response- DATA MANAGEMENT IN RESEARCH, QUALITY IMPROVEMENT (QI) AND EVIDENCE-BASED PRACTICE (EBP)

Jaime Katherine Reif

May 28 12:48am

Reply from Jaime Katherine Reif

Identifying Gaps in Knowledge and Practice Across Evidence Sources

Introduction

Understanding gaps in knowledge and practice is essential for developing a strong practice-focused question in a Doctor of Nursing Practice (DNP) evidence-based practice (EBP) project. Research studies are typically designed to identify gaps in scientific knowledge, whereas quality improvement (QI) and EBP projects focus on identifying gaps in clinical practice and outcomes. This discussion examines the practice gaps identified in the QI study by Khoja and Moosa (2023) and the DNP EBP project conducted by Bangura (2024). It also explains how these gaps informed the development of a practice-focused question. According to Bissett et al. (2025), identifying these gaps is a critical step in the Practice Question phase of the Johns Hopkins EBP model.

Gap in Practice in the Khoja and Moosa (2023) Study

Khoja and Moosa (2023) conducted a quality improvement study rather than a traditional research study. The purpose of their study was to improve adherence to existing evidence-based fall-prevention practices rather than to generate new knowledge. The primary practice gap identified in their study was the inconsistent implementation of established fall-prevention strategies within the clinical setting, which contributed to higher fall rates (Khoja & Moosa, 2023).

Although evidence-based interventions for fall prevention were already available, healthcare staff were not applying these strategies consistently in practice. This inconsistency created a gap between what was known to be effective and what was actually being performed in patient care. To address this issue, the authors implemented the Tailored Interventions for Patient Safety (TIPS) program, which aimed to standardize fall-prevention practices and improve staff compliance.

Gap in Practice in Bangura’s (2024) DNP EBP Project

Bangura (2024) conducted a DNP EBP project that also addressed a practice gap rather than a knowledge gap. The project focused on the inconsistent use of intentional rounding in a long-term care facility. Despite strong evidence supporting intentional rounding as an effective strategy for reducing patient falls, this intervention was not implemented consistently by nursing staff (Bangura, 2024).

This inconsistency resulted in unmet patient needs, which increased the risk of falls. Bangura (2024) identified that variability in how nurses performed rounding contributed to poor patient outcomes. To address this practice gap, the project implemented a standardized, nurse practitioner-directed intentional rounding protocol to ensure consistency and improve patient safety outcomes.

Development of the Practice-Focused Question

The development of the practice-focused question was guided by the identification of these practice gaps. According to Bissett et al. (2025), a well-developed practice question must be meaningful, measurable, and feasible to address within a clinical setting. Both the QI study by Khoja and Moosa (2023) and the EBP project by Bangura (2024) demonstrated that the primary issue was not a lack of evidence but rather inconsistent implementation of evidence-based fall-prevention strategies.

Recognizing this shared issue allowed for the formulation of a focused clinical question aimed at improving practice. The resulting PICOT question is as follows: In adult long-term care residents, how does implementing a standardized intentional rounding protocol, compared to usual care, affect fall rates over an eight-week period? This question aligns with the Johns Hopkins EBP model by emphasizing the application of evidence to improve clinical practice and patient outcomes (Bissett et al., 2025).

Evaluation and Comparison of the Studies and DNP EBP Project

Both Khoja and Moosa (2023) and Bangura (2024) identified practice gaps rather than knowledge gaps. In each case, evidence-based strategies for fall prevention were already available, but they were not implemented consistently in clinical practice. Khoja and Moosa (2023) focused on improving adherence to fall-prevention strategies through the TIPS program, while Bangura (2024) focused on standardizing intentional rounding practices.

The purpose of both projects was to improve clinical processes and patient outcomes rather than to generate new scientific knowledge. This distinguishes them from traditional research studies. The DNP EBP project builds on these findings by synthesizing evidence and focusing on improving the consistency of intervention implementation. By addressing variability in clinical practice, the project aims to reduce fall rates and enhance patient safety.

