MAKALAH MODEL - MODEL EVIDANCE BASED PRACTICE

Disusun Untuk Memenuhi Tugas Mata Kuliah

DOSEN PENGAMPU :

Dr. Finta Isti Kundarti, M.Keb

DISUSUN OLEH :

Nama : Elok Islyonasari (P17321235004)

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN KEMENKES MALANG

PROGRAM STUDI KEBIDANAN

SARJANA TERAPAN KEBIDANAN KEDIRI

TAHUN 2023/2024
 DAFTAR ISI

DAFTAR ISI……………………………………………………………………. i

MODEL-MODEL EVIDANCE BASED PRACTICE……………………….. 1

1. IOWA MODEL……………………………………………………………….. 1
2. STETLER MODEL…………………………………………………………… 2
3. ACE STAR MODEL………………………………………………………….. 3
4. JOHNS HOPKINS MODEL………………………………………………….. 6
5. ROSSWURM DAN LARRABEES MODEL………………………………… 7
6. EVIDENCE BASED PRACTICE MODEL FOR STUFF NURSE…………… 8

DAFTAR PUSTAKA…………………………………………………………… 10

I
 MODEL-MODEL EVIDANCE BASED PRACTICE

1. Iowa Model
The lowa Model of Evidence-Based Practice to Promote Quality Care. The Io
wa model of evidence-based practice to promote quality care (Titler, Kleiber, Steelma
n, et al., 2001) provides guidance for nurses and other clinicians in making decisions a
bout day- to-day practices that affect patient outcomes. The Iowa model (Figure 11.3)
outlines a pragmatic multiphase change process with feedback loops. The original mo
del has been revised and updated (Titler, Kleiber, Steelman, et al., 1994; Titler et al., 2
001). The model is based on the problem-solving steps in the scientific process and is
widely recognized for its applicability and ease of use by multidisciplinary healthcare
teams.
Using the lowa Model. The Iowa model begins by encouraging clinicians to identi
fy practice questions or "triggers" either through identification of a clinical problem or
from new knowledge. Important triggers often come from questioning current practice
Problem-focused triggers will often have existing data that highlight an opportunity f
or improvement. Knowledge-focused triggers come from dis- seminated scientific kno
wledge (e.g., national guidelines, new research) leading practitioners to question curre
nt practice standards.
Staff nurses identify important and clinically relevant practice questions that can
be addressed through the EBP process. A number of clinically important topics have b
een addressed using the Iowa model, including enteral feedings (Bowman, Greiner, D
oerschug, et al., 2005), sedation management (Cullen, Greiner, Greiner, et al., 2005),
verification of nasogastric tube placement (Farrington, Lang, Cullen, et al., 2009), bo
wel sounds assessment after abdominal surgery (Madsen, Sebolt, Cullen, et al., 2005),
double gloving in the operating room (Stebral & Steelman, 2006), transfer of pediatric
patients out of critical care (Van Waning, Kleiber, & Frey- enberger, 2005), and drawi
ng blood samples from umbilical artery catheters (Gordon, Bartruff, Gordon, et al., 20
08). Administrative topics also have been addressed using the Iowa model (Stenger,
Montgomery, & Briesemeister, 2007).

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 Iowa Model adalah model yang sangat sering digunakan dalam meningkatkan pel
ayanan kesehatan karena berfokus pada kesuluruhan sistem perawatan kesehatan (mis
alnya pasien, praktisi, infrastruktur) untuk menerapkan dan memandu keputusan prakt
ik berdasarkan penelitian dan bukti terbaik yang tersedia. Ciri khas dari model Iowa a
dalah adanya konsep “triggers’’ dalam pelaksanaan EBP.
Triggers merupakan sebuah masalah klinis maupun informasi yang berasal dari l
uar organisasi. Ada 3 kunci dalam membuat sebuah keputusan antara lain adanya pen
yebab mendasar timbulnya sebuah masalah atau pengetahuan terkait dengan kebijaka
n-kebijakan institusi atau organisasi, penelitian yang cukup kuat, dan pertimbangan m
engenai kemungkinan diterapkannya perubahan ke dalam praktek sehingga dalam mo
del tidak semua jenis masalah dapat diangkat dan menjadi topik prioritas organisasi.

