Applying the best evidence to support nursing practice and generating new knowledge for use in practice are the hallmarks of excellence and allow practitioners to meet patient care quality and safety priorities. Although identifying a patient care problem comes easily to staff nurses, the process of clarifying the problem and channeling those ideas through to a practice change can be daunting for bedside nurses. This article provides guidance to staff nurses who want to identify a clinical problem and change practice.

Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.