The Johns Hopkins Nursing Evidence-Based Practice Model organizes a project into three phases: Practice question, Evidence and Translation, known as PET.
Many EBP frameworks follow a similar order. What sets this one apart is its evidence rating tool, which gives every source a strength level and a quality grade. For a capstone committee that wants to see exactly how you weighed the evidence, that tool does much of the justification work.
The Johns Hopkins Model at a Glance
To apply the Johns Hopkins model, form a small interprofessional team and write a focused practice question. Then search internal and external evidence, rate each source from Level I to V and Quality A to C, synthesize the findings and state a recommendation.
In the Translation phase, check fit and feasibility, build an action plan, implement, evaluate against a baseline and disseminate. Most capstones use the PET labels as section headings.
What the Johns Hopkins Model Is
The model was developed in the early 2000s by nurse leaders at Johns Hopkins Hospital and the Johns Hopkins School of Nursing. It has been revised in several editions since, each updating the tools and guidance.
It was built as a practical, hospital-based tool rather than a theoretical one. It comes with standard worksheets and appraisal tools, which is why many programs adopt it: students get concrete templates rather than an abstract description.
The model assumes an interprofessional team from the first step. That makes it a natural fit for unit-level or organizational practice concerns, rather than one nurse's individual decision.
Editions differ slightly in how they number and name the steps. Use the edition and worksheets your program specifies, and cite it in APA 7th.
The Three PET Phases at a Glance
| Phase | What it covers | Typical output |
|---|---|---|
| Practice question | Team, an answerable question, scope and leadership support | A scoped question with a sponsoring team |
| Evidence | Search, appraise and rate each source, summarize, synthesize and recommend | A rated evidence table and a stated recommendation |
| Translation | Fit and feasibility, action plan, implementation, evaluation and dissemination | An evaluated practice change with a dissemination plan |
The Evidence phase asks for more structured work than most comparable models. Where others discuss appraisal in general terms, this one gives you a rating scale to apply to every source, which is what many rubrics expect to see in an appendix.
Phase 1: Practice Question
This phase lays the foundation, and a rushed version causes trouble later. It has four practical steps.
- Recruit an interprofessional team. Choose people who touch the problem directly. At capstone scale this is often you, a preceptor or unit champion, and one or two affected stakeholders such as a charge nurse or unit educator.
- Develop and refine the question. Turn the concern into a specific, answerable question, usually in PICO or PICOT form.
- Define the scope. Decide whether it covers one unit, a department or a facility, and be honest about what your timeline allows.
- Secure support and leadership. Confirm who is accountable and get the sign-off your setting requires, from a manager's approval to a formal committee review.
A question scoped too broadly for one semester is one of the most common reasons capstones stall halfway through.
Phase 2: Evidence
This is the model's most distinctive phase, and it produces the appraisal table committees expect. It has five steps.
- Search internal and external evidence. Use library databases such as CINAHL and PubMed, and also check unit policies, earlier quality data and guidelines your organization has adopted.
- Appraise level and quality. Read each source for design, sample and rigor, then rate it with the model's tools.
- Summarize each source. State the population, intervention and specific result, not just the topic.
- Synthesize the overall evidence. Describe what the sources show together, how consistent they are and where the evidence is thin or silent.
- Develop a recommendation. Say plainly whether to proceed with a change, proceed cautiously with monitoring, or gather more evidence first.
Internal evidence is often overlooked, yet it can be the most directly applicable evidence you have. A unit's own fall or infection data shows the problem in your setting.
How the Model Rates Strength and Quality
Every source gets two ratings: a Level for research design and a Quality grade for how well that study was carried out. Rating only one of them is a common error.
| Level | Type of evidence |
|---|---|
| Level I | Randomized controlled trials, experimental studies, or systematic reviews of RCTs |
| Level II | Quasi-experimental studies, or systematic reviews mixing experimental and quasi-experimental designs |
| Level III | Non-experimental studies, qualitative studies or qualitative meta-syntheses |
| Level IV | Clinical practice guidelines and consensus panel statements from expert bodies |
| Level V | Literature reviews, quality improvement and program evaluation data, financial evaluations, case reports and expert opinion based on experience |
| Quality grade | What it signals |
|---|---|
| A: High | Consistent, generalizable results, adequate sample and controls, definitive conclusions |
| B: Good | Reasonably consistent results, adequate sample, some limitations |
| C: Low or major flaws | Weak design controls, inconsistent results, no firm conclusions possible |
The two combine. A Level I, Quality A trial weighs far more in your recommendation than a Level V, Quality C case report. Most appendices show one table: citation, Level, Quality and a one-line finding.
Phase 3: Translation
Translation turns the recommendation into an evaluated practice change. It has five steps.
- Determine fit, feasibility and appropriateness. Weigh resources, priorities and timing. Strong evidence can still need to wait for a better moment.
- Create an action plan. Name who does what by when, with a timeline.
