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Nursing and Allied Health: Evidence-Based Nursing: Evidence Application

Online Learning
Step 4:  Evidence Application (Resources)


Centre for Evidence Based Medicine:
Describes the process of evidence application

Indiana Center for Evidence Based Nursing Practice:
Contains several links for information for evidence application/translatio

Step 4:  Evidence Application


Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.

Step 4:  Evidence Application

The fourth step is evidence application.  A model of evidence based practice is used to apply research findings in nursing practice. Evidence application involves the integration of relevant evidence with clinical experience. Evidence that has been obtained must be relevant and valid research to be applied to the research question. The effectiveness of a therapeutic intervention, based on the evidence, is determined by assessing the internal validity and external validity of a given study.   The evidence is applied by making a practice decision that integrates evidence, clinical expertise, and patient factors and preferences. 

  • Internal validity:  Is it a high quality study in terms of its methods (does it measure what it was intended to measure)?
  • External validity:  Is the population and setting of the study similar to that of the one evaluated in the clinical question?


Organizational Models


FUNK Model


Funk S, Tornquist E, Champagne, M. (1989). A model for improving the dissemination of nursing research, Western Journal of Nursing Research,11(3), 361-367.

Tabak R. Ljppmg E. Chambers A, Ross D. (2012) Bridging research and practice: models for dissemination and implementation research, American Journal of Preventative Medicine, 43(3) 337-350.  Retrieved from Elsevier Science Direct.

Book:  Resources for Models of Evidence-Based Nursing Practice and Research Utilization (Melnyk & Fineholt-Overholt, 2005


IOWA Model


Doody, C. M., & Doody, O. (2011). Introducing evidence into nursing practice: using the IOWA model. British Journal of Nursing, 20(11), 661–664. Retrieved from CINAHL.

Dugan, K. A. (2019). EVIDENCE-BASED NURSING. A “snippet” of evidence leads to practice change. Nursing Management, 50(6), 16–18. Retrieved from CINAHL.

Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., … Williamson, A. (2015). Sacred Cow Gone to Pasture: A Systematic Evaluation and Integration of Evidence-Based Practice. Worldviews on Evidence-Based Nursing, 12(1), 3–11.  Retrieved from CINAHL.

Krom ZR, Batten J, & Bautista C. (2010). A unique collaborative nursing evidence-based practice initiative using the Iowa model: a clinical nurse specialist, a health science librarian, and a staff nurse’s success story. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 24(2), 54–59. Retrieved from CINAHL.

Lenz BK, & Barnard P. (2009). Advancing evidence-based practice in rural nursing. Journal for Nurses in Staff Development, 25(1), E14-9.

Reavy K, & Tavernier S. (2008). Nurses reclaiming ownership of their practice: implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing, 39(4), 166–172. Retrieved from CINAHL.




Bradbury L, Clipsham K, & Kitson A. (2005). Developing nursing research. Journal of Orthopaedic Nursing, 9(4), 199–204. Retrieved from CINAHL.

Harvey G, & Kitson A. (1996). Achieving improvement through quality: an evaluation of key factors in the implementation process. Journal of Advanced Nursing (Wiley-Blackwell), 24(1), 185–195. Retrieved from CINAHL.

Kitson, A. (2000). Towards evidence-based quality improvement: perspectives from nursing practice. International Journal for Quality in Health Care, 12(6), 459–464. Retrieved from CINAHL.

Kitson A. (1997). Issues in research. Lessons from the 1996 Research Assessment Exercise. Nurse Researcher, 4(3), 81–93. Retrieved from CINAHL.

Kitson A, Ahmed LB, Harvey G, Seers K, & Thompson DR. (1996). From research to practice: one organizational model for promoting research-based practice. Journal of Advanced Nursing (Wiley-Blackwell), 23(3), 430–440.

Kitson A, Harvey G, Hyndman S, & Yerrell P. (1994). Criteria formulation and application: an evaluative framework. International Journal of Nursing Studies, 31(2), 155–167. Retrieved from CINAHL.

