Ch. 13: Building an Evidence-Based Nursing Practice

12. Which is true about the literature search criteria for a meta-analysis? a. They include only published works from refereed journals. b. They include the full range of related sources based on the topic. c. They usually are narrowly focused around the research question. d. They use works from a single database to remain consistent.

ANS: C The search criteria for a meta-analysis are usually narrowly focused around the research question. The search needs to be rigorous and to include published and unpublished works that are pertinent, using varied databases.

8. A nurse studies the effects of teaching the MyPlate.gov materials to preschoolers by providing this education to preschoolers in a single day care center and then following their BMI scores over a 5-year period and comparing their scores to those of children from another day care center. In this study, which element is represented by the O in the PICOS acronym? a. BMI scores b. Five-year follow-up c. MyPlate.gov materials d. Preschoolers

ANS: A In PICOS, the O stands for outcomes, which, in this study, are the BMI measures thought to be affected by the intervention. The 5-year follow-up is part of the study design, or S. The MyPlate.gov materials are used for the intervention, or I. The preschoolers are the population, or P.

20. When using the Stetler Model of Research Utilization, the nurse researcher critically appraises the research reports to determine their soundness. Which part of the model is this? a. Phase II: Validation b. Phase III: Comparative Evaluation c. Phase IV: Translation/Application d. Phase V: Evaluation

ANS: A In the Validation phase, the researcher critically appraises the research reports to determine their soundness. In the Comparative Evaluation phase, the researcher substantiates the evidence, evaluates the fit of the healthcare setting, determines the feasibility of using research findings, and identifies concerns with current practice using the three Rs of risks, resources, and readiness. In the Translation/Application phase, the researcher plans for actual use of the research evidence in practice. In the Evaluation phase, determines the impact of the research-based change on the healthcare agency, personnel, and patients.

7. To develop a clinical question when reviewing the effectiveness of nursing interventions, the nurse will use which format? a. PICOS b. PRISMA c. Study design d. Systematic review

ANS: A PICOS (population, intervention, comparison of intervention, outcomes, and study design) is the most common format for developing a research question by nurse researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was developed in 2009 to improve the quality of reporting for systematic reviews and meta-analyses and includes 27 items to ensure that this is done. The study design is part of PICOS but, by itself, does not determine the study question. The systematic review is conducted to evaluate existing research and is generally performed when the study question is known.

10. What must a researcher describe to identify that a comprehensive, systematic literature search was conducted? a. All key search terms and databases used in the search b. A list of gray literature sources used in the review c. The date restrictions applied to the literature search d. The use of literature only from prestigious journals

ANS: A The key search terms, different databases searched, and search results need to be recorded in the systematic review and meta-analysis publications to indicate that a comprehensive search was performed. A list of gray literature sources and the data restrictions applied are important parts of the discussion about the review but do not indicate how comprehensive the search has been. Using literature only from prestigious journals can lead to bias because it may exclude other relevant sources.

19. Which is the strongest source of research and evidence for developing evidence-based guidelines? a. Meta-analyses of specifically focused research questions b. Panels of experts sharing their opinions on best practices c. Quasi-experimental studies d. Rigorous experimental studies

ANS: A The strongest source of research evidence is synthesized to develop recommendations for practice and generally comes from meta-analyses. Often consultants, other researchers, and additional expert clinicians are asked to review the guidelines as well. Although panels of experts may be asked to review the guidelines, the use of meta-analyses provides the strongest research evidence. Quasi-experimental studies, along with other studies, are included in meta-analyses to provide the strongest research evidence. Rigorous experimental studies are analyzed together in meta-analyses to provide the strongest research evidence.

1. Which of the following are true statements about the challenges to evidence-based nursing practice? Select all that apply. a. EBP requires synthesizing research evidence from randomized controlled trials (RCTs), which are still limited in nursing. b. Systematic reviews and meta-syntheses conducted in nursing also are limited when compared with other disciplines. c. All healthcare agencies and administrators do not provide the resources or support necessary for nurses to implemenIt d. More work is needed to promote the use of evidence-based guidelines with individual patients. e. Lack of support and resources for EBP include unlimited funds to support research projects.

