Evidence Based Practice in Home Health: Why is it nearly Impossible to Implement?

Evidence based practice (EBP) is when a nurse utilizes knowledge and experience and integrates it with current evidence based research. This integration creates wisdom and when applied to nursing practice enables quality nursing care and improvement in patient outcomes.

So why is it nearly impossible to implement EBP in home health? The organizational infrastructure of home healthcare does not support this type of nursing practice because it requires a shift from skilled nursing interventions "the act of doing" to skilled nursing assessment, planning and evaluation "the act of thought and judgment."  Supporting evidence based nursing practice means that home health organizations need to provide the following to support discovery of fact and evidence:

• Time
• Resources
• Know-how

Home health nurses need time to think and research. Currently home health organizations set daily visit productivity and visit weights to ensure the nurse is spending time in the patient home "doing" patient care. However this current staffing model does not allow the nurse the ability to step back and formulate the questions to address the patient needs and advance nursing practice. EBP requires time to formulate the questions, time to research, time to move theory to application and then time to re-evaluate.

Resources are another key element to evidence based practice. Many home health organizations are independent entities with no affiliations to medical libraries and have limited technology. Home health nurses need access to articles, periodicals, studies and other evidenced based materials. Whether the resources are retrieved from an academic medical library or subscription to an online database, home health organizations need to provide both the affiliation and technology for access to evidence based materials.

Knowing how to implement evidence based practice is the other key element. If EBP is a priority to home health organizations then continuing nurse education activities are essential. Home health nurses need support in learning how to search and retrieve information, how to assess its validity and how to re-evaluate once the evidence has been put into practice. Sharing the knowledge through publication is important because it builds the evidence to support the practice. Home health nurses need continuing education activities which help the practitioner become a scholarly writer so that others can read what practice changes are effective for a given problem and the measurable outcomes associated to the change.

While I have only identified three elements to evidence based practice, I am sure there are other factors. I look forward to learning about them during the VNAA 28th Annual Meeting pre-conference with faculty Dr. Marcia Rachel and Rebecca Askew, both published authors of the recent Home Healthcare Nurse journal article Keeping It Real: Evidence Based Practice in Home HealthCare. Stay tuned for an updated blog, hopefully with additional strategies to help home health organizations successfully implement evidence based practice. In the mean time I am including additional resources to reference.

Evidence Based Practice Resources
Web Tutorials
Yale University
Nursing Library and Information Resources
Cushing/Whitney Medical Library
http://www.med.yale.edu/library/nursing/education/ebhc2.html

Information Services Department of the Library of the Health Sciences-Chicago, University of Illinois at Chicago.
Evidence-Based Practice in the Health Sciences: Evidence-Based Nursing Tutorial
http://ebp.lib.uic.edu/nursing/

Penn State University, University Park
Evidence Based Practice Tutorial for Nurses
http://www.libraries.psu.edu/instruction/ebpt-07/index.htm

University of Minnesota
Welcome to Evidence-Based Practice: An Interprofessional Tutorial
http://www.biomed.lib.umn.edu/learn/ebp/

Web Resources
Virginia Commonwealth University
Evidence-Based Nursing Resource Guide
http://www.library.vcu.edu/tml/bibs/ebnursing.html

Agency for Healthcare Research and Quality
http://www.ahrq.gov/clinic/epcix.htm

National Guideline Clearinghouse™ (NGC)
http://www.guideline.gov/

Conferences
University of Iowa's 17th National Evidence-Based Practice Conference
http://www.uihealthcare.com/depts/nursing/rqom/evidencebasedpractice/ntlconference.html