title: The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting.
abstract: BACKGROUND
  There are gaps in knowledge about the extent to which home care nurses' practice is based on best evidence and whether evidence-based practice impacts patient outcomes.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the relationship between evidence-based practice and client pain, dyspnea, falls, and pressure ulcer outcomes in the home care setting. Evidence-based practice was defined as nursing interventions based on best practice guidelines.
  
  
  METHODS
  The Nursing Role Effectiveness model was used to guide the selection of variables for investigation. Data were collected from administrative records on percent of visits made by Registered Nurses (RN), total number of nursing visits, and consistency of visits by principal nurse. Charts audits were used to collect data on nursing interventions and client outcomes. The sample consisted of 338 nurses from 13 home care offices and 939 de-identified client charts. Hierarchical generalized linear regression approaches were constructed to explore which variables explain variation in client outcomes.
  
  
  RESULTS
  The study found documentation of nursing interventions based on best practice guidelines was positively associated with improvement in dyspnea, pain, falls, and pressure ulcer outcomes. Percent of visits made by an RN and consistency of visits by a principal nurse were not found to be associated with improved client outcomes, but the total number of nursing visits was.
  
  
  CONCLUSIONS
  Implementation of best practice is associated with improved client outcomes in the home care setting. Future research needs to explore ways to more effectively foster the documentation of evidence-based practice interventions.
authors.affiliation: Professor Emerita, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Doran
authors.forename: Nancy
authors.initials: N
authors.lastname: Lefebre
authors.forename: Linda
authors.initials: L
authors.lastname: O'Brien-Pallas
authors.forename: Carole A
authors.initials: CA
authors.lastname: Estabrook
authors.forename: Peggy
authors.initials: P
authors.lastname: White
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carryer
authors.forename: Winnie
authors.initials: W
authors.lastname: Sun
authors.forename: Gan
authors.initials: G
authors.lastname: Qian
authors.forename: Yu Qing Chris
authors.initials: YQ
authors.lastname: Bai
authors.forename: Mingyang
authors.initials: M
authors.lastname: Li
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000451:nursing*; D055317:Evidence-Based Practice / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010146:Pain / Q000451:nursing*; D003668:Pressure Ulcer / Q000451:nursing*; D019984:Quality Indicators, Health Care; D012044:Regression Analysis
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