Faculty of Nursing Zagazig University

Master Degree

Models of
Implementation in
Nursing

Under supervision of

Prof Dr. Fathia Attia

Prepared by

Eman Nasser Elsayed

Dina Sabber
Raghda Mohammed
Outlines:

1. Introduction

2. The Role of Implementation Models in Nursing

3. Different Models of Implementation in Nursing Practice

4. Benefits of Using Implementation Models in Nursing

5. Challenges in Implementing Nursing Models

6. The Impact of Implementation Models on Patient Care

7. References
1. Introduction
In the field of nursing,
Implementation: refers to the process of putting evidence-based practices
into action to improve patient outcomes and enhance the quality of care.
Due to implementing new practices in a healthcare setting can be complex
so that implementation models come into play.
Implementation models provide a structured framework and guide for
nurses and healthcare professionals to effectively implement evidence-
based practices and interventions.
These models help ensure that new practices are successfully integrated
into clinical settings and lead to positive outcomes for patients.
Model versus theory
Model: is a human construct to help us better understand real world
system, it is used to verify a theory, and model is trivially true.
Theory: is an explanation of natural world that can incorporate laws,
hypotheses, and facts, it is used for proving points
It is testable and can be refined or rejected.
2. The Role of Implementation Models in Nursing
Implementation models play a crucial role in nursing practice by providing
a systematic approach to implementing evidence-based practices and
interventions. Here are some key roles of implementation models in
nursing:
a) Guiding Practice: Implementation models provide a structured
framework for nurses to follow when implementing new practices or
interventions.
b) Identifying Barriers and Facilitators: Implementation models help with
understanding the factors that may hinder or support implementation,
nurses can develop strategies to overcome challenges and enhance the
likelihood of success.
c) Tailoring Interventions: Implementation models emphasize the
importance of tailoring interventions to fit the specific context and needs
of the healthcare setting. Nurses can use these models to ensure that
interventions are feasible and effective.
d) Enhancing Patient Outcomes: By following implementation models,
nurses can effectively implement evidence-based practices and
interventions, ; best practices are consistently applied, leading to
improved patient outcomes; resulting in higher quality care and better
patient experiences and satisfaction.
Criteria for selection of appropriate model
1. Applicability
2. Validity
3. Value and ethics
4. Cost &types
5. time

3. Different Models of Implementation in Nursing Practice

In the field of nursing, implementing evidence-based practices and

interventions is crucial for providing high-quality care and improving
patient outcomes. Various models have been developed to guide the
implementation process in nursing practice. Let's explore some of the
different models commonly used:

1. The Iowa Model of Evidence-Based Practice to Promote Quality Care:

This model provides a systematic approach to implementing evidence-
based practice in nursing.
It involves six steps:
(1) Identification of a problem or opportunity
(2) Assemble; appraise and synthesize body of evidence
(3) Development of an implementation plan
(4) Implementation
(5) Evaluation
(6) Dissemination of results.
 The Iowa Model emphasizes the importance of integrating research
evidence, clinical expertise, and patient preferences in decision-making.
2. The Ottawa Model of Research Use (OMRU) is a conceptual model of
health research use derived from planned action theories, research
utilization, and physician behavior change literature. The model consists of
several key components, including:

a. Practice Environment: This component focuses on the environment

in which research is being used, encompassing factors such as
patients, cultural and social influences, structural elements,
economic considerations, and uncontrolled events
b. Potential Adopters: This component involves assessing the
individuals or groups who may adopt the research findings. It
includes subcomponents such as awareness, attitudes,
knowledge/skill, concerns, and current practice
c. Evidence-Based Innovations: This component involves the
assessment of evidence-based innovations, including their
development process and innovation attributes
d. Implementation of Interventions: This component encompasses the
strategies and actions taken to implement research findings,
including barrier management and transfer
e. Adoption: This component focuses on the degree of adoption of
research findings and the effectiveness of the intervention strategies

3. The Promoting Action on Research Implementation in Health Services

(PARIHS) model is a conceptual framework that posits key, interacting
elements that influence successful implementation of evidence-based
practices (EBPs) in healthcare settings. The key components of the PARIHS
model include:

a. Evidence: This component encompasses research evidence, clinical

experience, patient experience, and local knowledge. It ranges from
weak anecdotal evidence to strong evidence from randomized
controlled trials and evidence-based guidelines
 b. Context: This component includes culture, leadership, and
evaluation. It focuses on the environment in which research is being
used, encompassing factors such as patients, cultural and social
influences, structural elements, economic considerations, and
uncontrolled events
c. Facilitation: This component involves the characteristics, role, and
style of the facilitator. It encompasses the strategies and actions
taken to implement research findings, including barrier
management and transfer
4. The Plan-Do-Study-Act (PDSA) model is a four-stage problem-solving
model that teams may use to improve a process or make a practice
change. The key components of the PDSA model are as follows:

a. Plan: In this stage, the team identifies the problem or opportunity

for improvement, formulates a plan to test the change, and predicts
the outcomes of the proposed change. This involves developing the
initiative, setting goals, identifying areas for improvement,
determining changes to implement, and establishing measures to
assess the impact of the change
b. Do: The team implements the plan on a small scale, often involving
a portion of the practice or a small sample size. This step involves
carrying out the planned change, documenting the process, and
collecting data to evaluate the change
c. Study: During this stage, the team analyzes the data collected
during the "Do" stage to determine whether the change resulted in
improvement, whether the results matched the predictions, and
whether there were any unintended consequences.
d. Act: Based on the results of the study stage, the team determines
what action to take next. This may involve adopting, adapting, or
abandoning the plan. Successful changes are scaled up, and new
theories are developed for unsuccessful changes.
4. Benefits of Using Implementation Models in Nursing

