ACE Star Model

The ACE Star model (Figure 13.1) depicts the Cycle of Knowledge Transformation. It is an
EBP model that provides an inclusive framework with which to organize EBP processes and
approaches. A fi ve-point star is used to illustrate fi ve stages of what the originators term knowledge
transformation. These stages are
1. Knowledge discovery
2. Evidence summary
3. Translation into practice recommendations
4. Implementation into practice
5. Evaluation
As learners go from one point on the star to the next, they begin to have a context within which
to place the various aspects of EBP. Evidence-based processes and methods vary from one point
of the Star model to the next and depend on the form of knowledge at that particular stage of
transformation. For example, research fi ndings represented on the fi rst point are transformed into
a single statement by combining all research (Point 2 of the Star). The ACE Star model places
previous research utilization work within the context of the more comprehensive EBP paradigm
and serves as an organizer for examining and applying EBP.

The Iowa Model of Evidence-Based Practice

to Promote Quality Care
The Iowa model of evidence-based practice to promote quality care (Titler, Kleiber, Steelman,
et al., 2001) provides guidance for nurses and other clinicians in making decisions about day today practices that affect patient outcomes. The Iowa model (Figure 11.3) outlines a pragmatic
multiphase change process with feedback loops. The original model has been revised and
updated (Titler, Kleiber, Steelman, et al., 1994; Titler et al., 2001). The model is based on the
problem-solving steps in the scientifi c process and is widely recognized for its applicability and
ease of use by multidisciplinary healthcare teams.
Using the Iowa Model
The Iowa model begins by encouraging clinicians to identify practice questions or triggers
either through identifi cation 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 for improvement. Knowledge-focused triggers come from disseminated
scientifi c knowledge (e.g., national guidelines, new research) leading practitioners to
question current 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 been addressed
using the Iowa model, including enteral feedings (Bowman, Greiner, Doerschug, et al., 2005),
sedation management (Cullen, Greiner, Greiner, et al., 2005), verifi cation of nasogastric tube
placement (Farrington, Lang, Cullen, et al., 2009), bowel 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 (VanWaning, Kleiber, & Freyenberger,
2005), and drawing blood samples from umbilical artery catheters (Gordon, Bartruff,
Gordon, et al., 2008). Administrative topics also have been addressed using the Iowa model
(Stenger, Montgomery, & Briesemeister, 2007). Important issues have been addressed using
the Iowa model well ahead of regulatory standards or changes in reimbursement (e.g., pain,
falls, suicide risk, urinary catheter use) by supporting EBP projects on important clinical topics.
Administrators and nurses in leadership positions can support clinicians use of the EBP process
by creating a culture of inquiry and a system supporting evidence-based care delivery ( Cullen,
Dawson, & Williams, 2009; Cullen et al., 2005; Davies, Edwards, Ploeg, et al., 2006; Gifford,
Davies, Edwards, et al., 2006; Gifford, Davies, Edwards, et al., 2007).
Not every clinical question can be addressed through the EBP process. Identifi cation
of issues that are a priority for the organization will facilitate garnering the support needed to
complete an EBP project. Higher priority may be given to topics that address high-volume, highrisk,
or high-cost procedures, those that are closely aligned with the institutions strategic plan,
or those that are driven by other institutional or market forces (e.g., changing reimbursement).

The Clinical Scholar Model

The Clinical Scholar (CS) model was developed and implemented to promote the spirit of
inquiry, educate direct care providers, and guide a mentorship program for EBP and the conduct
of research at the point of care. The words of Dr. Janelle Krueger planted the seeds for the model
when she encouraged the conduct and use of research as a staff nurse function and promoted
the notion that clinical staff are truly in a position to be able to link research and practice. The
philosophy and process used in the Conduct and Utilization of Research in Nursing project,
based on Diffusion of Innovation theory, formed the early thinking for the model (Horsley,
Crane, Crabtree, et al., 1983; Rogers, 2003). The concepts presented in the Clinical Scholarship
resource paper published by Sigma Theta Tau International provided the overarching principles
(Clinical Scholarship Task Force, 1999). The innovative ideas cultivated through the curiosity of
clinical nurses and the visionary and creative leadership of a nurse researcher combined to flush
out the CS model. The CS model affords a framework for building the capacity and skills for
using evidence at the point of care, thus, providing a long-term solution to changing patterns of
thinking and promoting evidence-based care

Melnyk, B.M., & Fineout-Overholt,, E. (2011). EVIDENCE-BASED PRACTICE in

Nursing & Healthcare A GUIDE TO BEST PRACTICE (2nd ed.). Retrieved from
The University of Phoenix eBook Collection database..

