NURS 700 Week 5 Discussion Board Two on EBP and Quality Improvement Example

Discussion Board Two: EBP and Quality Improvement

NURS 700 Advanced Nursing Research, Discussion Board Two

Thread by [Student Name]

The project, network and classmates replied to are composites written for a model discussion.

Before my network launches its nurse-led lung cancer screening outreach next spring, I have had to answer a question that sounds academic but has practical consequences: is the project research, evidence-based practice or quality improvement? My answer is that it is evidence-based practice carried out through quality improvement methods, and the reasons matter for how the project is approved, designed and shared. Getting the category wrong in either direction has a cost: calling research "improvement" can skip protections that patients are owed, while calling improvement "research" can bury a simple local project in months of approvals it does not need.

The three activities differ mainly in purpose. Research aims to produce new knowledge that can be generalized beyond the setting where it was gathered. Evidence-based practice starts from what is already known, judges how trustworthy it is and combines it with clinical expertise and patient preferences to change care. Quality improvement uses systematic, often rapid, local methods such as Plan-Do-Study-Act cycles to improve a specific process in a specific place. A useful contrast comes from the screening literature itself. Carroll et al. (2026) randomized 894 patients in a Colorado health system by birth month to receive or not receive a pre-visit letter encouraging a screening discussion, registered the study as a clinical trial and published it to answer a general question about whether such a nudge works. That is research. My project does something different: it takes the finding from a large trial that coordinated stepped reminders raise annual adherence and applies it, adapted for nurse delivery, in four rural clinics, with the goal of improving our own screening rates. That is evidence-based practice, and the monthly measurement and adjustment that will drive it are quality improvement.

The label has three consequences. First, oversight: because the project applies established evidence to improve local care, uses no randomization and poses minimal risk, our quality committee will review it, with a determination from the institutional review board that it is not human subjects research. Second, design: instead of a control group, the project will use run charts and an interrupted time series, which are suited to tracking change in one setting over time. Third, dissemination: if we later publish our results, we must describe them as a local improvement project and avoid claiming they prove the intervention works everywhere. Improvement reporting guidelines exist precisely so that readers can judge how much a local result might transfer, and following them would make our report useful to other rural networks without overstating it.

The line is not always sharp, and published guidance acknowledges that the same activity can be improvement in one organization and research in another depending on intent and design. If we decided midway to randomize clinics to different outreach scripts in order to publish a comparison, the project would move toward research and would need review as such. The safest habit is to decide the category before the first patient is called, and to revisit it whenever the plan changes. Proverbs observes that plans are established by counsel (English Standard Version Bible, 2001/2016, Proverbs 20:18), and seeking the quality committee's and review board's counsel early is part of planning well.

Reply to Nadia

Nadia, you described your pilot of a falls-prevention bundle on one unit as proof that the bundle works and suggested spreading it across the hospital next quarter. I would encourage you to think of your pilot as a feasibility study first. The lung cancer screening literature offers a useful example. Sharifian et al. (2026) ran a single-arm pilot of a multilevel intervention that combined a decision aid, patient reminders, notifications to physicians in the record and support for social needs. Their main questions were feasibility and acceptability, and the results were reported that way: most patients rated each component helpful, while interviews revealed barriers such as scheduling problems, insurance delays and smoking-related stigma that would shape a larger test. Without a comparison group, a single-arm pilot cannot show that an intervention caused an improvement, because rates may have been rising anyway or the unit may have had an unusually good quarter. Your falls data over twelve months before the pilot could help: if you plot the monthly fall rate as a run chart with a clear baseline, you could see whether the drop exceeds the usual variation. James counsels believers to be quick to hear and slow to speak (English Standard Version Bible, 2001/2016, James 1:19), and a pilot is a chance to listen to what the data and staff are saying before announcing a result. Would your manager support one more quarter of measurement before spreading the bundle?

Reply to Ethan

Ethan, I liked your plan to use Plan-Do-Study-Act cycles to improve diabetic eye exam completion in your clinic, and I wonder whether a structured audit and feedback tool could make each cycle sharper. Studts et al. (2026) describe a system developed in Kentucky to support high-quality lung cancer screening in community and rural settings. It includes a quantitative index covering six essential domains of screening program quality, an audit and feedback process that connects the index scores to an online resource portal, and coaching and technical assistance on request. Although it was built for lung screening, the structure would translate well to eye exams: score your process across a set of domains, such as identifying eligible patients, ordering, scheduling, completion and communicating results, then use the lowest-scoring domain to choose the next cycle's change. That would keep your cycles focused on the weakest link rather than on whatever problem seems most visible that month. It would also give you a before-and-after score to report alongside completion rates. The index in that system was paired with coaching, which suggests that scores alone may not drive change; someone has to help the team act on them. In your clinic, that might be a monthly fifteen-minute review with the medical assistant who schedules referrals. Which part of your process do you suspect is weakest right now, identifying eligible patients or getting them to the eye appointment?

References

Carroll, N. M., Maclennan, A. J., Wain, K. F., Hixon, B., Steiner, J., & Ritzwoller, D. P. (2026). Increasing uptake of lung cancer screening through a patient "nudge": A randomized pragmatic trial. American Journal of Preventive Medicine. Advance online publication. https://doi.org/10.1016/j.amepre.2026.108552

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Sharifian, M., Hoyt, M. A., Madan, A., Lee, S., Nguyen, T. Q., & Sadigh, G. (2026). Patients' and providers' perspective of a multi-level approach to improve participation in low-dose CT for lung cancer screening (Empower LCS): A mixed-methods analysis. Academic Radiology, 33(6), 2352-2360. https://doi.org/10.1016/j.acra.2026.03.014

Studts, J. L., Knight, J. R., Yates, A. R., Alexander, J. L., Damron, K. J., Barry, A. M., Studts, C. R., Brooks, M. T., & Mullett, T. W. (2026). Quality implementation of lung cancer screening system: A system to support high-quality delivery of lung cancer screening in diverse settings. Chest, 170(2), 619-631. https://doi.org/10.1016/j.chest.2025.10.050