Evidence-Based Practice for Clinical Nurses: The PEACE Model

Nurses are in charge of the patients and their families throughout the hospital and health system experience. They assist patients through illness to achieve higher levels of health. They coordinate the care throughout the patients' experiences with the healthcare system. Nurses are the leaders of patient care at the bedside and beyond. It is important that as clinical leaders, nurses have the most accurate, most up-to-date, and evidence-based information available so that they can always do the right thing. The PEACE model develops clinical nurses as leaders in care of both patients and their families. Clinical nurses, those at the point of care, have embraced this model for guiding their practice. The PEACE model helps clinical nurses solve challenging problems through a rigorous evidence-based practice process-from problem identification to evaluation and dissemination.

The crux of the PEACE model is the mnemonic that simplifies the evidence-based practice (EBP) process for clinical nurses. The PEACE model is used across NewYork-Presbyterian (NYP), one of the nation's most comprehensive academic healthcare delivery systems. NYP is composed of 10 hospitals in New York and employs more than 11,000 nurses across the enterprise.

One striking advantage of the model is that it emerged from the work of clinical nurses who were struggling to find a way to remember and apply the components of other EBP models. Clinical nurses have indicated that the components of the PEACE model make the model memorable and useful:

P for problem identification

E for evidence review

A for appraising the evidence

C for changing practice or conducting research

E for evaluating and disseminating the findings

The last stage of the PEACE model is particularly important to advancing nursing practice across institutions. We have found that unless the model results are disseminated through scholarly presentations and publications, the clinical challenges continue to be present across sites and institutions. We emphasize this phase and conduct publication workshops to help clinical nurses shape the dissemination of their EBP work. Nurses' active participation in EBP and research is critical to improving the care we provide to patients and furthering nursing science. It is important to note that the design of the PEACE model intentionally linked EBP, quality improvement (QI), and research.

The mnemonic PEACE promotes understanding and application by clinical nurses, providing a way to easily remember the EBP component stages. The uniqueness of the PEACE model is its simplicity. This relevance leads to continued application in day-to-day nursing practice. As we strive for peace at many levels of our lives and work, the mnemonic is easy to remember. The PEACE model may be adapted to any setting where nurses practice.

Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN, is the Director of Nursing Research and Innovation at NewYork-Presbyterian (NYP) and Assistant Professor of Clinical Nursing at Columbia University School of Nursing, both in New York, New York. He is also an Associate Professor of Nursing at Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, Ohio. In his current role at NYP, he oversees the implementation of evidence-based initiatives, research studies, and practice innovations that will advance nursing science and improve patient outcomes/care. Rivera's research and contributions focus on nurse engagement and practice innovations including nurse residency program, academic-practice collaboration initiatives, mentoring, narrative nursing, appreciative inquiry, use of liberating structures, and enhancing professional governance. Rivera served as a board member of the American Organization for Nursing Leadership, Advisory Board of the Duke-Johnson & Johnson Nurse Leadership Program, President of the American Association of Critical Care Nurses (AACN) New York City Chapter, and President of the Philippine Nurses Association of America. He is a board member of the American Association for Men in Nursing (AAMN) Foundation as well as an advisory board of the Rockefeller University, Heilbrunn Family for Research Nursing. He has received many prestigious awards, such as the Teachers College, Columbia University Outstanding Alumni Award, AACN Flame of Excellence Award, and the AAMN Lee Cohen Award. He is a fellow of the American Academy of Nursing and of the Academy's Selection Committee. Rivera received his BSN from University of the East Ramon Magsaysay Memorial Medical Center in the Philippines; MA in assessment and measurement psychology from Ateneo de Manila University, Philippines; MA and EdM in nursing executive role from Teachers College, Columbia University, New York; Post Masters in advanced nursing practice from New York University, New York; and Doctor of Nursing Practice from Frances Payne Bolton School of Nursing, Case Western Reserve University in Ohio.

Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, is the Inaugural Director of the Marian K. Shaughnessy Nurse Leadership Academy and Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU) in Cleveland, Ohio, where she was Dean from 1982 through 1997. Fitzpatrick is widely published in nursing and healthcare literature with over 400 publications, including more than 80 books. She served as coeditor of the Annual Review of Nursing Research series, Volumes 1-26. She is editor of the classic Encyclopedia of Nursing Research, now in its 4th edition, and coeditor of the Encyclopedia of Nursing Education. Currently she edits the journals Applied Nursing Research and Archives in Psychiatric Nursing. From 1997-1999 she served as President of the American Academy of Nursing (AAN); she currently serves as Vice-Chair of the American Nurses Foundation. She has received numerous honors and awards; she was elected a Fellow in the American Academy of Nursing in 1981, Fellow in the National Academies of Practice in 1996, and an Honorary Fellow of the American Academy of Nurse Practitioners in 2018. She received the American Journal of Nursing Book of the Year Award 20 times. In 2014 Fitzpatrick was inducted into the STTI Research Hall of Fame. In 2016 she was named a Living Legend by AAN, and in 2018 she received the prestigious ANA Jessie M. Scott Award that recognizes leadership in demonstrating the interdependence between nursing education, practice, and research. In June 2019 she was awarded the International Council of Nurses and Florence Nightingale Foundation International Achievement Award, recognizing her contribution to advancing international nursing education through research, innovative conceptual models, and theory development. She earned a BSN (Georgetown University), an MS in psychiatric-mental health nursing (The Ohio State University), a PhD in nursing (New York University), and an MBA (CWRU). In 1990, Fitzpatrick received an honorary doctorate, Doctor of Humane Letters, from Georgetown University. In 2011 she received an honorary doctorate, Doctor of Humane Letters, from the Frontier University of Nursing.