EBP by any other name is still a rose.

Working with clinical agencies is a constant eye opener, especially when it comes to trying to implement conceptual or theoretical models in practice. This is no different for the evidence-based practice (EBP) process model. In my roles as visiting faculty at a large home care agency in New York and consultant at a community hospital in Westchester over the past 2 years, I have learned that EBP by any other name gets the job done (to improve practice and patient outcomes) and avoids semantic arguments that usually come from individuals being immersed in different paradigms or not being familiar with the jargon of research, EBP, and/or practice improvement (PI). One experience that has enlightened my view is working with nurses who are experts in and who use a practice improvement approach (see, for example, Langley, Nolan, Nolan, Norman, & Provost, 1996) to achieving desired patient outcomes-a different model than EBP but with the similar goal of improving clinical practice and patient outcomes. My PI colleagues and I have spent many hours talking about how we could integrate these two models-taking the best of each one. The jargon of each model was what got in the way. When we finally threw out the jargon and focused on the processes as helping us achieve our patient care goals, we could begin to understand each other ' s worlds and see the best of each one. The other experience was with nurses who are not familiar at all with the language or definitions of either of these models or paradigms. Working with them in EBP project groups, I realized the use of the terminology, which seems second nature to me, is often misunderstood by these nurses. Again, throwing out the jargon or model terms brought us together on the same page and has moved us forward in developing ways to improve clinical practice and, it is hoped, to positively influence patient outcomes. THE ROSE We begin the process of improving our clinical practice by noting a discrepancy between what our practice is and what we want it to be. This discrepancy is usually observed or intuited when we are not achieving the outcomes we desire, whether they be patient outcomes or system outcomes. Next we need to describe the problem using both background information from the literature and internal organizational data, for example the rate of falls per hospital unit compared to desired benchmarks and reasons for patient falls. The question to ask here is: Is this really a problem that needs our attention or is it simply an infrequent occurrence or outlier that one or two clinicians thought might be an issue? Once this internal information is analyzed, we can determine whether we can validate our practice problem. The description of the problem should include data to help us describe the extent of the problem, the affected population, and the outcomes we want to influence and/or achieve. Once we truly understand the clinical problem, we can then bring our practice questions into clear focus. Using patient falls as an example, an initial question might be: What is the most valid tool to use to assess risk for falling among hospitalized patients? This question can be used to guide an initial literature search to find information about tools that assess risk for patient falls. …