In-Text Citation
1
2
3

Insert the paraphrased material (Melnyk & Fineout-Overholt,, 2011, p. ).

According to Melnyk and Fineout-Overholt, (2011), Insert the paraphrased
material (p. ).
Insert the quotation (Melnyk & Fineout-Overholt,, 2011, p. ).

After the teaching session, a self-assessment was completed

by the student. One copy was given to the author and one
was kept for her own. The student was asked to evaluate or
comment on the authors teaching style and method and if
the aims and objectives were met (Walsh, 2010).
It is recognized that the cognitive learning theory is the best
used with students who have a background knowledge base
in the subject being taught ( Gopee, 2008). Throughout the
authors teaching session she had applied Kolbs (1984) four
stage cycle, which demonstrate the importance of reflective
learning and the mentors role in order to facilitate this. The
authors informal teaching was inspired by the learners who
demonstrated interest through discussion of existing
knowledge that both patient and student wanted to become
competent in the physical skill on "how to set up a feeding
pump". It is important that both the patient and the student
are enthusiastic about learning, as the ward environment is
an acutely busy place which may not always be conducive to
learning, due to staff shortages and time constraints.

However, Fulton et.al. (2007) suggest that it is the mentors

responsibility to build a good mentor-student relationship in
order to facilitate sound learning outcomes that are
achievable and ensure that learning is reflected upon.
When assessing a student, the author needs to make sure
that the student completed a standard of competence in
theory and practice. It is also the mentors responsibility to
ensure that these are carried out by the student in the
clinical area. Oliver and Endersby (2000) suggest that in
order to assess clinical competency of a student, continuous
assessment must be done. The commonly used assessment
methods are formative and summative assessment of his/her
student. Hinchcliff (1999) recognized, with continuous
observation of the student and giving feedback on regular
basis, this formative assessment helps student to
acknowledge her achievements and highlights the strengths
and weaknesses. It also provides students the opportunity to
improve their performance in a given time scale. This
includes re-evaluation of learning needs and strategy
without awarding and affecting the final grade or mark.
(Rose and Best, 2005). It allows the student to perform or
practice without getting stress of being graded for the
efforts. Following the formative assessment, summative
assessment is the final stage learning process and counts
towards the final grade or mark (Welsh and Swann, 2002).
Formative assessment is frequently use in daily practice,
however, Hinchcliff (1999) recommended the use of criterion
referenced assessment instead of norm-referenced
assessment. Criterion-referenced assessment assesses a
particular students using a predetermined criteria. It enables
the mentor to be objective and avoid pitfalls of subjectivity
during assessment process. The norm-referenced
assessment, assesses student against another student or
group of students at same level or stage of learning and not
recommended in clinical practice as it is biased (Anderson,
2011).
The success of student assessment is based on validity and
reliability (Udlis, 2008).
Through student self-evaluation and feedback, the author

able to know if the aims and objectives of the formal

teaching were met and able to adjust the style and method
in the future. Giving positive feedback or comments
motivated students or increased their enthusiasm in the
learning process (Walton and Reeves, 1999). The feedback
obtained from the students involved in the formal teaching
session stated that they gained full understanding of the use
of the syringe pump to adult palliative patient, however they
felt that they will benefit more from practicing this
procedure. Feedback received from the student performing
the informal teaching was different from the formal teaching
because the student in the informal teaching session had the
opportunity to perform the task which made the student feel
competent and have a sense of achievement upon
completion of the task.
On reflection, despite having abundant time to prepare the
formal teachingsession, inexperience in teaching made the
author anxious, nervous and stressed. As a foreign nurse and
English is not the author first language, the author was
worried that student, colleague and mentor if they will
understand her or not. With encouragement and full support
received from the authors mentor, the formal teaching
ended successfully.
According to Moore (2005) the number of students on
placement will affect the effectiveness of the learning
experience. No more than three students to be supported by
mentors on same period of time (NMC, 2006)
The student nurse must be involved in the learning activity
to help them develop into skilled, competent practitioners
who can demonstrate "fitness for practice". Johns and
Freshwater (2005) suggest reflection to be an essential
aspect of the learning process.