Johns Hopkins EBP model DNP project

Q: What is the difference between the Johns Hopkins EBP Model and a theoretical framework?

The JHNEBP Model is a process model that guides you through identifying a problem, finding evidence, and translating it into practice. A theoretical framework provides the rationale behind behavior change. Many DNP projects use both: the JHNEBP Model as the EBP process framework and a separate theory to support implementation.

Q: Can I use the Johns Hopkins EBP tools without permission?

No. The tools are copyrighted by The Johns Hopkins Hospital and The Johns Hopkins University. Complete a Copyright Permission Form through the Institute for Johns Hopkins Nursing website to receive access. Permission is typically granted for educational and clinical use.

Q: How many evidence levels does the Johns Hopkins Model use?

The JHNEBP Model classifies evidence into five levels. Levels I through III represent research evidence (RCTs to non-experimental studies), while Levels IV and V represent non-research evidence (expert opinion, organizational experience, QI data, case reports). Each level is rated for quality as A (high), B (good), or C (low quality).

Q: What is the difference between a broad and intervention EBP question?

A broad question is exploratory and does not include a specific intervention or outcome. An intervention question is focused and follows a PICO-like structure. Intervention questions typically evolve from an initial broad question and evidence review.

Q: Should I use the 4th or 5th edition of the JHNEBP Model?

The 5th edition (2025) by Bissett, Ascenzi, and Whalen is the most current and includes expanded translation guidance and updated tools. Many current DNP students began their projects using the 4th edition (2022). Check with your faculty advisor about which edition to cite.

Q: How do I cite the Johns Hopkins EBP Model in APA format?

5th Edition: Bissett, K., Ascenzi, J., & Whalen, M. (2025). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (5th ed.). Sigma Theta Tau International. 4th Edition: Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Weston Samuel February 22, 2026 DNP

The Johns Hopkins Evidence-Based Practice (JHNEBP) Model is one of the most widely adopted frameworks for guiding clinical decision-making in nursing and healthcare. For Doctor of Nursing Practice (DNP) students, it provides a clear, structured pathway for translating research evidence into real-world practice changes — which is exactly what a DNP project demands.

Originally developed at the Johns Hopkins Hospital and Johns Hopkins University School of Nursing, the model has been refined through more than a decade of real-world application across hundreds of healthcare organizations. Now in its fifth edition (Bissett, Ascenzi, & Whalen, 2025), the JHNEBP Model remains a go-to framework for DNP scholarly projects because of its practicality, its built-in toolkit, and its strong alignment with the AACN Essentials for doctoral nursing education.

Unlike purely theoretical frameworks, the JHNEBP Model was designed to be used at the bedside. It equips DNP students with actionable tools — question development worksheets, evidence appraisal checklists, stakeholder analysis templates, and translation planning guides — that transform a complex scholarly project into a manageable, step-by-step process.

Why DNP Students Choose the Johns Hopkins Model

Practice-oriented — Built for clinicians, not just researchers
Comprehensive toolkit — Includes appendices (A–J) that guide every phase of the project
Interprofessional focus — Emphasizes team-based approaches to complex care problems
AACN alignment — Maps directly to DNP Essentials and scholarly project requirements
Proven track record — Used in over 250 healthcare organizations worldwide
Appendix J — Specifically designed for DNP scholarly EBP projects

At the heart of the JHNEBP Model is the PET process — a three-phase approach that stands for Practice Question, Evidence, and Translation. Each phase contains specific steps supported by dedicated tools (appendices) that guide the DNP student from problem identification through implementation and evaluation.

Phase 1: Practice Question Steps 1–5

P Practice Question Phase

This foundational phase is where your DNP project takes shape. The team identifies a clinical problem, recruits interprofessional stakeholders, and develops a focused, answerable EBP question. The model supports both broad questions (exploratory, when little is known) and intervention questions (focused, often following a PICO format).

