Most capstone students are first handed an evidence-based practice model that starts with an existing body of appraised evidence and focuses on applying it. Rosswurm and Larrabee's EBP Change Model starts one step earlier: it asks you to formally establish that a practice problem exists and is worth changing, before it ever sends you looking for evidence.
That earlier starting point is what makes this model distinct from several of its peers. It walks a clean, six-step line from noticing a problem to actually sustaining the fix, with a specific step, Step 2, dedicated to translating your problem into searchable, standardized language before the literature search even begins.
This guide covers where the model came from, all six steps in detail, a full worked example, and the mistake most students make when applying it, treating Step 6 as optional because their capstone timeline ends before long-term monitoring data exists. For the wider landscape of EBP and change frameworks this model sits alongside, see our nursing theory and change frameworks hub. If your program's approved model list also names a broader evidence-based practice guide, our evidence-based practice paper help guide covers that wider ground.
What Is Rosswurm and Larrabee's EBP Change Model?
Rosswurm and Larrabee's EBP Change Model was introduced by Mary Ann Rosswurm and June Larrabee in a 1999 publication describing a structured, six-step process for moving nursing practice from tradition-based habit toward evidence-based decision-making. It was developed at a time when many nursing units were beginning to formalize evidence-based practice as a distinct organizational responsibility, rather than something left to individual initiative.
The model's defining feature is where it starts. Rather than assuming a practice problem has already been identified and simply needs an evidence-based answer, Rosswurm and Larrabee's first step is the formal work of establishing that a problem exists, gathering internal data, comparing it against external benchmarks, and naming the gap in specific terms before any solution is proposed.
Because the model was built around organizational change rather than a single clinician's individual decision, it assumes a project team and institutional support from an early stage, which makes it a natural fit for a capstone or DNP project framed around a unit-level or organizational practice concern.
Like most EBP models capstone students encounter, Rosswurm and Larrabee's six steps describe a universal change process rather than a set of doctoral-only tasks. What changes between a BSN, MSN, and DNP application is how much of the cycle a given project realistically completes, and at what depth, a distinction covered later in this guide.
The Six Steps of the Model
| Step | What it covers | Typical output |
|---|---|---|
| 1. Assess the Need for Change | Identify a triggering issue, gather internal data, compare it against external benchmarks, and name the specific problem | A defined practice problem backed by internal and external data |
| 2. Link the Problem With Interventions and Outcomes | Name candidate interventions and measurable outcomes, and connect the problem to standardized nursing language | A problem statement expressed in searchable, comparable terms |
| 3. Synthesize the Best Evidence | Search, critique, and weigh the evidence for each candidate intervention's feasibility, benefit, and risk | A synthesized evidence base supporting one preferred intervention |
| 4. Design a Practice Change | Define the proposed change in detail, engage stakeholders, plan resources, and design a pilot | A concrete pilot plan with stakeholder buy-in |
| 5. Implement and Evaluate the Change | Carry out the pilot, evaluate process, outcome, and cost data, and draw conclusions | Pilot results with a recommendation to proceed, revise, or stop |
| 6. Integrate and Maintain the Change | Communicate the change to stakeholders, formally integrate it into policy or protocol, and monitor it over time | An adopted, monitored practice standard |
Notice that evidence gathering, Step 3, sits in the middle of the cycle rather than at the start. The two steps before it, assessing the need for change and linking the problem to interventions and outcomes, exist specifically to make sure the evidence search that follows is aimed at the right question, not a broad, unfocused literature review.
Applying the Model Step by Step
The six steps below walk through the full cycle in order. Read the note after each one for how a typical capstone student engages with that step, since very few projects work through all six at equal depth.
Assess the Need for Change in Practice
Identify the triggering issue, an incident, a quality metric that has drifted, or a pattern noticed on the unit, and back it with internal data: chart audits, incident reports, or existing quality dashboards. Compare that internal data against external benchmarks, national rates, professional-organization standards, or published outcomes elsewhere, to confirm the gap is real and not just a local impression. State the resulting problem in one specific sentence before moving on.
Link the Problem With Interventions and Outcomes
Name the candidate interventions that could plausibly close the gap you identified, and the specific outcome measures that would show whether each one worked. Where your program expects it, connect your problem, intervention, and outcome to a standardized nursing terminology, such as NANDA, NIC, or NOC, so the question is expressed in language a literature search and a future audit can both recognize consistently.
Synthesize the Best Evidence
Search for evidence addressing each candidate intervention, critically appraise what you find, and weigh it for feasibility, benefit, and risk in your specific setting. This is where most of a capstone literature review's real analytical work happens, not simply summarizing sources one by one, but comparing candidate interventions against each other on the evidence supporting them.