2. Stetler Model
The Stetler Model of Evidence-Based Practice. The original Stetler/Marram m
odel for RU was published in 1976 to fill a void regarding the realistic application of r
esearch findings to practice (Stetler & Marram, 1976). The original model has underg
one three revisions in order to provide a conceptual framework and strengthen its und
erpinnings, integrate emerging concepts of EBP, and clarify and highlight critical con
cepts (Stetler, 1994a, 2001a, 2001b, in press). The core foci of all revisions were and
continue to be critical thinking and a primary concern with use of research findings.

Overview of the Stetler Model, Stetler Model adalah model yang tidak berorien
tasi pada perubahan formal tetapi pada perubahan individu tenaga kesehatan. Model i
ni dapat dijadikan sebagai panduan perseptor dalam mendidik bidang yang baru karen
a dapat menyusun masalah berdasarkan data internal (quality improvement dan operas
ional) dan data eksternal yang bersal dari penelitian.
Model ini membantu praktisi untuk menilai bagaimana temuan penelitian dan
bukti relevan lainnya dapat diterapkan dalam praktik. Model ini mengkaji terkait baga
imana praktii individu dapat menggunakan penelitian secara informal ebagai bagian d
ari pemikiran kritis dan praktik reflektif. Model ini menghubungkan penggunaan pene
litian, sebagai langkah pertama dengan praktik berdasarkan bukti.

Stetler Model (Ciliska et al., 2011; Stetler, 2001). The Stetler Model enables prac
titioners to assess how research findings and other pertinent evidence are implemented

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 in clinical practice. The model examines how to use evidence to create change that fos
ters patient-centered care.
Essentials Steps (Steps in this model are referred to as phases) :

 Phase I. Preparation: Identify a priority need. Identify the purpose of the EBP proj
ect, the context in which the project will occur, and relevant sources of evidence.
 Phase II. Validation: Assess sources of evidence for level and overall quality. Det
ermine whether the source has merit and goodness of fit and whether to accept or re
ject the evidence in relation to the project purpose.
 Phase III. Comparative Evaluation/Decision Making: Evidence findings are logic
ally summarized and similarities and differences among sources of evidence are ev
aluated. Determine whether it is acceptable and feasible to apply summation of find
ings to practice.
 Phase IV. Translation/Application: Develop the “how to’s” for implementation of
summarized findings. Identify practice implications that justify application of findi
ngs for change.
 Phase V. Evaluation: Identify expected outcomes of the project and determine wh
ether the goals of EBP were successfully achieved.

Salient Points to Consider:

 Designed to encourage critical thinking about the integration of research findings

 Promotes use of best evidence as an ongoing practice
 Helps lessen errors in critical decision-making activity
 Allows for categorization of evidence as external (e.g., research) or internal (e.g.,
organization outcome data)
 Emphasizes use by single practitioner but may include groups of practitioners or
other stakeholders

3. Ace Star Model

Ace Star Model merupakan model transformasi pengetahuan berdasarkan researc
h dan memiliki 5 tahapan utama yang menggambarkan bentuk pengetahuan dalam uru
tan relative. Model ini disarankan dapat digunakan oleh mahasiswa ungraduate dikare
nakan model dengan proses yang lebih sederhana dan sama dengan proses kebidanan.
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 The Star Model depicts various forms of knowledge in a relative sequence, as
research evidence is moved through several cycles, combined with other knowledge
and integrated into practice. The ACE Star Model provides a framework
for systematically putting evidence-based practice processes into operation.
Configured as a simple 5-point star, the model illustrates five major stages of
knowledge transformation: 1) discovery research, 2) evidence summary, 3) translation
to guidelines, 4) practice integration, and 5) process, outcome evaluation. Evidence-
based processes and methods vary from one point on the Star Model to the next.