Step 1: Recruit an interprofessional team
Step 2: Develop and refine the EBP question
Step 3: Define the scope of the question and identify stakeholders
Step 4: Determine responsibility for project leadership
Step 5: Schedule team meetings and establish a project timeline

Key Tools: Question Development Tool (Appendix B) · Stakeholder Analysis Tool (Appendix C) · PET Process Guide (Appendix A)

Phase 2: Evidence Steps 6–10

E Evidence Phase

This is the research-intensive phase. The team conducts a systematic search for evidence, starting with pre-appraised evidence (clinical practice guidelines, systematic reviews) before moving to individual studies. Each piece of evidence is appraised for both its level (type of study) and quality (rigor and reliability), then synthesized to form practice recommendations.

Step 6: Conduct internal and external search for evidence
Step 7: Appraise the level and quality of each piece of evidence
Step 8: Summarize the individual evidence
Step 9: Synthesize the overall strength and quality of evidence
Step 10: Develop recommendations for change based on evidence synthesis

Key Tools: Evidence Level and Quality Guide (Appendix D) · Research Evidence Appraisal Tool (Appendix E) · Non-Research Evidence Appraisal Tool (Appendix F) · Individual Evidence Summary Tool (Appendix G)

Phase 3: Translation Steps 11–18

T Translation Phase

Translation is where evidence becomes action — and where your DNP project demonstrates its impact. The team evaluates the fit, feasibility, and appropriateness of evidence-based recommendations for the specific practice setting. An action plan is created, the change is implemented (often using PDSA cycles), outcomes are evaluated, and results are disseminated.

Step 11: Determine fit, feasibility, and appropriateness of recommendations
Step 12: Create an action plan
Step 13: Secure support and resources
Step 14: Implement the action plan
Step 15: Evaluate outcomes
Step 16: Report outcomes to stakeholders
Step 17: Identify next steps for sustainability
Step 18: Disseminate findings

Key Tools: Translation and Implementation Tool (Appendix H) · EBP Project Portfolio (Appendix I) · DNP Scholarly Project Guide (Appendix J)

A defining feature of the JHNEBP Model is its evidence rating system, which classifies evidence by both level (study type) and quality (rigor). Understanding this system is essential for your DNP project’s evidence appraisal and synthesis sections.

Level	Type of Evidence	Examples
Level I	Experimental study or RCT, or systematic review of RCTs (with or without meta-analysis)	Randomized controlled trials, Cochrane systematic reviews
Level II	Quasi-experimental study, or systematic review of a combination of RCTs and quasi-experimental studies	Pre-post intervention studies with a control group but without randomization
Level III	Non-experimental study, qualitative study, or systematic review of non-experimental studies (with or without meta-analysis)	Descriptive studies, correlational studies, qualitative research, mixed-methods studies
Level IV	Opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence	Clinical practice guidelines, consensus statements, expert panel reports
Level V	Experiential and non-research evidence: literature reviews, quality improvement projects, program evaluations, financial evaluations, case reports, expert opinion	Organizational experience, integrative reviews, quality improvement data, case reports

Each piece of evidence also receives a quality rating:

A — High Quality

Consistent, generalizable results with sufficient sample size, adequate control, and definitive conclusions. Comprehensive literature review with thorough reference to scientific evidence.

B — Good Quality

Reasonably consistent results with some control and fairly definitive conclusions. Based on a fairly comprehensive literature review.

C — Low Quality

Little evidence with inconsistent results, insufficient sample size, or conclusions that cannot be drawn. May have major flaws in methodology.

DNP Project Tip

When your evidence synthesis includes mostly Level I and II evidence with consistent findings, your team can recommend a practice change with high confidence. With predominantly Level II and III evidence, proceed cautiously — typically with a pilot study first. Practice changes should generally not be based on Level IV or V evidence alone.

Here’s a practical walkthrough of how the JHNEBP Model maps to the typical DNP project timeline. This section bridges the gap between the model’s theoretical framework and your actual project deliverables.