ANS: A, D EBP requires synthesizing research evidence from randomized controlled trials (RCTs) and other types of intervention studies, which are still limited in nursing. Sometimes it is difficult to transfer research knowledge to individual patients, who respond in unique ways or have unique circumstances and values; therefore more work is needed to promote the use of evidence-based guidelines with individual patients. Systematic reviews and meta-analyses conducted in nursing also are limited when compared with other disciplines, such as medicine and psychology. Some healthcare agencies and administrators do not provide the resources or support necessary for nurses to implement EBP. Lack of support and resources for EBP include limited funds to support research projects and research-based changes in practice.

17. Which method will a researcher use to evaluate a group of qualitative studies? a. Meta-analysis b. Meta-synthesis c. Mixed-methods systematic review d. Systematic review

ANS: B A meta-synthesis is used to pool and combine findings from qualitative studies. A meta-analysis is a review of quantitative studies by statistically pooling or combining the results from these studies into a single quantitative analysis. A mixed-methods systematic review is used to evaluate a combination of quantitative and qualitative studies. A systematic review is a structured, comprehensive synthesis of the research literature to determine the best research evidence available to help determine best practice.

14. In a meta-analysis, the researcher displays a symmetrical funnel plot of the data from a group of studies. This indicates a. heterogenicity of study samples. b. limited publication bias. c. methodological bias. d. reporting bias.

ANS: B A symmetrical funnel plot indicates limited publication bias and occurs with homogeneity of study samples. Asymmetry of the funnel plot indicates publication, methodological, and reporting bias

9. Which type of research literature would be included in gray literature sources? a. Book chapters b. Dissertations c. Journal articles d. Textbooks

ANS: B Gray literature sources tend to be those that are not published and may include dissertations or theses. Book chapters, journal articles, and textbooks are all published sources.

21. Which EBP model is provided to assist nurses in determining the quality of evidence-based guidelines and the steps for using these guidelines in practice? a. The Iowa Model of Evidence-Based Practice b. The Grove Model for Implementing Evidence-Based Guidelines in Practice c. The Stetler Model of Research Utilization to Facilitate Evidence-Based Practice d. The Idaho Model of Evidence-Based Practice

ANS: B Nursing students and RNs need to assess the usefulness and quality of each evidence-based guideline before they implement it in their practice. The Grove Model for Implementing Evidence-Based Guidelines in Practice is provided to assist nurses in determining the quality of evidence-based guidelines and the steps for using these guidelines in practice. The Iowa Model of Evidence-Based Practice presents directions for implementing patient care based on the best research evidence and monitoring changes in practice to ensure quality care. The Stetler Model of Research Utilization to Facilitate EBP provides a comprehensive framework to enhance the use of research evidence by nurses in practice. The Idaho Model of Evidence-Based Practice is incorrect.

11. What is true about a meta-analysis? a. It helps to determine whether studies should be replicated. b. It identifies and appraises previous research. c. It pools results from previous studies into a single quantitative analysis. d. It replicates previous studies to confirm statistical results.

ANS: C A meta-analysis is a review of quantitative studies by statistically pooling or combining the results from these studies into a single quantitative analysis. The meta-analysis does not determine which studies need to be replicated. A systematic review is a structured, comprehensive synthesis of the research literature to determine the best research evidence available to help determine best practice. A meta-analysis examines previous studies but does not replicate previous studies.

5. The electronic database covering the English-language journal literature for nursing and allied health is known as a. PsycINFO. b. MEDLINE. c. CINAHL. d. MEDLINE with MeSH.

ANS: C CINAHL (Cumulative Index to Nursing and Allied Health Literature) is an authoritative resource covering the English-language journal literature for nursing and allied health. The database was developed in the United States and includes sources published from 1982 to the present. The American Psychological Association developed the PsycINFO database that includes professional and academic literature for psychology and related disciplines from 1887 to the present. MEDLINE was developed by the National Library of Medicine in the United States providing access to more than 11 million MEDLINE citations back to the mid- 1960s and to additional life science journals. MEDLINE with MeSH, also developed by the National Library of Medicine, provides authoritative medical information on medicine, nursing, dentistry, veterinary medicine, the healthcare system, preclinical services, and more.

