literature conducted with the guidance of a nurse researcher. Key aspects of the evidence-based recommendations, as well as factors that facilitated or hindered this effort, are shared.

Physical and emotional patient safety. A different look at nursing-sensitive outcomes.

Data on nursing-sensitive outcomes, beyond traditional isolated indicators such as pressure ulcers, are often unavailable for nurses to evaluate the overall quality of their care. This article describes a quality improvement effort to provide nurses with both a positive and a negative patient outcomes score. The approach can make visible the often invisible role of nurses in the growing field of patient safety.

Integration of evidence into practice and the change process: fall prevention program as a model.

A Fall Prevention Program was initiated at an acute care academic medical center grounded on a dynamic evidence-based framework. Multiple sources of evidence were collected and integrated to engage clinical managers and staff in an evolving process designed to both reduce falls and enhance evidence-based thinking. Clinical practice now is based more frequently on evidence rather than ritual, unsystematic clinical experiences, or tradition. This article provides details on this replicable method of enhancing professional practice.

Evidence-based practice and the role of nursing leadership.

A new term, evidence-based practice, is beginning to appear both in the healthcare literature and at professional, conferences. Its meaning, however, is not always clear, nor is its full implication for nurse administrators explained. This article provides a pragmatic definition of evidence-based practice developed in the nursing division at Baystate Medical Center, Springfield, Massachusetts. It outlines steps required to institutionalize evidence as a routine part of nursing practice and provide examples of its use.

Utilization-focused evaluation of acute care nurse practitioner role.

Using nurse practitioners in acute care is a relatively new phenomenon with little existing data on related expectations and effectiveness. This article describes one organization's program evaluation of the Advanced Practice Registered Nurse (APRN) role. It includes a conceptual model as well as pragmatic data on: perception of the performance of agreed-upon role expectations, influence on targeted aspects of care, retention of a focus on nursing, and factors facilitating or hindering APRN effectiveness.

Impact of organizational redesign.

Little in-depth objective information is available about the outcomes of restructuring or reengineering. One reason for this is the difficulty of conducting traditional research within the context of dynamic organizational development activities. The authors describe an alternative program evaluation approach that proved successful for assessing and enhancing large-scale organizational change in an acute-care medical center. Sample results are presented and recommendations made for increasing an evaluation's usefulness by tailoring reports to the user.

Enhancing research utilization by clinical nurse specialists.

A research utilization forum for clinical nurse specialists was initiated in the early 1990s in two service settings. The primary purpose of this voluntary, small-group strategy was to help master's-prepared clinicians gain knowledge and skills regarding the systematic use of research findings. This article describes the forum strategy and its conceptual base. It also reviews outcomes related to program objectives, utilization competencies, and case reports of subsequent clinical nurse specialist research utilization behavior.

Patient-centered redesign. More collaborative clinical input into capital budget decisions.

As part of a restructuring program at a large, acute care hospital, a new, collaborative form of clinical management called triads has been initiated. Members of these collaborative management teams are being collectively empowered to better enable them to establish a continuously improving, cost-effective clinical service. This article describes the impact of this new structure on the capital budgeting process in changing a centralized, committee-based system of decision making with limited clinical nursing input to one that is increasingly decentralized, interdisciplinary, and focused on patients.

Strategic considerations in developing a delivery model.

Nurse executives must challenge basic assumptions about their organizations and help create visions that are feasible and applicable to the institutions' realities. Evaluative criteria and the relationship of the nurse executive to a reality-based model of care are vital to this goal.

Research utilization among clinical nurse specialists.

The purpose of this descriptive study was to explore utilization behavior of clinical nurse specialists (CNSs) relative to research-based information as distinguished from nonresearch-based information. A nontraditional conceptualization of knowledge utilization as encompassing both cognitive and instrumental application was employed. Twenty-four CNSs were interviewed in a field survey. Results indicated that subjects most frequently use findings conceptually; while on occasion, as illustrated in case examples, they reported using research both conceptually and instrumentally. Only half of the subjects, however, could list explicit criteria for evaluation of the applicability of findings to practice. What is most striking in this study's findings is its congruence with results from other research conducted on various, nonnursing populations.

A strategy for teaching research use.

Research use is a frequent theme in the literature, but few strategies facilitate nurses' education in this area. The Stetler/Marram model, a practitioner-oriented perspective on use, has been converted into a series of questions that guide the learner through a conceptual and decision-making process. These guidelines can be used through one of a number of related assignments.

A staff education consortium: one model for collaboration.

This article describes the development of a staff education consortium consisting of five large medical center hospitals. The major reasons for the existence of the Consortium are collaboration for the purpose of mutual sharing, reduction in duplication, and cost containment of educational programming. The development, organization, activities, problems and future of this Consortium are discussed.