Conclusion

In conclusion, both the Khoja and Moosa (2023) QI study and Bangura’s (2024) DNP EBP project identified significant practice gaps related to the inconsistent implementation of evidence-based fall-prevention strategies. These gaps informed the development of a practice-focused question aimed at improving adherence to standardized interventions. Addressing these inconsistencies is essential for improving patient outcomes and aligns with the Johns Hopkins EBP model’s emphasis on translating evidence into clinical practice (Bissett et al., 2025).

References

Bangura, F. (2024). Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facility (Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global.

Bissett, K., Ascenzi, J., & Whalen, M. (2025). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (5th ed.). Sigma Theta Tau International Honor Society of Nursing.

Khoja, A., & Moosa, L. (2023). Impact of tailored interventions for patient safety (TIPS) to reduce fall rates. MEDSURG Nursing, 32(2), 89–93.

Niedz, B. (2024). Terminology [Video]. Walden University. https://waldenu.instructure.com

Tzeng, H.-M., & Yin, C.-Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults. Nursing Economics, 35(6), 304–313

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David Tobon

May 27 9:58pm

Reply from David Tobon

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The articles by Tzeng and Yin (2017), Khoja and Moosa (2023), and Bangura (2024) illustrate the distinct yet complementary roles of research, quality improvement (QI), and evidence-based practice (EBP) in addressing patient falls. In the research study by Tzeng and Yin (2017), the gap in knowledge centered on the lack of multi-hospital data regarding which fall prevention interventions healthcare staff perceived as most effective. Although fall prevention strategies already existed, there was limited evidence combining staff perspectives across multiple healthcare settings to help guide broader practice improvements. The QI study by Khoja and Moosa (2023) identified a gap in practice; despite having fall prevention protocols in place, their medical-surgical unit continued to experience high fall rates. This local performance gap led to implementation of the Tailored Interventions for Patient Safety (TIPS) program, which focused on improving patient engagement and individualized care planning.

The DNP EBP project by Bangura (2024) emerged from a persistent practice problem in a veterans’ long-term care facility where patient falls remained a major safety concern. Practice-focused questions in the EBP process often arise from real-world clinical issues identified in practice and are refined through stakeholder input and literature review (Bissett et al., 2025). In this case, the project translated existing evidence into a structured nurse practitioner–directed intentional rounding intervention tailored to the facility’s needs.

When evaluating the three projects, each serves a different purpose. The research study by Tzeng and Yin provided broader, more generalizable information through a quantitative survey design, although it relied heavily on staff perceptions rather than direct outcome measurement. Its strength lies in contributing foundational knowledge to the literature. The QI study by Khoja and Moosa demonstrated strong practical application by implementing a tailored intervention to improve outcomes within a specific unit. However, because it was site-specific, the findings may not be as generalizable to other healthcare settings. The DNP EBP project by Bangura demonstrated the translation of evidence into practice. The project focused on applying existing evidence to address a real clinical issue and evaluated measurable outcomes related to fall reduction.

The research question aimed to generate new knowledge that could potentially apply across multiple organizations, while the QI and practice-focused questions were narrower and centered on local improvement and evidence translation (Bissett et al., 2025). Together, these articles highlight how research builds scientific knowledge, while QI and EBP projects help translate that knowledge into meaningful improvements in patient care and safety.

 

References

Bangura, F. (2024).  Development and evaluation of a nurse practitioner–directed intentional rounding strategy, and its impact on decreasing falls in a veterans long-term care facility (Publication No. 30991997) [Doctoral dissertation, Wilmington University]. ProQuest Dissertations and Theses Global.

Bissett, K., Ascenzi, J., & Whalen, M. (2025).  Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (5th ed.). Sigma Theta Tau International Honor Society of Nursing.

Khoja, A., & Moosa, L. (2023). Impact of tailored interventions for patient safety (TIPS) to reduce fall rates.  MEDSURG Nursing, 32(2), 89–93.

Tzeng, H.-M., & Yin, C.-Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults.  Nursing Economics, 35(6), 304–313.