- Secure support and implement. Confirm approvals, carry out the plan and record any changes you make along the way.
- Evaluate outcomes. Measure the outcome named in your question against a defined baseline.
- Report and disseminate. State results honestly, set next steps, and share findings through a poster, presentation or manuscript.
Write-ups that claim implementation went exactly as planned read as less credible. Noting real adjustments shows you managed the change thoughtfully.
Worked Example: Reducing Urinary Catheter Days
Here is the model on a realistic capstone-scale problem: catheters left in place longer than needed on a medical-surgical unit, raising infection risk.
Practice question. The student recruits a charge nurse, the unit's infection prevention liaison and a physician assistant who writes most catheter orders. The question: among adult medical-surgical patients with an indwelling catheter, does a nurse-driven removal protocol with daily necessity criteria, compared with physician-initiated removal, reduce average catheter days? Scope: one 24-bed unit over eight weeks, with the nurse manager's support.
Evidence. The team searches published literature and internal infection data, keeping eleven sources. Three RCTs rate Level I, Quality A or B; four quasi-experimental studies rate Level II, mostly Quality B; two guidelines rate Level IV; two internal reports rate Level V. The synthesis finds strong, consistent support, and the recommendation is to implement.
Translation. The EHR already supports a daily necessity prompt, and the physician assistant agrees to pre-authorize removal within set criteria. The plan sets the criteria, two weeks of staff education and a go-live date. Average catheter days fall from a baseline of 4.1 to 2.6, and results go to a unit safety huddle with quarterly monitoring.
All figures in this example are illustrative. Your capstone must report your own setting's real data.
Each phase produces a checkable output: a scoped question, a rated table, a stated recommendation and a measured result. That specificity is what a rubric built on this model checks for.
Johns Hopkins Compared with Other EBP Models
| Model | How it differs |
|---|---|
| Iowa Model | Also team-based and organizational, but treats appraisal in general terms without a built-in rating scale |
| PARIHS and i-PARIHS | Weighs context and facilitation as separate dimensions; Johns Hopkins folds these into the fit and feasibility step |
| ACE Star Model | Traces how knowledge moves from research to practice, a broader lens than the project-focused PET sequence |
| Stetler Model | Built for an individual practitioner deciding alone, without a team from the first step |
If a committee member asks why you chose this model, point to the rating tool. It gave you a structured, teachable way to show how strong and how well conducted each source was. The Iowa Model guide is the closest comparison if you are still deciding.
When Another Model Fits Better
If the project is one nurse's decision with no team, Stetler carries that framing more naturally. If your committee wants context and facilitation analyzed in depth, PARIHS or i-PARIHS does that more directly.
Where Each Phase Sits in Your Capstone
| Capstone chapter | PET content |
|---|---|
| Introduction and problem statement | Practice question: the concern, its scope and the team |
| Literature review | Evidence: search strategy, appraisals and the rated table |
| Theoretical framework | The model explained and why a team-based, rated approach fits |
| Methods or implementation plan | Translation: fit and feasibility, action plan and implementation |
| Results and discussion | Translation: outcome data and what it means for sustaining the change |
| Dissemination | Translation: reporting, next steps and presentation plan |
Explain the model once in the framework chapter, then refer to each phase by name in later chapters.
Common Mistakes with the Model
- Giving a source a Level but no Quality grade, or the reverse
- Framing the Practice question phase as a solo decision with no team
- Summaries that state each source's topic, not its finding
- Leaving the recommendation implied instead of stating it
- Describing implementation as if nothing changed from the plan
- Stopping at evaluation and skipping dissemination
How NurseCapstone Helps with the Johns Hopkins Model
Send your practice question, the sources you have found, your rubric and your program's preferred edition of the model. A writer matched to your level builds a model section with a rated evidence table, a clear synthesis and recommendation, and a Translation plan with timeline and evaluation measures.
Use it as a reference while you write your own capstone. We never invent outcome data or clinical experiences, and free revisions within the scope of your original request are included.
Want the Model Applied to Your Project?
Send your practice question, sources and rubric. You get a model section with a rated evidence table, recommendation and action plan.
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Frequently Asked Questions
Practice question, Evidence and Translation. Many capstones use these three labels directly as section headings.
Both are team-based and organizational. Johns Hopkins adds a Level I to V strength scale and an A to C quality grade for every source, which the Iowa Model does not supply.
Usually only the core studies that drive your recommendation. Background sources often need no rating, but some rubrics want every source rated, so check yours.
The model does not require Level I evidence. Report the mix honestly and choose a cautious, closely monitored change if the evidence is weaker.
Yes. The phases and rating tools work the same at a single-unit scope with a small team.
The model sets no number. Two to four people who touch the problem directly is common at capstone scale.
The synthesis describes what the sources show together. The recommendation is the explicit next step that follows from it, and the two should be stated separately.
Use the edition your program names. Step names and worksheets vary slightly between editions.