Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^172) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
determining the fit, feasibility, and appropriateness of the recommendations for
translation (see Appendix H). These are the main questions to be considered: Can
this practice change be implemented given the current organizational infrastruc-
ture? What additional actions or resources are needed? Specific criteria can be
helpful to make this determination. Stetler (2001, 2010) recommends using the
criteria of substantiating evidence, fit of setting, feasibility, and current practice.
When considering the overall evidence summary, the team should assess the find-
ing’s consistency (whether results were the same in the other evidence reviewed),
quality or applicability (the extent to which bias was minimized in individual
studies so that the evidence is generalizable to the population or setting of inter-
est), and quantity (number, sample size and power, and size of effect; Agency for
Healthcare Research and Quality, 2002; White et al., 2016).
Organizational context and infrastructure such as resources (equipment or prod-
ucts), change agency (linkages with people who foster change or adoption of
evidence), and organizational readiness also need to be considered (Greenhalgh,
Robert, Bate, Macfarlane, & Kyriakidou, 2005). Additionally, nursing-related
factors such as nursing processes, policies, and competencies need to be present
before implementing recommendations. The following guiding questions can help
to determine whether the proposed recommendation adds value:
■■ Would this change improve clinical outcomes?
■■ Would this change improve patient or nurse satisfaction?
■■ Would this change reduce the cost of care for patients?
■■ Would this change improve unit operations?
Determining the feasibility of implementing EBP recommendations is essential
in assessing whether they add significant value to improving a specific problem.
Implementing processes with a low likelihood of success wastes valuable time
and resources on efforts that produce negligible benefits.