The Interconnected Roles of Research, Quality Improvement, and Evidence-Based Practice in Nursing

Research, quality improvement (QI), and evidence-based practice (EBP) are foundational pillars in modern nursing that collectively drive improvements in patient care, safety, and outcomes. These methodologies—while distinct in purpose and design—are interrelated and complementary, forming a continuum of inquiry and action that supports informed clinical decision-making. As Florence Nightingale demonstrated in the 1800s through her use of data to reduce mortality rates, nursing has long been rooted in scientific observation and practical application (Gray & Grove, 2020). Today, nurses continue to lead efforts in healthcare transformation by engaging in research to generate new knowledge, implementing QI initiatives to refine care delivery, and applying EBP to integrate the best available evidence with clinical expertise and patient preferences.

To illustrate how these three domains function within nursing practice, this paper examines three fall-prevention articles: a research study , a quality improvement initiative , and an evidence-based DNP project . Each represents a different approach to addressing the persistent problem of patient falls in healthcare settings, and together they demonstrate how research, QI, and EBP work collaboratively to improve care.

Understanding the Gap in Knowledge: Research Study

The research article by Tzeng and Yin (2017), titled "A Multihospital Survey on Effective Interventions to Prevent Hospital Falls in Adults," aimed to identify which fall-prevention strategies were most commonly used and perceived as effective across multiple hospitals. Employing a quantitative survey design , the researchers gathered data from numerous institutions to assess trends in fall prevention practices.

Identified Gap in Knowledge:

Despite identifying widely used interventions such as hourly rounding, bed alarms, patient education, toileting schedules, and environmental modifications, the study revealed a significant gap in knowledge : while many facilities reported using similar strategies, there was no consensus or objective evidence regarding which specific interventions were most effective in reducing actual fall rates . The findings were based largely on perception rather than measurable outcomes.

This highlights a classic gap in knowledge —the need for empirical evidence linking interventions to measurable reductions in falls, rather than just frequency of use or provider belief in their effectiveness.

Research Question:

What interventions are most commonly used and perceived as effective in preventing hospital falls?

This broad question aligns with traditional research goals of identifying patterns and generating generalizable insights.

Identifying the Gap in Practice: Quality Improvement Study

In contrast, Khoja and Moosa’s (2023) article, "Impact of Tailored Interventions for Patient Safety (TIPS) to Reduce Fall Rates," presents a quality improvement initiative focused on adapting and testing fall-prevention strategies within a medical-surgical unit.

Identified Gap in Practice:

The authors identified a gap in practice : despite existing evidence supporting certain fall-prevention strategies, those strategies were not being consistently or effectively applied within their unit. Staff lacked standardized protocols, risk assessments were inconsistent, and environmental modifications were underutilized.

Through iterative testing using the PDSA (Plan-Do-Study-Act) model , the team implemented customized interventions such as staff training, patient risk assessments, and environmental adjustments, resulting in a measurable reduction in fall incidents.

Practice Improvement Question:

How can we reduce fall rates through tailored interventions in our unit?

This question reflects the local, context-specific focus of QI, emphasizing adaptation and implementation over generalization.

Formulation of the Practice-Focused Question: DNP EBP Project

Bangura’s (2024) DNP project, "Development and Evaluation of a Nurse Practitioner–Directed Intentional Rounding Strategy, and Its Impact on Decreasing Falls in a Veterans Long-Term Care Facility," exemplifies how evidence-based practice integrates research and QI to address real-world clinical problems.

Emergence of the Practice-Focused Question:

According to Dang et al. (2021), the development of a practice-focused question in EBP follows a structured process outlined in T