Design a Practice Change
Define the chosen intervention in enough operational detail that someone else could carry it out, engage the stakeholders who will be affected by or responsible for it, and plan the resources, staffing, materials, or system changes, the change requires. Design a pilot scaled to something you can realistically implement and evaluate within your capstone timeline, rather than planning for a full-scale rollout from day one.
Implement and Evaluate the Change in Practice
Carry out the pilot as designed, tracking what actually happened against the plan. Evaluate process data, whether staff followed the new protocol as intended, outcome data, whether the target measure moved, and where relevant, cost data. Draw a clear conclusion: proceed to full adoption, revise the approach and pilot again, or stop because the evidence did not support continuing.
Integrate and Maintain the Change in Practice
Communicate the recommended change to the stakeholders who will own it going forward, and formally integrate it into a policy, protocol, or standard of care document rather than leaving it as an informal habit. Name a plan for monitoring the practice periodically after adoption, and where appropriate, disseminate the results through a unit presentation, poster, or manuscript.
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Get nursing capstone help →Why Choose Rosswurm and Larrabee's Model for Your Capstone
Reach for this model specifically when your program or committee wants to see a formal, data-backed case that a practice problem exists before you propose any solution, rather than starting from an already-assumed problem statement. It is a strong fit for a capstone whose central contribution is the assessment and evidence-synthesis work itself, not just the implementation.
It also fits especially well when your setting expects standardized nursing terminology, NANDA, NIC, or NOC, woven into your problem statement, since Step 2 builds that expectation directly into the model rather than treating it as an optional add-on. Programs that teach standardized nursing language early often pair it naturally with this model for that reason.
If your project's real story is almost entirely about staff resistance or organizational readiness once a solution is already chosen, a model built specifically around implementation context, such as i-PARIHS, or a dedicated change theory, such as Kotter's or Lewin's, will likely carry more of that story's weight at Steps 4 and 5. Many strong capstones use Rosswurm and Larrabee's six steps as the outer frame and a change theory to fill in the implementation detail.
A Worked Example: Reducing 30-Day Heart-Failure Readmissions
To make each step concrete, here is how the model plays out on a realistic capstone-style topic: reducing 30-day readmissions among heart-failure patients discharged from a general medical unit.
Assess the Need for Change. Chart audits show the unit's heart-failure 30-day readmission rate running several points above the hospital's overall average and above the published national benchmark for similar units. Chart review of readmitted patients repeatedly shows gaps in discharge teaching documentation, particularly around daily weight monitoring and diuretic adjustment.
Link the Problem With Interventions and Outcomes. The student names two candidate interventions: a structured teach-back discharge protocol and a post-discharge telephone follow-up call, and defines the outcome measure as 30-day all-cause readmission rate for heart-failure patients, mapped where relevant to a standardized outcome classification for patient knowledge and self-management.
Synthesize the Best Evidence. A search and appraisal of the literature finds consistent, moderate-to-strong evidence for structured teach-back protocols reducing readmission, and somewhat weaker, more mixed evidence for telephone follow-up alone. The synthesis recommends the teach-back protocol as the primary intervention, with a follow-up call as a secondary, lower-cost addition rather than a stand-alone solution.
Design a Practice Change. The team defines a specific teach-back script covering daily weights, diuretic self-adjustment criteria, and warning signs requiring a call to the clinic, engages the unit's nurse educator and charge nurses as stakeholders, and designs an eight-week pilot on the unit with a defined start date and staff training plan.
Implement and Evaluate the Change. Nurses deliver the teach-back script at discharge for eight weeks. Compliance tracking shows the script delivered consistently in most discharges, and the pilot's 30-day readmission rate for the cohort drops meaningfully compared with the pre-pilot baseline, supporting a recommendation to proceed toward full adoption.
Integrate and Maintain the Change. The teach-back script is written into the unit's standard discharge workflow and discharge-documentation template, with the plan reported to unit leadership and a quarterly audit of documentation compliance and readmission rate built in to confirm the change holds after the capstone itself concludes.
Notice that the student's own original contribution runs through all six steps, but at a scale realistic for a single unit and a fixed timeline, a pilot and an eight-week evaluation window, rather than a multi-year, system-wide rollout.
Rosswurm and Larrabee's Model vs. Other EBP Frameworks
| Model | How it differs from Rosswurm and Larrabee's model |
|---|---|
| Iowa Model | Also begins at a clinical trigger, but does not name a separate step for linking the problem to standardized nursing language before the evidence search. See our full Iowa Model guide. |
| PARIHS / i-PARIHS | Gives structured, multi-level attention to organizational context and facilitation during implementation, where this model's Steps 4 and 5 are comparatively general. See our full PARIHS and i-PARIHS guide. |
| ACE Star Model | Maps the full upstream path evidence travels from primary research through translation, a broader knowledge-transformation lens than this model's project-focused six steps. See our full ACE Star Model guide. |
| Johns Hopkins EBP Model | Supplies a detailed Level and Quality evidence-rating scale for individual sources, where Rosswurm and Larrabee's Step 3 discusses synthesis and weighing in more general terms. See our full Johns Hopkins EBP Model guide. |
If a committee member asks why you chose this model over an alternative, a grounded answer usually points to Steps 1 and 2: the project needed to formally establish that a problem existed and translate it into standardized, searchable language before evidence gathering began, rather than starting from an already-assumed solution.