The use of implementation models in nursing practice offers several

benefits:

a) Structured Approach: Implementation models provide a structured

framework for nurses to follow when implementing evidence-based
practices. They guide nurses through the steps of planning, implementing,
and evaluating interventions, ensuring a systematic approach to
implementation.

b) Evidence-Based Practice: Implementation models promote the

integration of research evidence into nursing practice. By following these
models, nurses can ensure that their practice is based on the best available
evidence, leading to improved patient outcomes.

c) Consistency and Standardization: Implementation models help promotes

consistency and standardization in nursing practice. They provide guidelines
and protocols that can be followed by nurses across different healthcare
settings, ensuring that interventions are implemented consistently and
effectively.

d) Improved Patient Outcomes: By using implementation models, nurses

can enhance the quality of care and improve patient outcomes. These
models help ensure that evidence-based practices are implemented
correctly, leading to better patient outcomes and experiences.

5. Challenges in Implementing Nursing Models

While implementation models offer valuable guidance, there are challenges

that nurses may face during the implementation process:

a) Resistance to Change: Implementing new practices or interventions may

be met with resistance from healthcare professionals. Overcoming
resistance and fostering a culture of change can be challenging but is
essential for successful implementation.

b) Resource Limitations: Limited resources, such as time, staffing, and

financial constraints, can pose challenges to implementation. Nurses may
need to find creative solutions and advocate for necessary resources to
support the implementation process.

c) Complex Healthcare Systems: Healthcare systems can be complex, with

multiple stakeholders and layers of bureaucracy. Navigating these systems
and obtaining buy-in from key stakeholders can be challenging but is crucial
for successful implementation.

d) Sustainability: Sustaining implemented changes over the long term can

be challenging. Nurses need to consider strategies for maintaining and
embedding new practices into routine care to ensure long-term success.

6. The Impact of Implementation Models on Patient Care

In the field of nursing, implementation models play a crucial role in

improving patient care. These models provide a structured framework for
nurses to effectively implement evidence-based practices and
interventions, leading to positive outcomes for patients. Let's explore the
impact of implementation models on patient care:

a) Standardization of Care: Implementation models promote the

standardization of care by providing guidelines and protocols for nurses to
follow. This ensures that evidence-based practices are consistently
implemented across healthcare settings, reducing variations in care and
improving patient outcomes.

b) Enhanced Quality of Care: By following implementation models, nurses

can ensure that their practice is based on the best available evidence. This
leads to the delivery of high-quality care that is aligned with current
research and best practices, resulting in improved patient outcomes and
experiences.
c) Improved Patient Safety: Implementation models emphasize the
integration of evidence-based practices that enhance patient safety. By
implementing standardized protocols and guidelines, nurses can reduce the
risk of errors, adverse events, and healthcare-associated infections,
ultimately improving patient safety.

d) Increased Patient Satisfaction: When evidence-based practices are

effectively implemented, patients experience better outcomes and higher
satisfaction with their care. Implementation models guide nurses in
providing patient-centered care, considering individual preferences and
needs, and promoting shared decision-making.

 Application on LOWA Model :

LOWA Model
(1)identification of a problem  Health care providers are experiencing
or opportunity burnout at alarming rate.
 Ensure a problem have priority through
(MBI burnout survey)

(2) assemble; appraise and  Form a team: include nurses, advanced

synthesize body of evidence practice provider, physician and
manager.
 Search for updated evidence about
problem.
 Develop protocol about updated
applicable evidence.
(3) development of an  Identify staff who will be involved in the
implementation plan study.
 Identify resources needed to apply study
(extra time for storytelling during
rounding, additional budget for
motivation)
 Develop protocol that will be applied on
staff.
  Identify evaluation plan (dispositional
resilience scale)
(4) implementation  Follow and apply protocol on small
group of staff (pilot study)
 Train leader to recognize and address
burnout.
 Increase number of staff work in unit
(one nurse for one patient)
 Involve nurses in decision making
related to schedule.
 Implement support programs through:
o teaching better break scheduling
o Holding departmental meetings to talk
about health and problems.
o Creating comfortable respite area for
nurses.
 Reduce non- clinical tasks (post
discharge follow up and monitoring)
that depressurize a nurse workload
(5) evaluation  Use DRS to assess level of satisfaction
and burnout.
 Close observation and discussion with
staff
 About 75% of staff shared in pilot study
improved level of satisfaction
 Decrease in rates of burnout
6) Dissemination of results.  Staff meeting
 Poster presentation
 Published article or abstract
 Generalization of protocol on all staff
through managers
 Application on The Plan-Do-Study-Act (PDSA) model :
1. Plan:

a. Define the Problem:

The issue of healthcare provider burn out. Identify specific aspects

contributing to burnout, such as long working hours, high patient loads,
administrative burdens, or inadequate support.

b. Set Objectives:

Establish measurable goals for addressing burnout. This include:

reducing the number of hours worked per week, improving work-life
balance, increasing overall job satisfaction.

c. Develop a Plan:

Identify and implement potential interventions to address the causes of

burnout. This include: changes to work schedules, workload distribution,
the introduction of wellness programs, or improvements in communication
and support systems.

