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The article establishes the study aimed at investigating the relationship among evidence-based practice (EBP) and outcomes in case of client pain, dyspnea, falls and pressure ulcer found in the home care setting. In this regard EBP is set as “nursing interventions based on best practice guidelines” (Doran et al., 2014, p. 274). The research question is support by quantitative study in which data collection measures and procedures are supplied with structural and process variables as independent, which cause changes in outcome variables as dependent. The study purpose clearly addresses the health-related problem typical of contemporary home care settings in Canada and maintains the relevant methodological base to analyze the investigated EBP.
An overview of the current research literature allowed the authors to establish three hypotheses by including structural and process variables. Studying the hypotheses became possible due to a cross-sectional design revealed both as qualitative and quantitative. This type of design is germane to the study purpose, since covering different layers of the research through chart audit over a nine-month period is of great significance.
The study design relied upon protection of human subjects, which was shown in research ethics. Its approval was gained through “the university research ethics review board and each participating organizations’ internal research ethics review process” (Doran et al., 2014, p. 276). While the researchers received secondary de-identified client data, the sample included clients aged over 18 who conformed to all the characteristics performed in the statement of the research question. Specifically, the clients had to have three or more nursing visits during the analyzed period, and the visits were initiated by for-profit and not-for-profit service providers or home-making services under contract, which were chosen to cover urban, suburban and rural areas. Another criterion comprised the presence of documentation where the client’s outcomes could be registered. Finally, the absence of surgery during the course of care was taken into account.
In order to test the hypothesis, the researchers resorted to administrative databases and the organizations’ billing records as instruments to focus on structural variables. The process ones required administrative databases, evidence based nursing intervention, a chart audit tool by Doran to measure the frequency of EBP, inter-rater reliability and to determine agreement among auditors. The procedure was generally realistic and satisfactory, although the authors concluded about a low degree of inconsistency set by kappa statistic. The interventions during the study were consistently performed with respect to best practice guidelines recommendations, and in this case the independent variable was manipulated. The instruments were constantly employed across all the stages of the research in different settings of home care service organizations in which the administration, principal nurses, visiting nurses and clients participated.
The data were collected for nine months when the researchers centered on nursing intervention and client outcomes. Afterwards the data were examined through descriptive analysis and presented by mean and standard deviation. Additionally, t-tests and Q-Q plot were employed as statistical methods appropriate for measuring changes in the client outcomes and assumption of normality inherent to the structure of interaction.
As for the study results, the authors revealed nurse and client structural variables, process and output-outcome ones: dyspnea, pain, falls, pressure ulcer outcomes. The findings addressed all the aspects of the study purpose, which proved to be the first study of this kind. Namely, examining the link between EBP and client outcomes in the home care context took precedence. The authors stated that the total number of visits enhanceded client outcomes, but they analyzed the documentation used during the study and concluded about its inconsistency. In particular, there was less documentation for nursing interventions than EBP in terms of assessing client health status. The same was found with the previous research. The limitations of the study are associated with the existence of records undocumented by nurses. Besides, the use of chart audit data is restricted to unavailability of missing records or availability of incomplete data. However, these limitations can affect generalizability of the results in case of populations and settings.
The article under critique indicates practical implications with regard to quality of care to be improved when there are outcomes data which present change in a client’s condition (Doran et al., 2014, p. 281). The paper also contains implications for further research which flow directly from the findings. They stress gaps in understanding the relationship between EBP and client outcomes in home care. For instance, more exploration of organizational contextual factors is needed, as well as more accurate assessment of nursing interventions apart from chart audits. Electronic documentation in home care is likely to improve the whole investigation process.
Doran, D., Lefebre, N., O’Brien-Pallas, L., Estabrooks, C. A., White, P., Carryer, J., Li, M. (2014). The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting. Worldviews on Evidence-Based Nursing, 11(5), 274-283. doi: 10.1111/wvn.12051