THE ACE STAR MODEL STAGES

Star Point 1. Discovery Research
This is a knowledge generating stage. In this stage, new knowledge is discovered
through the traditional research methodologies and scientific inquiry. Research results
are generated through the conduct of a single study. This may be called a primary
research study and research designs range from descriptive to correlational to causal;
and from randomized control trials to qualitative. This stage builds the corpus
ofresearch about clinical actions.

Star Point 2. Evidence Summary

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Evidence summary is the first unique step in EBP the task is to synthesize the corpus
of research knowledge into a single, meaningful statement of the state of the science.
The most advanced EBP methods to date are those used to develop evidence
summaries (i.e., evidence synthesis, systematicreviews, e.g., the systematic
review methods outlined in the Cochrane Handbook) from randomized control trials.
Some evidence summaries employ more rigorous methods than others, yielding more
credible and reproducible results.

Star Point 3. Translation to Guidelines

The transformation of evidence summaries into actual practice requires two stages:
translation of evidence into practice recommendations and integration into practice.
The aim of translation is to provide a useful and relevant package of summarized
evidence to clinicians and clients in a form that suits the time, cost, and care standard.
Recommendations are generically termed clinical practice guidelines (CPGs) and may
be represented or embedded in care standards, clinical pathways, protocols, and
algorithms.

Star Point 4. Practoces Integration

Integration is perhaps the most familiar stage in healthcare because of society's long-
standing expectation that healthcare be based on most current knowledge, thus,
requiring implementation of innovations. This step involves changing both individual
and organizational practices through formal and informal channels. Major aspects
addressed in this stage are factors that affect individual and organizational rate of
adoption of innovation and factors that affect integration of the change into
sustainable systems.

Star Point 5. Process, Outcome Evaluation

The final stage in knowledge transformation is evaluation. In EBP, a broad array of
endpoints andoutcomes are evaluated. These include evaluation of the impact of EBP
on patient health outcomes,provider and patient satisfaction, efficacy, efficiency,
economic analysis, and health status impact.As new knowledge is transformed
through the five stages, the final outcome is evidence-based qualityimprovement of
health care.

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4. John Hopkins Model

The Johns Hopkins Evidence-Based Practice model for Nurses and

Healthcare Professionals is a powerful problem-solving approach to clinical
decision-making and is accompanied by user-friendly tools to guide individuals
or groups through the EBP process. Feedback from a wide variety of end-users,
both clinical and academic, inform the continued development and improvement
of the Johns Hopkins EBP model. The most recent revision highlights EBP as an
interprofessional activity to enhance team collaboration and patient care
coordination. As with previous editions, our goal remains constant: - to build
capacity among front-line users to identify best practices and incorporate them
into the everyday care we provide our patients.

John Hopkins Model adalah model yang menerapkan pendekatan

pemecahan masalah untuk pengambilan keputusan klinis sehingga model ini
sangat disarankan untuk mahasiswa sarjana dan master karena model ini
mempunyai 3 domain prioritas masalah yaitu praktek, penelitian dan pendidikan.
Dalam pelaksanaannya model ini terdapat beberapa tahapan yaitu : (Amelia &
Rosyidah, 2020)

a. Practice question yaitu menggunakan pendekatan tim, pertanyaan EBP diid

entifikasi.
b. Evidence yaitu tim mencari, menilai, kekuatan bukti, menjelaskan kualitas b
ukti, dan membuat rekomendasi praktik berdasarkan kekuatan bukti.

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 c. Transalation yaitu penentuan kelayakan, rencana aksi dibuat, dan perubaha
n diterapkan dan dievaluasi. Temuan disajikan kepada organisasi perawatan
kesehatan dan komunikasi keperawatan yang lebih luas.

