Abstract
Although Evidence-Based Practice (EBP) and Quality Improvement (QI) are frequently used to guide practice change, EBP lacks the sustainability component of QI and QI traditionally favors the use of internal evidence to the exclusion of external (research) evidence. EBP models focus on finding research evidence, critically appraising it and then synthesizing it to identify the intervention best suited to the problem, population, and context. Next, a practice change is developed, implemented, and evaluated but then what? What about continuous monitoring and sustaining the change? EBP models are weak in the continuous monitoring and sustaining of practice change. On the other hand, QI neglects external evidence and risks trying many ineffective solutions that waste resources (Author, 2024a).
The Mountain Model (MM) is a widely used nurse-lead framework that integrates research as the foundation of EBP and QI and provides a systematical process that moves from research to its application in practice (using implementation science strategies) with continuous monitoring to ensure the highest quality care (Reynolds & Granger, 2023; Author, 2024a).
Traditionally, EBP and QI efforts have been deemed of lower value in the evidence hierarchy, but a new critical appraisal tool is now available to determine their quality and applicability to your practice (Author, 2024a; Author, 2024b). If, after all the evidence is synthesized and appraised it is not enough or of high enough quality to change practice, then there is more research to be done, and the practice change will need to wait. If there is strong evidence to support practice change then SMART aims are articulated, a change (protocol, process, etc.) is developed and a plan for making the change stick using strategies from implementation science is developed and implemented using QI principles. To determine if the change is working, frequent monitoring and comparing of data using run charts and process control charts keeps the involved parties informed and engaged. If the data demonstrates that things are not working, then changes can be made iteratively. An important component of the MM is dissemination. While EBPQI work is not generalizable it can be transferable and adapted to other similar settings and populations and others can build on it.
Notes
References:
Reynolds, S. S., & Granger, B. B. (2023). Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice. Dimensions of critical care nursing: DCCN, 42(1), 33–41. https://doi-org.proxy.lib.duke.edu/10.1097/DCC.0000000000000556
Waldrop, J. & Dunlap, J.J. (2024a). The Mountain Model for evidence-based practice quality improvement initiatives. The American Journal of Nursing, 124(5), 32-37. https://doi.org/10.1097/01.NAJ.0001014540.57079.72
Waldrop, J. & Dunlap, J.J. (2024b). Beyond PICO - A new question simplifies the search for evidence. American Journal of Nursing, 124(3), 34-37. https://doi.org/10.1097/01.NAJ.0001007676.91191.dd
Waldrop, J., Dunlap, J.J, Reynolds, S. (2024). Evidence-based practice quality improvement critical appraisal tool. Journal of Nursing Care Quality. Published ahead of print. https://doi.org/10.1097/NCQ.0000000000000789
American Association of Colleges of Nursing (2021). The Essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/essentials
Sigma Membership
Beta Beta (Houston)
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Global Leadership, Faculty Development, Instrument and Tool Development, Evidence-Based Practice, Interprofessional Evidence-Based Solutions, Quality Improvement, Mountain Model, EBPQI
Recommended Citation
Dunlap, Jayne Jennings and Waldrop, Julee Briscoe, "Re-Envisioning the Path to Sustainable Practice Change with the Mountain Model" (2025). Biennial Convention (CONV). 196.
https://www.sigmarepository.org/convention/2025/presentations_2025/196
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-05
Re-Envisioning the Path to Sustainable Practice Change with the Mountain Model
Indianapolis, Indiana, USA
Although Evidence-Based Practice (EBP) and Quality Improvement (QI) are frequently used to guide practice change, EBP lacks the sustainability component of QI and QI traditionally favors the use of internal evidence to the exclusion of external (research) evidence. EBP models focus on finding research evidence, critically appraising it and then synthesizing it to identify the intervention best suited to the problem, population, and context. Next, a practice change is developed, implemented, and evaluated but then what? What about continuous monitoring and sustaining the change? EBP models are weak in the continuous monitoring and sustaining of practice change. On the other hand, QI neglects external evidence and risks trying many ineffective solutions that waste resources (Author, 2024a).
The Mountain Model (MM) is a widely used nurse-lead framework that integrates research as the foundation of EBP and QI and provides a systematical process that moves from research to its application in practice (using implementation science strategies) with continuous monitoring to ensure the highest quality care (Reynolds & Granger, 2023; Author, 2024a).
Traditionally, EBP and QI efforts have been deemed of lower value in the evidence hierarchy, but a new critical appraisal tool is now available to determine their quality and applicability to your practice (Author, 2024a; Author, 2024b). If, after all the evidence is synthesized and appraised it is not enough or of high enough quality to change practice, then there is more research to be done, and the practice change will need to wait. If there is strong evidence to support practice change then SMART aims are articulated, a change (protocol, process, etc.) is developed and a plan for making the change stick using strategies from implementation science is developed and implemented using QI principles. To determine if the change is working, frequent monitoring and comparing of data using run charts and process control charts keeps the involved parties informed and engaged. If the data demonstrates that things are not working, then changes can be made iteratively. An important component of the MM is dissemination. While EBPQI work is not generalizable it can be transferable and adapted to other similar settings and populations and others can build on it.
Description
The Mountain Model (MM) is a nurse-led framework that integrates research as the foundation of evidence-based practice and quality improvement and provides a systematical process that moves from research to its application in practice with continuous monitoring to ensure the highest quality care (Reynolds & Granger, 2023; Author, 2024a). This presentation will showcase how to integrate the MM with a newly developed EBPQI critical appraisal tool with global application.