The Pulse | Friday, June 17, 2022
Quality Improvement, Evidence-Based Practice and Research: Which Is Right For You?
Have you ever wanted to undertake a process improvement in your clinical area, or questioned age-old practices but weren’t sure where to look for evidence? Perhaps you are really motivated and want to discover new information or science. It’s an exciting idea that one person or a small group working together can change the shape of healthcare. You can make it a reality.
In this article, we’ll investigate ways to drive your nursing practice forward through three methods: quality improvement, evidence-based practice (EBP) and research. There are many frameworks for accomplishing these projects, but for the purpose of this article, we will only address a few.
Quality Improvement Projects
The easiest way to get your feet wet is with a quality improvement (QI) project. Quality improvement is typically data-driven and seeks to increase the value of patient care without compromising on safety. Most of these projects are driven by the Institute of Medicine’s framework, which identifies six healthcare aims: safety, efficacy, patient-centered, timeliness, efficiency and equity (AHRQ, 2018).
Examples of potential projects include reduction in hospital readmissions, improved first-case start times, decreased room turnover time, etc. Here are the basic steps to follow:
- Identify a system structure that is weak or an opportunity for gold standard process improvement
- Collect data specific to your problem
- Set a measurable goal for your project in collaboration with stakeholders; work with them to identify and implement a process to achieve your goal
- Monitor data for a period after the project to ensure the goal is being met; tweak the interventions as necessary to reach the goal or outcome.
In short, quality improvement projects are facility-tailored and process or system-centered endeavors to increase the value of care provided to our patients.
A second method used to update the provision of healthcare is via evidence-based practice. Nursing evidence-based practice is defined by Eastern Illinois University as “an integration of research evidence, clinical expertise and a patient’s preferences.” EBP begins with a practice question, often in the format of Population, Intervention, Comparison and Outcome (PICO). An example of a PICO question in endoscopy could be: Does capnography decrease the incidence of over-sedation in adult patients under moderate sedation compared to pulse oximetry? With the PICO framework, you would answer in the following way:
Population: Adult under moderate sedation
Comparison: Pulse oximetry
Outcome: Decreased incidence of over-sedation
Once you’ve framed your PICO question, you will search databases such as OVID, Ebscohost, Cochrane Library, PubMed or, at the very least, Google Scholar. Next, check which professional databases your employer or university provides access to. Reach out to your CNS, educator or EBP council for help with literature search strategies as needed. These individuals and committees will also be able to tell you which EBP framework/model they utilize. There are several models: The Johns Hopkins Nursing EBP Model, Iowa Model of EBP, Stetler Model and Ottawa Model of Research Use, to name a few.
It is necessary to follow a framework because it organizes your project and guides you through decision making from the development of your question to dissemination of your information. The beauty of EBP is that it enables bedside nurses to transition research findings into clinical practice, which improve patient outcomes and/or improve our work environment.
Lastly, there are times you may want to identify best practices or validate current practices, but literature searching yields minimal to no evidence. In this case, it is time to delve into research.
Research is carried out systematically to acquire new knowledge. It is defined as a systematic investigation to develop or contribute to generalizable knowledge (Health and Human Services, 2018), and starts with a question or an observation. A hypothesis is developed, and a rigorous experimental process proceeds to validate or nullify the hypothesis. If the research project has the potential to impact patients in any way, it will be reviewed by an Institutional Review Board (IRB).
The IRB serves to protect the rights and well-being of study participants, and consequently has the authority to approve, require changes or disapprove a research proposal. Regardless of whether the study is qualitative or quantitative in nature, statistics will be applied to provide a measurement of the findings, and thus enable reasoning. A statistician is often employed to assist with study design and analysis of the findings. Once this is complete, the research is professionally written and generally contains an abstract, methodology, findings, data interpretation and recommendations.
A quantitative research example: A clinical trial to evaluate the efficacy of an unlicensed drug for treatment of a specific disease.
A qualitative research example: The impact of COVID-19 on nurses’ perception of work environment, burnout and stress.
QI, EBP and research are avenues that help shape your clinical practice. If you have clinical questions or ideas, please consider reaching out to your supervisor for support in undertaking a project. Your projects, no matter how small or broad, can be written as scholarly articles and are welcome for submission to the Gastroenterology Nursing journal. Check out the following list of resources and references for more detailed information.
Agency for Healthcare Research and Quality. November 2018. Six Domains of Health Care Quality. https://www.ahrq.gov/talkingquality/measures/six-domains.html
Eastern Illiniois University (2022). Why is evidence based practice in nursing so important? Retrieved from: https://learnonline.eiu.edu
Health and Human Services Protection of Human Subjects, 45 C.F.R. 46.102 (2018).
Squire. (2020) Revised Standards for Quality Improvement Reporting Excellence: SQUIRE 2.0. Retrieved from: SQUIRE | SQUIRE 2.0 Guidelines (squire-statement.org)
Thomas L. Christenbery, ed (2017). Evidence-Based Practice in Nursing: Foundations, Skills, and Roles. Springer Publishing Company. DOI: 10.1891/9780826127594
This article was written by Beth Collins, on behalf of the SGNA 2022 Research Committee. The Research Committee supports and evaluates GI/endoscopy research to further the knowledge of the GI/Endoscopy nurses and associates and encourages the conduct of research studies. Learn more about SGNA's committees online here.