Research v. EBP v. Performance Improvement / Quality Improvement
When it comes to Clinical Inquiry, the presence or absence of evidence determines the direction the process will take. The graphic below offers additional insight. Upon examining the Clinical Inquiry Process Diagram, you will observe that your response to the question, 'Is there adequate evidence?' will dictate the path you follow.
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Research (Creation of New Knowledge) |
Evidence-Based Practice (Change in Practice) |
Performance Improvement (Process Improvement) |
|
|
Focus |
Knowledge Creation |
Evidence Translation |
Process Revision/Enhancement |
|
Gap |
Addresses gap in evidence |
Addresses gap in the translation of evidence |
Addresses gap in the current process |
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Definition |
Generate new knowledge or test an intervention or concern based on theory and uses rigorous methods (Hedges, 2006). |
The use of the best available evidence to guide decision-making in clinical practice. (Krugman, 2008). |
The process by which individuals work together to improve systems and processes with the intention to improve outcomes (Newhouse, 2007). |
|
Purpose |
Answer a question for which there is not adequate evidence. To generate new knowledge within the broader scientific community to produce knowledge that is generalized beyond the study sample (Hedges, 2006). |
To change practice in order to improve processes or patient care. Evaluate the evidence along a continuum to identify the strongest or best evidence to guide nursing practice within an organizational setting and with a specific patient population (Hedges, 2006.) |
Improve or enhance internal processes and practices within a specific patient group or organization (Hedges, 2006). To compare the organization to standards or benchmarks. |
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Problem-Solving System |
Scientific Method Qualitative or Quantitative Methods |
PICO or PICOTT SPIDER, PECODR, COPES, etc. |
Plan-Do-Study-Act (PDSA) Plan-Do-Check-Act (PDCA) |
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IRB |
Yes |
No/Yes |
No |
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Data Sources |
Primary and Secondary Data / Evidence |
Critical appraisal of internal and external sources of data |
Local practice assessment Appraisal and the use of the evidence Interpretation of Data Sources
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|
Support Resources |
Nurse Clinicians & Managers Advanced Practice Nurses Office of Clinical Research Nursing Research Advisory Council School of Nursing Nursing Research & EBP Leadership Council Office of Clinical Research |
EBP Mentors Nurse Clinician Clinical Nurse III, IV, V EBP Translation Committee Nursing Research and Evidence-Based Practice Leadership Council Nursing Interns & Scholars Program |
Nurse Clinician Nurse Manager Clinical Nurse III, IV, V Performance Improvement, Department Nursing Quality Outcomes Council |
|
Practice Impact |
Generate new knowledge for practice Add to the knowledge base |
Change practice Impact practice Translates the knowledge |
Improve patient care processes Improve processes in unit and organization Incorporates new knowledge
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Translation of Findings |
Local adoption/application at the unit or hospital level. Presentations to Units, Practice Councils and Other Hospital Groups Publications Posters Podium presentations |
Practice change that becomes hospital or unit policy. Presentations to Units, Practice Councils and Other Hospital Groups Publications Posters Podium presentations |
Standardization of practices, products, and treatments Presentations to Units, Practice Councils and Other Hospital Groups Publications Posters Podium presentations |
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Example |
Does location from the hospital impact follow up treatment for breast cancer patients? |
Positioning in the operating room to prevent pressure ulcers. Early mobilization to prevent pneumonia. |
Improvement of the discharge times of patients. Improving patient satisfaction. |
References:
Hedges, C. (2006). Research, evidence-based practice, and quality improvement. AACN Advanced Critical Care, 17 (4) 457-459.
Kloda, L. A., & Bartlett, J. C. (2013). Formulating Answerable Questions: Question Negotiation in Evidence-based Practice. Journal of the Canadian Health Libraries Association (JCHLA), 34(2), 55-60. doi:10.5596/c13-019
Kurgman, M. (2008). Evidence-based practice. Journal for Nurses in Staff Development, 137-139.
Newhouse, R. (2007). Diffusing confusion among evidence-based practice, quality improvement, and research. Journal of Nursing Administration, 37(10) 432-435.
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