DNP Project Walkthrough Using the JHNEBP Model

1. Identify the Clinical Problem

Start with a practice-based trigger — either a problem-focused trigger (e.g., rising fall rates, increased infection rates, poor patient satisfaction scores) or a knowledge-focused trigger (e.g., new research findings, updated clinical guidelines). Use the EBP Decision Tree to confirm that an EBP project is the appropriate approach and that sufficient evidence exists.

2. Assemble the Team and Define the Question

Recruit interprofessional stakeholders relevant to your clinical problem. Use the Question Development Tool (Appendix B) to formulate your EBP question. For intervention-focused projects, structure it using the PICO format. For broader exploratory projects, use the model’s broad question template: “In/among [population], what are best practices/strategies for [topic of interest]?”

3. Search for and Appraise the Evidence

Conduct a systematic literature search beginning with pre-appraised evidence (systematic reviews, clinical practice guidelines). If a high-quality synthesis already exists, your team may move directly to translation. Otherwise, conduct a targeted or exhaustive search using databases such as PubMed, CINAHL, and Cochrane Library. Appraise each article using the Evidence Level and Quality Guide (Appendix D) and the appropriate appraisal tool (Appendix E for research, Appendix F for non-research).

4. Synthesize Evidence and Develop Recommendations

Summarize your findings using the Individual Evidence Summary Tool (Appendix G), then synthesize across studies to identify patterns, gaps, and the overall strength of evidence. Develop site-specific recommendations based on the certainty, risk, feasibility, fit, and acceptability of the evidence to your practice setting.

5. Plan and Implement the Practice Change

Create an action plan that specifies the intervention, timeline, responsible parties, resources needed, and outcome measures. Many DNP students use PDSA (Plan-Do-Study-Act) cycles during implementation. Obtain IRB approval or exemption as appropriate — most EBP quality improvement projects qualify for exempt status. Secure organizational support and implement your practice change.

6. Evaluate, Report, and Disseminate

Measure outcomes using structure, process, and/or outcome metrics established in your action plan. Report results to stakeholders and organizational leadership. Identify strategies for sustaining the change beyond your project timeline. Finally, disseminate findings through conference presentations, manuscript publication, or organizational reports — the fifth edition includes expanded guidance on manuscript preparation and publication strategies.

Appendix J is the JHNEBP Model tool specifically designed for DNP scholarly EBP projects. Developed by faculty at the Johns Hopkins School of Nursing, it bridges the gap between the general PET process and the specific requirements of a doctoral-level project.

Appendix J serves as a project management tool that summarizes the entire EBP project on a standardized template. It provides a structured, reproducible process that DNP students can follow while ensuring all required elements — from problem statement through dissemination — are documented systematically.

What Appendix J Covers

Project summary — Concise overview of the EBP project including problem, purpose, and setting
EBP question — Documentation of the refined practice question
Evidence summary — Synthesis of appraised evidence supporting the practice change
Translation plan — Site-specific action plan with timeline and responsible parties
Outcomes evaluation — Measurement plan and results documentation
Dissemination plan — Strategy for sharing findings beyond the project site

The JHNEBP Model has been used to guide DNP projects across a wide range of clinical topics. Below are examples that illustrate how the model applies to different practice settings and populations.

Example 1: Reducing Fall Rates in Long-Term Care

Practice Question: Among long-term care residents, what are evidence-based strategies to reduce fall rates?
Evidence Phase: Systematic search identified Level I–III evidence supporting multicomponent fall prevention programs including environmental modifications, medication review, exercise programs, and staff education.
Translation: Implemented a bundled fall prevention protocol across three units. Used PDSA cycles to refine the intervention. Measured fall rates, fall-related injuries, and staff compliance over 12 weeks.
Outcome: 28% reduction in fall rates with improved staff adherence to assessment protocols.