3. A nurse educator explains the importance of following evidence-based practice (EBP) competencies to a group of prelicensure nursing students. Which statement by a nursing student indicates the need for further teaching? a. "Adhering to institutional review board (IRB) guidelines is recognized as an EBP competency." b. "EBP competencies involve participating effectively in appropriate data collection and other research activities." c. "Consulting with clinical experts after deciding to deviate from evidence-based protocols is necessary." d. "Reading original research and evidence reports related to area of practice is necessary."

ANS: C Consulting with clinical experts before deciding to deviate from evidence-based protocols is necessary. All other answers are accurate statements describing EBP competencies.

22. When using the Stetler Model of research utilization, the nurse researcher reviews the risks, resources, and readiness of staff associated with making changes in practice based on evidence. Which part of the model is this? a. Phase I: Preparation b. Phase II: Validation c. Phase III: Comparative Evaluation d. Phase IV: Translation/Application

ANS: C In the Comparative Evaluation phase, the researcher substantiates the evidence, evaluates the fit of the healthcare setting, determines the feasibility of using research findings, and identifies concerns with current practice using the three "Rs" of risks, resources, and readiness. In the Preparation phase, the researcher determines the purpose, focus, and potential outcomes of making an evidence-based change in practice. In the Validation phase, the researcher critically appraises the research reports to determine their soundness. In the Translation/Application phase, the researcher plans for actual use of the research evidence in practice.

23. When using the Iowa Model of Evidence-Based Practice, the nurse researcher develops a team to gather and appraise evidence. Which step of the model is this? a. Step 1 b. Step 2 c. Step 3 d. Step 4

ANS: C The Iowa Model of Evidence-Based Practice is a seven-step model that promotes the implementation of EBP by nurses in clinical agencies. Step 3 involves developing a team to gather and appraise evidence. Step 1 involves generating the question from either a problem or new knowledge. Step 2 involves determining the relevance to organizational priorities. Step 4 involves determining if the evidence answers the question.

6. What is the purpose of the PRISMA statement? a. To help researchers develop a clinical question before a review b. To help determine whether studies reviewed should be replicated c. To improve reporting of meta-analyses and systematic reviews d. To outline the abstract when reporting on meta-analyses and other reviews

ANS: C The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was developed in 2009 to improve the quality of reporting for systematic reviews and meta-analyses and includes 27 items to ensure that this is done. It is not used to develop a clinical question prior to analyses or to determine whether studies should be replicated. It is not used to outline the abstract when reporting on analyses and other reviews.

2. Which standards were developed to help nursing students develop the skills, knowledge, and attitudes needed to continuously improve quality and safety? a. EBP b. IRB c. QSEN d. ANCC Magnet

ANS: C The Quality and Safety Education for Nursing, or QSEN, project was implemented to improve prelicensure nurses' knowledge, skills, and attitudes necessary to continuously improve quality and safety in healthcare systems. EBP is evidence-based practice, which is the basis for developing practice guidelines that are grounded in the best evidence and research. IRBs are institutional review boards; whose purpose is to protect human subjects in research studies. Magnet criteria are standards for a practice model for hospitals seeking accreditation through the American Nurses Credentialing Center.

4. When addressing a healthcare question to determine best practice, the nurse identifies and appraises quality research using a structured, comprehensive synthesis of the research literature to determine the best research evidence available. This is an example of a a. literature review. b. meta-analysis. c. meta-synthesis. d. systematic review.

ANS: D A systematic review is a structured, comprehensive synthesis of the research literature to determine the best research evidence available to help determine best practice. A literature review seeks to find all literature about a topic and is not as rigorous or systematic as a systematic review. A meta-analysis is a review of quantitative studies by statistically pooling or combining the results from these studies into a single quantitative analysis. A meta-synthesis is used to pool and combine findings from qualitative studies.

