1. Fowler, Susan B. PhD, RN, CNRN, CRRN, FAHA, FCNS

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Q: We want to start a new fall prevention initiative on our unit. What is the difference between quality improvement, evidence-based practice, and research?


Your project may be quality improvement (QI), an evidence-based practice (EBP) project, or research. They all start with a review of the literature and appraisal of the evidence. The question you ask is different, depending on the methodology. For example, the QI question may be: Will a fall prevention poster in the patient's living area that they can "see" and the home care staff can use for patient education decrease falls in homebound older adults? An EBP focused question asks: In homebound older adults, does use of a fall prevention poster in the patient's main living, compared with standard fall prevention practices, result in fewer falls? A research question focuses on the impact of an intervention, such as "What is the impact of a fall prevention poster in the living area of homebound older adults on falls?"


Quality improvement involves systematic and continuous actions that lead to measurable improvement in healthcare and the health status of targeted populations (U.S. Department of Health and Human Services, 2011). Key points: systematic-follows a process or steps, continuous, measurable outcomes, processes (services provided), and outcomes (patient focused). Quality improvement starts with an aim such as a reduction in falls by 50%. There are a variety of methodologies including: Plan Do Study Act, Lean, Six Sigma, and focus, analyze, develop, execute (FADE).


Evidence-based practice is described as a problem-solving approach to clinical decision-making that incorporates a search for the best and latest evidence, clinical expertise, and patient preference/values within a context of caring (Melnyk & Fineout-Overholt, 2019). Key points: Best evidence, clinical expertise, and patient preferences/values. There are a variety of EBP models, but most have similar basic steps: Identify triggering issues; Ask a PICO question; Form a team; Assemble, appraise, and synthesize the evidence; Decide if evidence is sufficient to change practice; Plan and conduct small test of change (pilot); Integrate and sustain the practice change.


Research is a diligent, systematic investigation to validate and refine existing knowledge and generate new knowledge (Gray et al., 2017). Key points: systematic, knowledge. Basic steps of the research process are 1) identification of the problem and significance to nursing, 2) review of the literature and identification of a gap in the literature, 3) application of a conceptual framework or theory, 4) determination of the methodology including population/sample, 5) collecting data and its analysis, 6) discussion of findings, and 7) dissemination of study results.


QI, EBP, and research are synergistic. Your initial thought was to conduct a research study on fall prevention strategies with a focus on visual tools, but after a review of the literature you found good quality evidence to support this intervention, so your next step is to translate those findings into practice as an EBP project. If you conducted a QI project on falls in homebound older adults and results indicated a reduction in the fall rate, the next step may be testing the intervention in other home care populations to add to generalizability of the intervention through research. All three-QI, EBP, and research contribute to the advancement of the art and science of home care practice.




Gray J. R., Grove S. K., Sutherland S. (2017). Burns and Grove's the Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence (8th ed.). Saunders Elsevier. [Context Link]


Melnyk B. M., Fineout-Overholt E. (2019). Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (4th ed.). Wolters Kluwer. [Context Link]


U.S. Department of Health and Human Services Health Research and Services Administration. (2011, April). Quality Improvement.[Context Link]