Example 2: Improving EBP Knowledge Among Hospital Nurses

Practice Question: For nurses working at [facility], will implementation of the JHNEBP Model improve attitudes, knowledge, and perceptions of EBP over 8–10 weeks?
Evidence Phase: Literature review supported educational interventions using structured EBP models to improve nurse competency. Pre- and post-intervention surveys (EBPB, EBPI, OCRSIEP) selected as validated measurement tools.
Translation: Delivered JHNEBP Model training with web-based educational modules across three nursing units (Critical Care, Behavioral Health, Medical-Surgical). Rogers’ Diffusion of Innovation theory used to support adoption.
Outcome: Statistically significant improvements in EBP beliefs, implementation behaviors, and organizational readiness scores.

Example 3: Implementing a Sepsis Screening Protocol in the ED

Practice Question: In adult patients presenting to the emergency department, does implementation of a nurse-driven sepsis screening tool improve early identification and time to treatment?
Evidence Phase: Level I and II evidence strongly supported standardized sepsis screening tools (e.g., qSOFA, SIRS criteria) for early identification. CPGs from the Surviving Sepsis Campaign provided Level IV support.
Translation: Developed and implemented an EMR-integrated screening tool with nursing education component. Measured door-to-antibiotic time, sepsis bundle compliance, and mortality rates.
Outcome: Reduced median door-to-antibiotic time from 142 minutes to 68 minutes. Sepsis bundle compliance increased from 41% to 78%.

DNP students often need to justify their choice of EBP model. This comparison highlights the key differences between the most commonly used frameworks.

Feature	Johns Hopkins (JHNEBP)	Iowa Model Revised	ARCC Model	ACE Star Model
Core approach	Problem-solving with PET process	Trigger-based organizational change	System-wide EBP culture via mentors	Knowledge transformation cycle
Toolkit included	Yes — Appendices A–J with appraisal tools, templates, and project guides	Yes — companion workbook available	Mentorship framework; limited standalone tools	Conceptual framework; no specific tools
Best for	Individual or team EBP projects, DNP scholarly projects	Organization-wide practice change initiatives	Building organizational EBP capacity	Understanding the EBP process conceptually
Evidence rating	5 levels (I–V) with A/B/C quality	Uses external rating systems	Relies on external appraisal tools	No proprietary system
DNP project support	Appendix J specifically for DNP scholarly projects	Adaptable but not DNP-specific	No DNP-specific tools	No DNP-specific tools

Common Mistakes to Avoid

Confusing EBP with research — A DNP EBP project translates existing evidence into practice. It is not designed to generate new knowledge through original research. Understanding this distinction affects your IRB application, methodology, and entire project design.
Skipping the pre-appraised evidence search — The model specifically directs teams to look for existing systematic reviews and CPGs before conducting an exhaustive literature search. This saves significant time and strengthens your evidence foundation.
Poorly defined EBP questions — A vague question leads to an unfocused search and weak recommendations. Use the Question Development Tool iteratively — expect your question to be revised multiple times.
Neglecting stakeholder engagement — The model emphasizes interprofessional collaboration from Step 1. Projects that skip meaningful stakeholder involvement face resistance during implementation.
Basing practice change on Level IV–V evidence alone — The model cautions against making practice changes without Level I–III evidence. If your evidence base is primarily Level IV–V, your recommendations should focus on awareness, education, or monitoring rather than direct practice change.
Ignoring sustainability — Step 17 explicitly addresses continuation and spread. Your project should include a sustainability plan beyond the implementation period.

