Evidence-based practice in home healthcare. A springboard for discussion.
Nursing has an increasing interest in EBP, and home healthcare nurses cannot afford to be left out of the loop. A variety of sources exist for home healthcare nurses to use in determining whether there is sufficient information for EBP. There are also various methods that can be used to develop EBP guidelines in home healthcare. Finally, home healthcare nurses have an ethical obligation to provide patient care that is effective and most likely to result in positive outcomes. Relying on tradition, intuition, and experimentation is no longer enough. It is hoped that this article will serve as a springboard, not the final word, for the development of EBP initiatives for home healthcare nurses. It is important also to "share the wealth" so that nurses and their patients can benefit. One way of doing this is to convene a group to evaluate current practice and publish the group consensus on the clinical issue of interest to home healthcare nurses. For example, Janet Steele, concerned about EBP, convenes a group of interested nurses from the agency to decide how the AHCRP guidelines can be incorporated into operations. This group rewrites the policies and procedures based on the CPGs, retrains the nursing and home care aide staff, and uses the patient information from AHCPR as the handouts for patients. Aside from the initial confusion relative to operational changes, EBP has enabled the nursing staff to be more consistent from patient to patient, and there is less confusion regarding what works for specific patient conditions. Evaluation of care 6 months after the change to EBP shows that patients have shorter times for healing, and fewer nursing visits are needed. This information is used by the agency administration in negotiations with payers on the quality of the care provided by the agency and is published in a peer reviewed journal such as Home Healthcare Nurse. Best of all, patient care no longer relies on tradition, intuition, and experimentation as colleagues throughout the country use these findings in their own agencies.
Madigan
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Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA. eam13@po.cwru.edu
D003152:Community Health Nursing / Q000592:standards*; D003195:Computer Communication Networks; D019317:Evidence-Based Medicine; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D007255:Information Services; D015399:Nursing Research; D017410:Practice Guidelines as Topic; D014481:United States; D016270:United States Agency for Healthcare Research and Quality