Rosswurm and Larrabee's EBP change model starts one step earlier than most evidence-based practice models: it makes you prove a practice problem exists before you look for evidence.
From there it follows six clear steps, from noticing a problem to sustaining the fix. Step 2 is distinctive: it turns your problem into searchable, standardized language before the literature search even begins. This guide covers each step, a full worked example and the mistake most students make with Step 6.
The Six Steps in Brief
The six steps are: assess the need for change, link the problem with interventions and outcomes, synthesize the best evidence, design a practice change, implement and evaluate the change, and integrate and maintain it.
Choose this model when your capstone must build a data-backed case for a problem, compare candidate interventions and plan a pilot. Most student projects enter at Step 1, and BSN or MSN projects often stop at a planned pilot.
What Is the Rosswurm and Larrabee Model?
Mary Ann Rosswurm and June Larrabee published the model in 1999 as a structured way to move nursing practice from tradition and habit towards evidence-based decisions. It appeared as nursing units were beginning to treat evidence-based practice as an organizational responsibility.
Its defining feature is where it begins. Instead of assuming a problem has been identified, Step 1 is the formal work of establishing it: gathering internal data, comparing it with external benchmarks and naming the gap precisely.
The model also assumes a project team and organizational support from the start. That makes it a natural fit for capstones and DNP projects framed around a unit-level or organizational problem.
The Six Steps at a Glance
| Step | What it covers | Typical output |
|---|---|---|
| 1. Assess the need for change | Trigger, internal data, external benchmarks, a named problem | A defined problem backed by data |
| 2. Link problem, interventions and outcomes | Candidate interventions, measurable outcomes, standardized language | A problem stated in searchable terms |
| 3. Synthesize the best evidence | Search, appraise and weigh each candidate intervention | One preferred, evidence-supported intervention |
| 4. Design a practice change | Detailed protocol, stakeholders, resources and a pilot | A pilot plan with buy-in |
| 5. Implement and evaluate | Run the pilot; evaluate process, outcome and cost data | A recommendation to adopt, revise or stop |
| 6. Integrate and maintain | Communicate, write into policy, monitor over time | An adopted, monitored standard |
The evidence search sits in the middle, not at the start. Steps 1 and 2 exist to make sure the search is aimed at the right question rather than producing a broad, unfocused review.
Applying Each Step
Step 1: Assess the Need for Change
Start with the trigger: an incident, a drifting quality measure or a pattern noticed on the unit. Back it with internal data such as chart audits, incident reports or quality dashboards.
Then compare your data with external benchmarks, such as national rates, professional standards or published results elsewhere. This confirms the gap is real rather than a local impression. Finish with a one-sentence problem statement.
Step 2: Link the Problem with Interventions and Outcomes
Name the interventions that could plausibly close the gap and the outcome measures that would show whether each worked. Where your program expects it, express the problem, intervention and outcome in standardized terms such as NANDA-I, NIC and NOC.
This keeps the language consistent, so a literature search and a future audit both recognize the same concepts.
Step 3: Synthesize the Best Evidence
Search for evidence on each candidate intervention, appraise it and weigh it for benefit, risk and feasibility in your setting. This is where the analytical work of your literature review happens.
The aim is comparison. Rather than summarizing sources one by one, set the candidate interventions against each other on the strength of their evidence.
Step 4: Design a Practice Change
Define the chosen intervention in enough detail that someone else could carry it out. Engage the people who will deliver or be affected by it, and plan the staffing, materials and system changes it needs.
Design a pilot scaled to what you can implement and evaluate within your timeline, not a full rollout from day one.
Step 5: Implement and Evaluate the Change
Run the pilot and track what actually happened against the plan. Evaluate process data (did staff follow the protocol?), outcome data (did the measure move?) and, where relevant, cost.
End with a clear decision: adopt, revise and pilot again, or stop because the results do not support continuing.
Step 6: Integrate and Maintain the Change
Communicate the change to the people who will own it, and write it into policy, protocol or a standard of care rather than leaving it as an informal habit. Set out a monitoring plan and share results through a unit presentation, poster or article.
Worked Example: Heart Failure Readmissions
Here is how the model plays out on a realistic topic: reducing 30-day readmissions among heart failure patients discharged from a general medical unit.
Step 1, assess: audits show the unit's 30-day heart failure readmission rate running above the hospital average and above a published benchmark for similar units. Reviews of readmitted patients' charts show gaps in discharge teaching on daily weights and diuretic adjustment.
Step 2, link: two candidate interventions are named, a structured teach-back discharge protocol and a post-discharge phone call. The outcome is 30-day all-cause readmission, with patient knowledge of self-management as a secondary outcome mapped to a NOC label.
Step 3, synthesize: the appraisal finds more consistent support for structured teach-back than for phone follow-up alone. Teach-back becomes the main intervention, with a call as a lower-cost addition.