2. Do:

a. Implement the Plan:

Put the identified interventions into action. This involves piloting

changes in specific departments or units before scaling up to the entire
organization.

b. Collect Data:

During the implementation phase, gather relevant data to monitor

progress and assess the impact of the interventions. This includes feedback
from healthcare providers, surveys, and performance metrics.
3. Study:

a. Analyze Data:

Evaluate the data collected to determine whether the interventions are

having the desired effect. Identify any unexpected outcomes or areas
where further improvement is needed.

b. Reflect on Findings:

Engage key stakeholders, including healthcare providers, in discussions

about the findings. Gather feedback to gain a deeper understanding of the
impact of the interventions on the work environment.

4. Act:

a. Adjust the Plan:

Based on the findings make adjustments to the interventions as

necessary. These involve refining existing strategies, discontinuing
ineffective measures, or introducing new initiatives.

b. Implement Changes:

Roll out the refined plan, incorporating lessons learned from the initial
implementation. Communicate changes effectively to healthcare providers
and ensure that support mechanisms are in place.

c. Continue Monitoring:

Establish ongoing monitoring mechanisms to track progress and identify

any emerging issues related to burnout. Regularly revisit and update the
plan as needed to address changing circumstances.
 Application on Ottawa Model :
Phase 1: Assess barriers and supports:

Graham & Logan (2004) noted that the assessment of barriers and
supports for a proposed change is the first important phase of all study
projects (Graham & Logan, 2004). Although the barriers were identified in
the pilot study and included; professional, political, and economic
elements: the same elements later became the platform for support in the
initiation and conceptualization of the nurse-led hypertension prevention,
detection, and treatment (N-HPDT) project.

Phase 2: Monitor interventions and degree of use.

During the intervention phase, a multimodal and multifaceted educational

program adapted from the WHOISH training Manual for Cardiovascular Risk
Assessment and Management (2009) (WHO, 2010) was used. Multiple
evidence based strategies were used including: provider education; follow
up; feedback and use of reminder system; and one-on-one supervision. The
participating nurses were asked to draw up a schedule to complete a 3
months educational program for practice change. Educational strategies
included: handouts, hypertension lectures on CDs and algorithms which
supplemented the theory and practical sessions.

Phase 3: Outcomes:

Participants’ demographic characteristics data were analyzed. All the

nurses (100%) completed the three month education intervention program.
The majority were females and had attained a diploma in nursing (71.4%)
and 42.9% were at the level of a nursing officer in professional nursing.

 Application on PARIHS model :

(1) Evidence:

o Conduct a comprehensive review of the literature to identify

evidence-based fall prevention strategies.

o Identify key studies, clinical guidelines, and best practice

recommendations that support the effectiveness of these
strategies.

o Develop an evidence summary document to guide the

implementation process.

(2) Context:

o Assess the context of the geriatric care unit, including

organizational culture, resources, leadership support, and staff
readiness for change.

o Identify potential barriers and facilitators to implementing fall

prevention strategies, such as staff workload, patient
characteristics, and physical environment.

(3) Facilitation:

o Provide education and training sessions for healthcare providers on

evidence-based fall prevention strategies.

o Engage in ongoing communication and collaboration with the

interdisciplinary team to address concerns and provide support.

o Assign a dedicated facilitator to guide the implementation process,

monitor progress, and address any challenges that arise.
(4) Implementation:

o Develop an implementation plan that outlines specific fall

prevention strategies to be implemented, along with timelines and
responsibilities.

o Adapt the strategies to fit the unique needs and characteristics of

the geriatric care unit.

o Ensure that necessary resources, such as equipment and educational

materials, are available to support the implementation.

(5) Evaluation:

o Collect baseline data on fall rates, fall-related injuries, and patient

outcomes prior to implementing the fall prevention strategies.

o Monitor and evaluate the implementation process, including

adherence to the strategies and any barriers encountered.

o Continuously assess fall rates and patient outcomes post-

implementation to determine the effectiveness of the strategies.

(6) Reflection and Adaptation:

Reflect on the implementation process and outcomes, considering

feedback from staff and patients.

o Identify areas for improvement and make necessary adaptations to

enhance the implementation of fall prevention strategies.

o Share the findings and lessons learned with the healthcare team and
consider opportunities for sustainability and spread to other units.
 References
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and assessment structures used

[2] Nursing Professional Development Evidence-Based Practice - StatPearls -

NCBI Bookshelf

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[7] AACN1903_291-300 nvh

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