Stetler Model of Nursing Evidence-Based Practice

Providing quality health services is a complex process that requires time and effort from hospital staff. Evidence-based practice (EBP) is an approach that combines the application of existing patient knowledge, staff experience, and patient preferences. Its use is designed to provide the most effective treatment and care for the patient. Despite the advantages of this approach, the implementation of changes through it cannot always be sustainable.

An example of the implementation of EBP initiatives is the use of digital technologies to help manage pain for children patients in oncology departments. Studying pain management for children demonstrates the effectiveness of methods such as providing educational information to children and parents (Mariyana et al., 2018) and distraction (Tutelman et al., 2018). These two aspects can be achieved by implementing digital technologies (Gates et al., 2020). It was proposed to use tablets with saved educational materials, in addition to games and films for distraction. The changes required the provision of conditions for the use of tablets, the creation of materials for education understandable to children, and the preparation of nurses to use these technologies. The initiative was adopted and remained sustainable, as it helped children distract from pain and manage it better. Moreover, it found an emotional response among the staff, which enabled them to prepare carefully for the new aspects of work.

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There are several strategies to enhance the sustainability of EBP initiatives. Depending on the situation, one can choose a more appropriate one, but I would use the Stetler Model of evidence-based practice in advanced nursing. This method is useful, as it implies applying critical thinking and oriented on skilled practitioners (Melnyk et al., 2019). The steps offered by this model – preparation, validation, comparison and decision making, application and evaluation of results – are understandable and, at the same time, practical.


Gates, M., Hartling, L., Shulhan-Kilroy, J., MacGregor, T., Guitard, S., Wingert, A, Featherstone, R., Vandermeer, B., Poonai, N., Kircher, J., Perry, S., Graham, T. A.D., Scott, S. D., & Ali, S. (2020). Digital technology distraction for acute pain in children: A meta-analysis. Pediatrics, 145(2). Web.

Mariyana, R., Allenidekania, A., & Nurhaeni, N. (2018). Parents’ voice in managing the pain of children with cancer during palliative care. Indian Journal of Palliative Care, 24(2), 156. Web.

Melnyk B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to practice (4th ed.). Wolters-Kluwer.

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Tutelman, P. R., Chambers, C. T., Stinson, J. N., Parker, J. A., Fernandez, C. V., Witteman, H. O., Nathan, P. C., Barwick, M., Campbell, F., Jibb, L. A., & Irwin, K. (2018). Pain in children with cancer. The Clinical Journal of Pain, 34(3), 198-206. Web.

The Stetler Model (Figure 14.2A and B) outlines a series of steps to assess and use research findings to facilitate safe and effective EBP. Over the course of its evolution, the model has grown in complexity in order to provide more guidance around utilization concepts, as well as more detail and options involved in applying research in the real world. In 2009, minor modifications were made to the 2001 model’s content, both Parts I and II, to better clarify phases and highlight implementation tools (Stetler, 2010). The Stetler Model has long been known as a practitioner-oriented model because of its focus on critical thinking and use of findings by the individual practitioner (Kim, 1999; Stetler & Marram, 1976). The 2001 version provided clarification that this guided problem-solving process also applies to groups of practitioners. Yet the model maintains the bottom-line assumption that even prepackaged, research-based recommendations are applied at the skilled practitioner level to individual patients, staff members, or other targets of use. This model is geared to advanced practitioners, such as CNSs, NPs, and DNP-prepared nurses. These advanced practitioners can use the model in their own practice and in a group setting, facilitating others’ use of the phases as appropriate (Stetler, 2010). Multiple examples of the model’s use in different settings for numerous topics, from cancer-related protocols to enlightenment of staff regarding patients’ psychosocial issues, are provided with the 2010 revision. Ongoing personal communications to the author from advanced practitioner students suggest that the model is currently used to guide capstone projects, dissertation research, clinical projects, and practice innovations.

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