Kitson A, McMahon A, Rafferty AM, & Scott E. (1997). High priority... setting priorities to raise the profile of nursing research. Nursing Times, 93(42), 26–30. Retrieved from CINAHL.

Kitson A. (1997). Using evidence to demonstrate the value of nursing. Nursing Standard, 11(28), 34–39. Retrieved from CINAHL.

McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, & Seers K. (2002). Getting evidence into practice: the meaning of “context.” Journal of Advanced Nursing (Wiley-Blackwell), 38(1), 94–104. Retrieved from CINAHL.

Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, & Titchen A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing (Wiley-Blackwell), 13(8), 913–924. Retrieved from CINAHL.

Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, & McCormack B. (2004). What counts as evidence in evidence-based practice? Journal of Advanced Nursing (Wiley-Blackwell), 47(1), 81–90. Retrieved from CINAHL.

Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, & Estabrooks C. (2002). Ingredients for change: revisiting a conceptual framework. Quality & Safety in Health Care, 174–180. Retrieved from CINAHL.

Rycroft-Malone J, Harvey G, Kitson A, McCormack B, & Titchen A. (2002). Getting evidence into practice: ingredients for change. Nursing Standard, 16(37), 38–43. Retrieved from CINAHL.

Walti-Bolliger M, Needham I, & Halfens R. (2007). Knowledge transfer in nursing: pious hopes or how to evade the cul-de-sac? Recherche En Soins Infirmiers, 90(3), 58–66. Retrieved from CINAHL.




Ciliska DK, Pinelli J, DiCenso A, & Cullum N. (2001). Resources to enhance evidence-based nursing practice. AACN Clinical Issues: Advanced Practice in Acute & Critical Care, 12(4), 520–528. Retrieved from

DiCenso A, Cullum N, & Ciliska D. (1998). Implementation forum. Implementing evidence-based nursing: some misconceptions. Evidence Based Nursing, 1(2), 38–40. Retrieved from CINAHL

DiCenso A, Bayley L, & Haynes RB. (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12(4), 99–101. Retrieved from CINAHL.

DiCenso A, Prevost S, Benefield L, Bingle J, Ciliska D, Driever M, … Titler M. (2004). Evidence-based nursing: rationale and resources. Worldviews on Evidence-Based Nursing, 1(1), 69–75. Retrieved from

Newhouse RP. (2006). Expert opinion: challenges and opportunities for academic and organizational partnership in evidence-based nursing practice. Journal of Nursing Administration, 36(10), 441–445. Retrieved from CINAHL

Stetler CB, & Marram G. (1976). Evaluating research findings for applicability in practice. Nursing Outlook, 24, 559–563. Retrieved from CINAHL

Stetler CB. (1994). Refinement of the Stetler/Marram model for application of research findings to practice. Nursing Outlook, 42(1), 15–25. Retrieved from CINAHL.

Stetler CB. (2001). To the editor...Evidence-based nursing: what it is and what it isn’t, Nurs Outlook 2000;48:151-2. Nursing Outlook, 49(6), 286. Retrieved from CINAHL.

Stetler CB. (2001). Updating the Stetler Model of Research Utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272–279. Retrieved from CINAHL.

Walti-Bolliger M, Needham I, & Halfens R. (2007). Knowledge transfer in nursing: pious hopes or how to evade the cul-de-sac? Recherche En Soins Infirmiers, 90(3), 58–66. Retrieved from CINAHL.


Rosswurm and Larrabee Model


Long LE, Burkett K, & McGee S. (2009). Promotion of safe outcomes: incorporating evidence into policies and procedures. Nursing Clinics of North America, 44(1), 57–70. Retrieved from CINAHL.

Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Image -- the Journal of Nursing Scholarship, 31(4), 317. Retrieved from PROQUEST Nursing and Allied Health.


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