1. Regina Taylor, MN, RN, ACNS-BC
Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice
Regina Taylor, MN, RN, ACNS-BC

2. Objectives
Differentiate between quality improvement, research and evidence based practice in nursing
Discuss strategies to ensure nurses at all levels in all areas of practice understand and can describe the differences

3. “A precursor to leading is understanding the distinct differences, yet overlapping associations between those 3 important activities.” (Newhouse, p.435)

4. Quality Improvement
“Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings.”
(Lynn, et al, 2007, p. 667*)
*= From ANCC Magnet Application Manual, 2008

5. Examples of QI Nursing Sensitive indicators Performance Measures
Compliance checks
Example: Examination of use of intervention at unit/facility level to attempt to decrease patient falls

6. Nursing Research
“A systematic search for knowledge about issues of importance to the nursing profession.” (Polit and Hungler, 1995*)

7. Example of Nursing Research
Testing of an innovation that may impact nursing practice in general (i.e. including outside of the facility), such as to prevent falls or injury from falls or pressure ulcers

8. QI or Research Research Process QI Rapid Cycle Process Plan Do Study
Act
Form hypothesis
Study protocol/Data collection
Analysis and interpretation of data
Implementation into practice
(Kring, p. 163)

9. QI or Research? Intervention Risk Audience Data source
(Reinhardt and Ray, p.5)

10. Differences Philosophical underpinning Purposes EBP value
Generalizability
Beneficiaries
Risks and Burdens
Sample Size
Instruments
Design and methods
Implementation of findings
Social acceptance
(Kring, 2008)

11. Evidence-Based Practice
“Conscious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice (adapted from Sackett, et al, 2000*)
EBP is a science-to-service model of engagement of critical thinking to apply research-based evidence (scientific knowledge) and practice-based evidence (art of nursing) within the context of patient values to deliver quality, cost-sensitive care.

12. Examples of EBP
Use of evidence-based standards from professional organization
Use of research to guide protocols
Institute for Healthcare Improvement (IHI) bundles
Specifics:
Safe patient handling
Falls prevention
Pressure ulcer prevention
Restraint free environments

13. Integration of QI, EBP, and NR
Met
Not Met
EBP
Evidence
No Evidence
NURSING RESEARCH

14. If in doubt…. Ask the experts Nurse researchers/scientists
Quality Management
Institutional Review Board
Advance Practice Nurses
Affiliated faculty

15. Strategies to ensure differentiation
Educational seminars, including
Grand Rounds (evidence based case study analyses)
Webinars
Reinforcement/Education at the bedside
Documentation:
EBP Fact Sheets
Website
Use of tools (Rating, differentiation, such as Kring, p. 167)
Journal Clubs (in person, on line)

16. Additional Strategies
Establish reasonable budget (as separate FCP or line items) for research
Start with basic education for staff: Research process, protection of human subjects, sharing your findings; enhance all staff nurses ability to evaluate research using their selected tool
Assist staff with verbalizing how research is systematically reviewed and used for evidence based practice; focus on enculturation of research and EBP
Articulate, and develop further, relationship with academic affiliates and own research staff, including MDs, regarding staff developing research skills/mentoring
Facilitate attendance at research and EBP conferences.
Assist with local research and EBP conferences

17. “Preparing the workforce involves developing competencies in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.” (Newhouse, p. 435)

18. Magnet Requirements: Educational
List continuing education programs (classroom or electronic) and the number of nurses completing each during the past 24 months. Do not include orientation or inservice education. Include programs covering…
Research, including protection of human subjects
Evidence-based practice
Application of ethical principles
Quality improvement
Data and information analysis competencies

19. Evidence Based Practice SOE
Describe and demonstrate
The structure(s) and process(es) used to evaluate existing nursing practice, based on evidence
The structure(s) and process(es) used to translate new knowledge into nursing practice.
How translation of new knowledge into nursing practice has affected patient outcomes.

20. Research SOE
Provide annual report (research efforts and presentations could be included here)
Provide a budget summary for most recent fiscal year, actual to budget, for nursing education, conference attendance, and research

21. Research SOE (cont.)
The institution’s policies, procedures (including IRB) and processes that protect the rights of participants in research (NK 2)
The credentials or related experience of all external experts and other resources used to develop and/or improve the infrastructures, capacities, and processes for evidence-based practice and research (NK4 and NK 4EO)

22. Research SOE (Cont.) Describe and demonstrate
Consistent membership and involvement by at least one (1) nurse in the governing body responsible for the protection of human subjects in research, and that a nurse votes on nursing-related protocols.
The structure(s) and process(es) used by the organization to develop, expand, and/or advance nursing research.
Nursing research studies from the past 2 years, ongoing or completed, generated from the structure(s) and process(es) above. Provide a table including:
Study title
Study status
Principal investigator name(s)
Principal investigator credential(s)
Role(s) of nurses in the study
Study scope (internal to a single organization, multiple organizations within a system independent organizations collaboratively)
Study type (replication-yes or no; qualitative, quantitative, or both). Select one (1) completed research study and respond to the four (4) criteria listed in the guidelines provided.

23. References ANCC Manual, 2008
Newhouse, R. (October, 2007). “Diffusing Confusion between Evidence Based Practice, Quality Improvement and Research.” Journal of Nursing Administration. Vol 37. No. 10,
Kring, D. (June, 2008). “Research and Quality Improvement: Different Processes, Different Evidence.” MED/SURG Nursing. Vol. 17, No. 3,
Reinhardt, A, and Ray, L. (February, 2003). “Differentiating Quality Improvement from Research.” Applied Nursing Research. Vol 16, No. 1, 2-8.

24. Regina Taylor, MN, RN, ACNS-BC
Questions?
Contact:
Regina Taylor, MN, RN, ACNS-BC
ext. 6487