18. A researcher evaluates data from a variety of studies, including those involving qualitative and quantitative research, and uses findings from qualitative studies to interpret synthesized quantitative studies. This is an example of a. meta-synthesis. b. mixed-method synthesis. c. multilevel synthesis. d. parallel synthesis.

ANS: D Parallel synthesis involves the separate synthesis of quantitative and qualitative studies, but the findings from the qualitative synthesis are used in interpreting the synthesized quantitative studies. A meta-synthesis is used to pool and combine findings from qualitative studies. A mixed-methods synthesis review is used to evaluate a combination of quantitative and qualitative studies. A multilevel synthesis involves synthesizing the findings from quantitative studies separately from qualitative studies and integrating the findings in the report.

1. Which is true about evidence-based practice? a. Evidence-based guidelines are unrelated to accreditation regulations. b. Evidence-based practice is determined only through experimental studies. c. Most nursing interventions are based on evidence-based principles. d. The use of evidence-based practice results in improved patient outcomes.

ANS: D The greatest benefits of EBP are improved outcomes for patients, providers, and healthcare agencies. The Joint Commission revised their accreditation criteria to emphasize patient care quality achieved through EBP. EBP guidelines are based on all types of research, using the best research knowledge available. Some nursing interventions are evidence based currently, but many require additional research to generate the knowledge essential for making changes in practice.

15. What is true about reporting the mean difference between two groups in a meta-analysis? a. It is a measure of differences between nominal data for the two groups. b. It is an estimate of the effect of differences between the two groups of subjects. c. It is not used to examine differences in ratio-level data. d. It is appropriate only when the same scale is used to measure outcomes.

ANS: D The mean difference is reported in a meta-analysis to identify the effect of an intervention but is appropriate only if the outcome is measured by the same scale in all the studies. It is not used to compare nominal data but is useful for ordinal and ratio-level data. It measures differences in outcomes and not subjects.

16. In a meta-analysis, a researcher wishes to examine differences in temperatures of subjects in two groups but notes that one study uses a centigrade scale and the other study uses a Fahrenheit scale. Which statistic will the researcher apply in this case? a. Dichotomous data reporting b. Funnel plot c. Mean difference d. Standardized mean difference

ANS: D The standardized mean difference is a summary statistic reported in a meta-analysis when the same outcome is measured by different scales. Dichotomous data reporting is used to describe outcome data that are noncontinuous. The funnel plot is used to provide graphic representations of possible effect sizes. The mean difference is reported in a meta-analysis to identify the effect of an intervention but is appropriate only if the outcome is measured by the same scale in all the studies.

13. A study yielding negative results is withheld for publication for several years, contributing to which type of bias? a. Citation bias b. Location bias c. Outcome-reporting bias d. Time-lag bias

ANS: D Time-lag bias occurs when results of some studies are released several years after those from other studies, meaning that the later results cannot be reported. Citation bias occurs when certain studies are cited more often than others and are more likely to be identified in database searchers. Location biases occur if studies are published in lower-impact journals and indexed in less-searched databases. Outcome-reporting biases occur when study results are not reported accurately and clearly.

25. A new research methodology (termed "bench to bedside") developed to improve the application of research evidence in practice is known as a. grounded theory research. b. historical research. c. mixed-methods research. d. translational research.

ANS: D Translational research has been termed "bench to bedside" research that involves the translation of basic scientific discoveries into practical application. Grounded theory research is an inductive technique that emerged from the discipline of sociology. Historical research examines events of the past. Mixed-methods studies include quantitative and qualitative research methods.

24. Which research discipline seeks to develop practical applications based on research knowledge? a. Meta-analysis b. Meta-synthesis c. Rigorous experimental studies d. Translational research

ANS: D Translational research is a new type of research to improve the translation of research knowledge into practice. A meta-analysis is a review of quantitative studies by statistically pooling or combining the results from these studies into a single quantitative analysis. A meta-synthesis is used to pool and combine findings from qualitative studies. Rigorous experimental studies are analyzed together in meta-analyses to provide the strongest research evidence.