ACE Star Model
Model ACE Star menggambarkan Siklus Transformasi Pengetahuan. Ini adalah sebuah
Model EBP yang menyediakan kerangka kerja inklusif untuk mengatur proses EBP. Bintang lima
titik digunakan untuk menggambarkan lima tahap dari apa yang disebut oleh pencetusnya sebagai
transformasi pengetahuan. Tahapan tersebut diantaranya
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 to-
day 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 institution’s 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 Insert the paraphrased material (Melnyk & Fineout-Overholt,, 2011, p. ).
2
3 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
Kolb’s (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 mentor’s
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
mentor’s 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 author’s 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.
