Implementing EBP in the Hospice Setting a Critical Step Toward Improving End-of-Life Care

There is considerable work to be done in relation to evidence-based practice (EBP) in hospice and palliative nursing. EBP is often the exception rather than the rule. Hospice and palliative nurses frequently struggle and lack the knowledge and skill to implement EBP. EBP improves quality of care and enhances clinical judgment in end-of-life nursing care. With each patient visit hospice and palliative nurses must continuously assess the risk and benefits associated with costs and inconveniences of treatment plans. When making clinical decisions the nurse must take into consideration the evidence associated with the treatment plan in the setting of the patient’s diagnosis, prognosis, and goals of care. EBP enhances the quality of their nursing practice, patient outcomes, and reduces costs; while taking into consideration patients’ goals.

The purpose of this project was to incorporate EBP into the nursing culture at a hospice and palliative care organization employing over 500 nurses; LPNs, RNs, and APNs. This hospice and palliative care organization is comprised of three regions including seven not-for-profit hospice affiliates, and one palliative care affiliate. In 2017 this hospice organization served 7,717 patients and families, with an average daily census of 1,467 patients. The project’s focus was on both hospice and palliative nurses’ and organizational readiness for EBP. Interventions were put into place to enhance hospice and palliative nurses understanding of EBP. Interventions included EBP education, developing EBP mentors, and EBP poster day.

There were three phases to the implementation plan. Phase I: Developing a spirit of inquiry. Phase I explained the basics of EBP which enabled the nurse to develop the knowledge and skill to begin implementing EBP. In Phase I nurses developed an understanding on how to take a clinical problem and correctly develop a PICOT question. Phase II & III: Strengthen the beliefs about the benefits of EBP. Phase II began the process of developing EBP mentors. EBP mentors encourage and support the nurse in EBP practice changes. Phase III: EBP Poster day. In Phase III nurses participated in EPB poster day by attending an EBP presentation, followed by a display of their EBP posters. EBP poster day recognized the efforts put forth in phase I and phase II.

EBP poster day incorporated Benner's novice to expert theory by having three unique poster categories. Category I: Just Getting Started, for the novice to EBP. Category I posters identified the clinical problem, developed the PICOT question, and identified the best available evidence. Category 2: EBP Project Completed, for the advanced beginner/competent in EBP. Category 2 posters displayed a completed EBP project. Category 3: Publications, for the proficient/expert in EBP. Category 3 posters displayed published EBP projects. A combined total of 19 posters were submitted. An exciting unplanned part of the EBP poster day was the interest by other disciplines to participate. EBP poster Day became an interdisciplinary event featuring EBP posters from pharmacy, medicine, respiratory, chaplains, and nurses at all levels (LPN to PhD).

EBP poster day was a day of celebration, recognizing individuals and teams for their efforts in understanding EBP. A keynote speaker delivered an EBP presentation to kick off the celebration. After the presentation, posters were on display with authors to answer questions related to their EBP poster. EBP poster day sparked excitement for continued efforts and enthusiasm of incorporating EBP into interdisciplinary practice.

Implementing EBP into hospice and palliative nursing is a critical step in improving end-of-life care for patients and families. By implementing the strategies presented in this project, this hospice and palliative care organization demonstrated the need for this important cultural shift in hospice and palliative care practice. In addition, with the implementation of conditions for participation, The Centers for Medicare and Medicaid Services require hospices to provided data which demonstrates how patient and family needs and treatment plans are assessed. A means to providing justification for the care delivered to end-of-life patients and families is through the implementation of EBP in combination with the nurse’s clinical expertise, and input from patient and families. Achieving an EBP nursing culture through the implementation of system wide strategies in the hospice and palliative setting demonstrates one hospice and palliative care's journey towards improving nurses EBP knowledge, nurses attitude towards EBP, and developing an organizational culture which values EBP.