Advancing Takotsubo Cardiomyopathy Management: A Comprehensive Review of Evidence-Based Practices


Takotsubo cardiomyopathy, also known as “broken heart syndrome,” is a rare and complex condition that can be triggered by emotional or physical stress. As advanced practice nurses, nurse educators, and nurse leaders, it is essential to understand the theoretical frameworks that underpin this condition and its management to provide the best care possible. In this essay, we will explore the Iowa Model as the theoretical framework for our project on Takotsubo Cardiomyopathy. The Iowa Model provides a structured approach to evidence-based practice (EBP), which aligns well with our capstone project’s goal of improving patient outcomes through evidence-based interventions.

Key Features of the Iowa Model

The Iowa Model is a widely recognized theoretical framework developed by Marita Titler and colleagues (Berger & Kichak, 2018). Its primary objective is to guide the integration of research findings into clinical practice effectively. The model emphasizes the importance of evidence-based practice and provides a systematic approach to promoting the translation of research evidence into nursing practice. The key features of the Iowa Model include a multi-step process involving problem identification, evidence synthesis, implementation, and evaluation (Titler et al., 2017).

Major Components of the Iowa Model

Trigger: The Iowa Model begins with the identification of a clinical problem or an issue in nursing practice that requires attention. In our case, the trigger would be Takotsubo Cardiomyopathy’s management and improving patient outcomes.

Evidence: The next step involves synthesizing and critically appraising the best available evidence related to the identified problem. This includes research studies, guidelines, and expert recommendations on Takotsubo Cardiomyopathy treatment and care.

Translation: The evidence gathered is then translated into specific recommendations or protocols that can be implemented in practice. This step involves developing an action plan for incorporating evidence-based interventions into clinical settings.

Integration: The translated evidence is integrated into nursing practice through education, training, and the implementation of standardized protocols. This stage involves fostering a culture of evidence-based practice among healthcare professionals.

Evaluation: The final step of the Iowa Model is evaluating the outcomes of the implemented interventions. Data is collected, analyzed, and compared with baseline measures to determine the effectiveness of the evidence-based interventions on patient outcomes.

Research Approaches Appropriate for the Iowa Model

The Iowa Model is well-suited for both quantitative and qualitative research approaches, as it involves a structured process of evidence synthesis and implementation (Johnson et al., 2020). For quantitative methods, data from patient records, pre/post-tests, and surveys can be used to assess the impact of evidence-based interventions on Takotsubo Cardiomyopathy outcomes. For qualitative methods, focus groups and interviews can help understand the experiences of patients and healthcare providers with the implemented interventions.

Quantitative/Qualitative Methods for the Project

In our capstone project on Takotsubo Cardiomyopathy, we can use various research methods aligned with the Iowa Model. Quantitatively, we can conduct pre/post-tests to assess changes in patient outcomes after implementing evidence-based interventions. Additionally, we can review medical records to gather data on patients’ treatment outcomes and compare them before and after intervention. For qualitative methods, conducting interviews with patients and healthcare providers can offer valuable insights into their experiences and perceptions of the implemented interventions.

Using the Theoretical Framework for Program Evaluation

The Iowa Model provides a structured approach for evaluating the effectiveness of evidence-based interventions. For our capstone project, we can use the model to assess the impact of evidence-based practices on the management and outcomes of Takotsubo Cardiomyopathy. By comparing pre- and post-implementation data, we can determine if the evidence-based interventions led to improved patient outcomes and enhanced nursing practices.

Critique of the Iowa Model for the Project

Resource and Time Intensive Nature
One notable critique of the Iowa Model is its resource and time-intensive nature, especially during the evidence synthesis and implementation stages (Finn, 2019). Conducting a thorough literature review and critically appraising the evidence can be a time-consuming process. Additionally, gathering data and implementing evidence-based interventions may require significant financial and human resources, which may not be readily available in all healthcare settings. As Takotsubo Cardiomyopathy is a relatively rare condition, finding sufficient high-quality evidence to support interventions specific to this condition could pose a challenge.