Best Practices for Success

Use Appendix J from the start — It aligns your project structure with the PET process and ensures no required element is missed.
Pair the JHNEBP Model with a change theory — Many successful DNP projects combine the JHNEBP framework with Kurt Lewin’s Change Theory, Kotter’s 8-Step Model, or Rogers’ Diffusion of Innovation to strengthen the implementation component.
Request permission for the tools — The Johns Hopkins tools are copyrighted. Submit a permission request through the Institute for Johns Hopkins Nursing website before using them in your project.
Define outcome measures early — Establish your structure, process, and outcome measures during the Practice Question phase, not as an afterthought during Translation.
Document everything — The EBP Project Portfolio (Appendix I) provides a standardized format. Thorough documentation strengthens your final manuscript and supports dissemination efforts.
Cite the correct edition — Use the most current edition in your references: Bissett, K., Ascenzi, J., & Whalen, M. (2025) for the 5th edition, or Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022) for the 4th edition.

What is the difference between the Johns Hopkins EBP Model and a theoretical framework?

The JHNEBP Model is a process model — it guides you through the steps of identifying a problem, finding evidence, and translating it into practice. A theoretical or conceptual framework (like Lewin’s Change Theory or the Health Belief Model) provides the “why” behind behavior change. Many DNP projects use both: the JHNEBP Model as the EBP process framework and a separate theory to support the implementation strategy.

Do I need IRB approval if I’m using the JHNEBP Model for my DNP project?

It depends on your project design. Most EBP quality improvement projects qualify for IRB exempt status because they are designed to improve practice at a specific site rather than generate generalizable new knowledge. However, you must still submit your project to the IRB for a determination — don’t assume exemption. If you plan to publish your findings or if the project involves any potential risk to participants, a full IRB review may be required.

Can I use the Johns Hopkins tools without permission?

No. The JHNEBP tools are copyrighted by The Johns Hopkins Hospital and The Johns Hopkins University. You must complete a Copyright Permission Form through the Institute for Johns Hopkins Nursing website to receive access. Permission is typically granted for educational and clinical use. Include proper citation in your project: Bissett, K., Ascenzi, J., & Whalen, M. (2025).

How many evidence levels does the Johns Hopkins Model use?

The JHNEBP Model classifies evidence into five levels. Levels I through III represent research evidence (from RCTs down to non-experimental studies), while Levels IV and V represent non-research evidence (expert opinion, organizational experience, quality improvement data, and case reports). Each level is further rated for quality as A (high), B (good), or C (low quality/major flaws).

What is the difference between a broad and intervention EBP question in the JHNEBP Model?

A broad question is exploratory and doesn’t include a specific intervention or outcome — for example, “What are best practices for managing chronic pain in older adults?” It produces a wide range of evidence and is useful when the team has limited knowledge of the topic. An intervention question is focused and follows a PICO-like structure — for example, “In older adults with chronic pain, does cognitive behavioral therapy compared to usual care reduce pain severity over 12 weeks?” Intervention questions typically evolve from an initial broad question and evidence review.

Should I use the 4th or 5th edition of the JHNEBP Model?

The 5th edition (2025) by Bissett, Ascenzi, and Whalen is the most current version and includes expanded translation guidance, updated dissemination strategies, and refined tools. If your program requires the most recent edition, use the 5th. However, many current DNP students began their projects using the 4th edition (2022) by Dang, Dearholt, Bissett, Ascenzi, and Whalen, which remains widely referenced. Check with your faculty advisor about which edition to cite.

How do I cite the Johns Hopkins EBP Model in APA format?

5th Edition (2025):
Bissett, K., Ascenzi, J., & Whalen, M. (2025). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (5th ed.). Sigma Theta Tau International.

4th Edition (2022):
Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

References

Bissett, K., Ascenzi, J., & Whalen, M. (2025). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (5th ed.). Sigma Theta Tau International.

Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Johns Hopkins Medicine. (2025). Evidence-based practice model and tools. Institute for Johns Hopkins Nursing. https://www.hopkinsmedicine.org/evidence-based-practice/model-tools

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Whalen, M., Ascenzi, J., & Bissett, K. (2025). Navigating the Johns Hopkins EBP model, fifth edition: Translation phase. American Journal of Nursing, 125(11), 46–48.

Johns Hopkins EBP model DNP project

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