it this way.” For example, consider the practice of restraining patients by tying
them to their beds or chairs to prevent falls. It has only been through research
studies examining this practice that nurses now know that although tying
patients to beds or chairs may have prevented falls, it also predisposed patients
to other injuries, such as strangling, as they tried to get out of the restraints.
Because 30–50% of patient falls result in injury, the need to conduct research
and disseminate the findings about the prevention of patient falls remains a
priority (the Joint Commission, 2015). Without the work of the CURN project,
an understanding of how nurses embrace and use research in their clinical
practice might not have occurred.
The Stetler Model
Whereas the CURN project has given nurses insight into how and why nurses
embrace research in clinical practice, the Stetler model (Stetler, 2001) focuses
on how individual practitioners adopt research findings at the bedside. Origi-
nally developed in 1976 as the Stetler/Merram model for research utilization,
this model can be used to systematically integrate research into practice. The
model was updated to facilitate examination of both the product and process
of research. Products of research are things such as research findings. An ex-
ample is that 9 out of 10 dentists recommend a certain chewing gum for their
patients who chew gum. The process of research tells how to go about solving a
problem. For example, nurses on a busy medical-surgical unit want to explore
why they have noticed an increase in patient falls. They begin to examine the
problem by conducting a chart audit of all the patients who have fallen in
the past year. Next they determine whether there are any common factors.
When the common factors are identified, a list of risk factors is developed
that can guide interventions to reduce the number of falls. These nurses are
engaging in a process of research. As evidenced in these examples, both product
and process are important to facilitate EBP.
Because Stetler’s model (2001) is prescriptively designed, it provides practi-
tioners with step-by-step instructions for integrating research into practice and
is useful to help nurses deliver safe patient care. In the updated version of the
model (see Figure 16-1), Stetler provides a traditional graphic accompanied
by a narrative of the five phases of the model.
In the first phase of the model, known as the preparation phase, Stetler
(2001) encourages nurses to be very clear about the purpose, the context, and
the sources of any research evidence. Questions to be answered include what
are the issues, who are the stakeholders, and how will we define our outcomes?
Questions such as these assist nurses to be very purposeful in their thinking
when making decisions about EBP.
16.1 Evidence-Based Practice Models to Overcome Barriers 427