Where This Model Fits in Your Capstone Document
| Capstone chapter | Step it corresponds to |
|---|---|
| Introduction / Problem Statement | Assess the Need for Change: internal data, external benchmarks, and the defined gap |
| Literature Review | Link the Problem, and Synthesize the Best Evidence: candidate interventions and the evidence weighing them |
| Theoretical/Conceptual Framework | Full explanation of the six-step model and where your project enters the cycle |
| Methodology (implementation plan) | Design a Practice Change: stakeholder engagement, resource planning, and pilot design |
| Results / Discussion | Implement and Evaluate the Change: pilot data and your resulting recommendation |
| Sustainability / Dissemination | Integrate and Maintain the Change: policy integration and the ongoing monitoring plan |
See our nursing theory and change frameworks hub for how this model compares with the other implementation and change frameworks covered across this cluster.
Common Mistakes When Applying This Model
- Skipping Step 1's internal-versus-external data comparison and jumping straight to a proposed solution without formally establishing the problem
- Treating Step 2 as a repeat of Step 1 instead of a distinct task: naming candidate interventions, outcome measures, and standardized terminology
- Blending Step 3's evidence synthesis with a source-by-source literature review, rather than comparing candidate interventions against each other
- Designing a pilot in Step 4 that is scoped for a full organizational rollout rather than something achievable within the capstone timeline
- Reporting Step 5's results as a closed endpoint rather than a clear recommendation to proceed, revise, or stop
- Treating Step 6 as unnecessary because the capstone ends before long-term data exists, instead of describing the integration and monitoring plan that will carry the change forward
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Frequently Asked Questions
The six steps are: assess the need for change in practice, link the problem with interventions and outcomes, synthesize the best evidence, design a practice change, implement and evaluate the change, and integrate and maintain the change. Each step produces a specific output that the next step depends on, so most capstone write-ups use these six phrases directly as section headers.
Both models start from a practice-level trigger and move through appraisal toward implementation, so they overlap in spirit. The clearest difference is Step 2, where Rosswurm and Larrabee explicitly asks you to link your problem to standardized nursing language and outcome classifications before you search for evidence, a step the Iowa Model does not name separately. Rosswurm and Larrabee's model also treats piloting the change, inside Step 4, as a distinct planning task rather than folding it into implementation.
At Step 1, almost always, since assessing the need for change is usually how a capstone topic gets identified in the first place. Where depth varies is later in the cycle. A BSN or MSN capstone often stops at a planned pilot in Step 4 or a short evaluation in Step 5, while a DNP project is expected to carry the change through Step 6, integrating it into a standing policy or protocol with a monitoring plan.
Step 2 names candidate interventions and the specific outcomes you would measure, and connects them to standardized nursing terminology so your problem is stated in searchable, comparable language. Step 3 is the separate task of actually gathering, appraising, and weighing the evidence behind those candidate interventions to decide which one the evidence best supports. Step 2 answers what should we look for; Step 3 answers what does the evidence actually say once we look.
Yes, with a scoped depth. A BSN student can work through all six steps at a single-unit scale, a small pilot and a short evaluation window rather than a system-wide rollout with a multi-year monitoring plan. The six steps describe a universal change process, not a set of doctoral-only tasks, so naming your entry point and scope explicitly is more important than which steps you technically touch.
Step 6 asks you to communicate the recommended change to the stakeholders who will own it going forward, formally integrate it into a policy, protocol, or standard of care document, and name a monitoring plan for checking that it sticks. For a capstone with a fixed end date, this usually means describing the handoff and monitoring plan in your write-up rather than personally observing months of sustained compliance, since your project window closes before that evidence exists.
Yes, and it is a common, defensible pairing. Rosswurm and Larrabee's model maps the evidence-based decision process from problem to maintained practice change, while a change theory like Kotter's eight steps or Lewin's unfreeze-change-refreeze describes how you move people and a system through that transition, most naturally at Steps 4 and 5. Naming both, this model as your overarching EBP framework and a change theory as the mechanism behind implementation, is generally stronger than stretching either model to do the other's job.
Yes. Our nursing writers can take your practice problem and setting and write a fully applied six-step section, naming your entry point and scope, synthesizing the evidence behind your chosen intervention, and building out the design, implementation, and integration steps specific to your project rather than a generic restatement of the six steps.