5. Rosswurm dan Larrabees Model

Rosswurm dan Larrabees Model yaitu model yang menjelaskan bahwa pe
nerapan Evidence Based Nursing ke lahan praktek harus memperhatikan latar
belakang teori yang ada, kevalidan dan kereliabilitiasan metode yang digunaka
n, serta penggunaan nomenklatur yang standar. Model ini disebut juga dengan
model Evidence Based Practice Change yang terdiri dari 6 langkah yaitu :
a. Mengkaji kebutuhan untuk perubahan praktis
b. Menentukan evidence terbaik
c. Kritikal analisis evidence
d. Design perubahan dalam praktek
e. Implementasi dan evaluasi perubahan
f. Mengintegrasikan dan maintain perubahan dalam praktek

Gambar 5.1 6 Langkah Model Evidenced Based Practice Change

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6. Evidence Based Practice Model For Stuff Nurse
It is a method by which practitioners across the healthcare professions
review and assess the most current, highest-quality research to inform their del
ivery of care. Although there is no precise standard for what constitutes eviden
ce-based practice in nursing, the approach consists of three main components a
nd five basic steps.

1. Best external evidence: Evaluate and implement the most current, clinic
ally relevant, and scientifically sound research. (See next section about ty
pes of research used.)
2. Individual clinical expertise: Draw on your personal experience of wha
t has worked and not worked in your clinical practice.
3. Patient values and expectations: Consider and value the preferences of
your individual patients.

According to the Cleveland Clinic, there are five steps in the process of i
mplementing evidence based medicine practice. Also known as the “five A’s o
f evidence based practice” in health science, these steps include:

1. Ask: Formulate answerable clinical questions about a patient, problem, in

tervention, or outcome.
2. Acquire: Search for relevant evidence to answer questions.
3. Appraise: Determine whether or not the evidence is high-quality and val
uable.
4. Apply: Make clinical decisions utilizing the best available evidence.
5. Assess: Evaluate the outcome of applying the evidence to the patient’s sit
uation. Some healthcare organizations choose to add a sixth step, “dissem
inate,” to the cycle.

Evidence Based Practice Model For Stuff Nurse adalah pengunaan bukti
eksternal, bukti internal (clinical expertise), serta manfaat dan keinginan pasie
n untuk mendukung pengambilan keputusan dipelayanan kesehatan. Evidence
Based Nursing Practice ialah pendekatan sistematis untuk meningkatkan kualit
as praktik keperawatan dengan mengumpulkan bukti terbaik dalam pengambil

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an keputusan praktik yangtelah menjadi tuntunan pada tatanan rumah sakit. (M
ituhu et al., 2021) (Amelia & Rosyidah, 2020)

DAFTAR PUSTAKA

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Stetler, C. (2001). Memperbarui model pemanfaatan penelitian Stetler untuk memfasilitasi pr
aktik berbasis bukti. Outlook Keperawatan, 49, 272-279. DOI: 10.1067/mno.2001.120517

Putradana, Agus. (2016). Konsep Evidence Based Practice. Magister Keperawatan. Universi
tas Diponegoro.

Amelia, P., & Rosyidah, R. (2020). EVIDENCE BASED MIDWIFERY (Rinata (ed.)).

Mituhu, A. P., Dwiantoro, L., & Kristina, T. N. (2021). Pengembangan Sistem Aplikasi Onlin
e untuk Penerapan Evidence Based Nursing Practice. Jurnal Kepemimpinan Dan Manajeme
n Keperawatan, 4(1). https://doi.org/10.32584/jkmk.v4i1.839

Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic

Center for Evidence-based Practice. The University of Texas Health Science Center at San
Antonio.

Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidenc
e-based practice for nurses and healthcare professionals: Model and guidelines. 4th ed. Sigm
a Theta Tau International

Bernadette Mazurek Melnyk et al., “Evidence-Based Practice: Step by Step: The Seven Steps
of Evidence-Based Practice,” The American Journal of Nursing, Jan. 2010: https://journal
s.lww.com/ajnonline/Fulltext/2010/01000/Evidence_Based_Practice__Step_by_Step__The
_Seven.30.aspx

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