Step 4, design: a teach-back script covers daily weights, when to adjust diuretics as prescribed and warning signs that need a call to the clinic. The nurse educator and charge nurses are engaged, and an eight-week pilot is planned with staff training.
Step 5, implement and evaluate: audits show the script was used in most discharges, and readmissions for the pilot group fall compared with baseline, supporting adoption.
Step 6, integrate: the script is built into the discharge workflow and documentation template, and leaders agree a quarterly audit of documentation and readmission rates.
The data and findings are illustrative. Use your own unit's figures and your own appraisal.
Notice the scale: one unit, one pilot and an eight-week window. The student works through all six steps, but at a size that fits a capstone.
When to Choose This Model
Choose it when your program or committee wants a formal, data-backed case that a problem exists before you propose a solution. It suits capstones whose main contribution is the assessment and evidence synthesis.
It also fits programs that expect standardized nursing terminology, since Step 2 builds that in. If your project is mostly about staff resistance once a solution is chosen, pair it with a change theory such as Lewin's or Kotter's at Steps 4 and 5.
How It Compares with Other EBP Models
| Model | How it differs from Rosswurm and Larrabee |
|---|---|
| Iowa Model | Also starts from a trigger, but has no separate step for standardized language before the search, and adds explicit decision points such as whether the topic is an organizational priority |
| Johns Hopkins EBP model | Provides detailed evidence level and quality ratings for each source; Rosswurm and Larrabee describe synthesis in more general terms |
| PARIHS and i-PARIHS | Focus closely on context and facilitation during implementation, where Steps 4 and 5 here are more general |
| ACE Star Model | Traces how knowledge moves from research to practice, a broader lens than this project-focused cycle |
If a committee member asks why you chose it, point to Steps 1 and 2: the project needed to establish the problem and express it in standardized, searchable language before gathering evidence. For a full walk-through of the main alternative, see the Iowa Model guide.
Where the Model Fits in Your Capstone
| Capstone section | Corresponding step |
|---|---|
| Problem statement | Step 1: internal data, benchmarks and the defined gap |
| Literature review | Steps 2 and 3: candidate interventions and the evidence weighing them |
| Framework | The six steps explained, with your entry point and scope |
| Implementation plan | Step 4: stakeholders, resources and pilot design |
| Results and discussion | Step 5: pilot data and your recommendation |
| Sustainability | Step 6: policy integration and monitoring |
How Far Each Level Usually Goes
The six steps describe a general change process, not doctoral-only tasks. What changes between levels is how far the project travels and at what depth.
- BSN: Steps 1 to 4 at unit scale, ending with a pilot plan and a proposed evaluation.
- MSN: often through Step 4 or a short Step 5, with stronger appraisal and a budget.
- DNP: usually through Step 5 with real data, and a detailed Step 6 integration and monitoring plan.
State your entry point and stopping point plainly in the framework section. Committees care more about that clarity than about touching every step.
Common Mistakes
- Skipping the internal and external data comparison in Step 1 and jumping to a solution.
- Treating Step 2 as a repeat of Step 1 rather than naming interventions, outcomes and terms.
- Writing Step 3 as an article-by-article summary instead of comparing interventions.
- Designing a Step 4 pilot sized for a full organizational rollout.
- Reporting Step 5 results without a clear adopt, revise or stop recommendation.
- Leaving out Step 6 because the capstone ends before long-term data exists. Describe the handover and monitoring plan instead.
How NurseCapstone Helps You Apply This Model
Send your practice problem, setting, any unit data you are allowed to use and your rubric. A writer at your level drafts a model framework section and the chapters around it, applying each step to your project and stating your entry point and scope.
Use it as a reference for your own work. Free revisions within the scope of your original request are included.
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Frequently Asked Questions
Assess the need for change, link the problem with interventions and outcomes, synthesize the best evidence, design a practice change, implement and evaluate it, and integrate and maintain it.
Rosswurm and Larrabee published it in 1999 as a model for moving nursing practice towards evidence-based decisions.
Both begin with a practice trigger. Rosswurm and Larrabee add a distinct step for linking the problem to interventions, outcomes and standardized language before the evidence search.
Usually at Step 1, since assessing the need for change is how most topics are identified. Depth varies later in the cycle by program level.
Step 2 decides what to look for: candidate interventions, outcomes and terms. Step 3 finds out what the evidence says about them and picks the best-supported option.
Yes, at unit scale. A BSN project can cover the first four steps and propose how Steps 5 and 6 would work.
Describe who will own the change, how it is written into policy and how it will be monitored. You are not expected to observe months of sustained results.
Yes. Use Rosswurm and Larrabee as the overall EBP framework and a change theory to explain how staff move through the change at Steps 4 and 5.