Limited Availability of Evidence
Another challenge that may arise while implementing the Iowa Model in our capstone project is the limited availability of evidence on Takotsubo Cardiomyopathy. Since this condition is rare, there may be a scarcity of research studies, guidelines, and expert recommendations specifically targeting Takotsubo Cardiomyopathy (Titler & Kleiber, 2021). This can make it challenging to find evidence that is directly applicable to our project’s context. In such cases, the Iowa Model may require adaptation to accommodate evidence from related conditions or a broader approach to evidence synthesis.

Overcoming Resistance to Change
Implementing evidence-based interventions often requires a shift in healthcare practices, which can encounter resistance from healthcare providers (Berger & Kichak, 2018). The Iowa Model encourages a culture of evidence-based practice, but changing established routines and protocols may be met with skepticism or reluctance from some clinicians. Overcoming this resistance to change and promoting buy-in among healthcare professionals may require additional strategies and support to ensure successful implementation.

Practicality and Feasibility
The Iowa Model’s focus on evidence synthesis and implementation might raise questions about its practicality and feasibility in real-world healthcare settings, especially for smaller clinics or under-resourced facilities (Johnson et al., 2020). While the model is well-suited for academic and research-oriented institutions, its comprehensive nature may be more challenging to apply in practice settings with limited resources. Nurse leaders and educators utilizing the Iowa Model need to consider the practicality of evidence-based interventions in their specific contexts and identify strategies to overcome barriers to implementation.

Continual Monitoring and Evaluation
The Iowa Model emphasizes the importance of evaluation to assess the outcomes of evidence-based interventions (Titler et al., 2017). However, the ongoing nature of evaluation requires dedicated time and effort for data collection and analysis, which can be challenging to sustain in busy clinical environments. It is crucial to strike a balance between ongoing evaluation and efficient use of resources to ensure that the model’s benefits outweigh its implementation costs.

In conclusion, the Iowa Model serves as a valuable theoretical framework for our capstone project on Takotsubo Cardiomyopathy, offering a systematic approach to evidence-based practice and the potential to improve patient outcomes. Despite its strengths, the model is not without its critiques. The resource and time-intensive nature of evidence synthesis and implementation, along with the limited availability of evidence on rare conditions like Takotsubo Cardiomyopathy, may pose challenges. Additionally, overcoming resistance to change among healthcare providers and considering the practicality and feasibility of evidence-based interventions are essential aspects to address during implementation. By recognizing and addressing these critiques, nurse educators, leaders, and advanced practice nurses can optimize the application of the Iowa Model in their pursuit of evidence-based, patient-centered care for Takotsubo Cardiomyopathy patients.


In conclusion, the Iowa Model provides a robust theoretical framework for our capstone project on Takotsubo Cardiomyopathy. Its structured approach to evidence-based practice aligns well with our goal of improving patient outcomes through evidence-based interventions. By identifying the problem, synthesizing evidence, translating it into practice, and evaluating the outcomes, the Iowa Model ensures a systematic and evidence-driven approach to nursing care. While the model has some limitations, its emphasis on evidence-based practice remains invaluable in the pursuit of better patient outcomes and enhanced nursing practice in the management of Takotsubo Cardiomyopathy.


Berger, J. T., & Kichak, J. P. (2018). The Iowa model of evidence-based practice: Relevance and application to critical care nursing. Critical care nursing clinics of North America, 30(3), 335-347.

Finn, P. (2019). Applying the Iowa model of evidence-based practice to improve quality of care for the elderly. Journal of gerontological nursing, 45(2), 9-12.

Johnson, M., Mant, J. W., Jones, M. C., & Williams, B. (2020). The Iowa model: A practical guide to clinical excellence. British Journal of Nursing, 29(5), 292-297.

Titler, M. G., Kleiber, C., Steelman, V., Goode, C. J., Rakel, B., Barry-Walker, J., … & Buckwalter, K. C. (2017). The Iowa model of evidence-based practice to promote quality care. Critical care nursing clinics of North America, 29(2), 169-176.

Titler, M. G., & Kleiber, C. (2021). Evidence-based practice in nursing: A guide to successful implementation. Sigma Theta Tau.