chapter 5- evidence based practice

A professor is explaining the importance of the scientific method of research to a group of nursing students. Which statement by a student suggests that the student requires further explanation?

"The scientific method is without fault." "The scientific method may influence the opinions of the researcher in the final outcome."

The registered nurse is teaching a group of student nurses about quantitative nursing research. Which statement made by a student indicates effective learning?

"It focuses on statistical analysis."

The nurse finds topics for research studies in different scientific literature databases. Which source is described correctly?

AHRQ gives clinical guidelines and evidence summaries.

Critiquing the evidence is one of the most important steps in the process of implementing evidence-based practice. Which is the most important information required while critiquing evidence?

Are the findings clinically applicable?

Which aspect of Florence Nightingale's work set the stage for evidence-based practice (EBP) in nursing?

Close monitoring of the effectiveness of interventions

Which factor is an essential requirement for implementing evidence-based (EBP) in personal practice or within the health care department or organization?

Collaboration Collaboration with others provides a mechanism for implementing best practices for nursing care for personal practice, across nursing units, departments, or health care organizations.

The nurse caring for patients in an inpatient unit asks a clinical question using a PICOT format. What does C stand for in a PICOT question?

Comparison of interest

The nurse is referring to various research articles in order to acquire information about a PICOT question for which no pilot study has been done. After studying the references, the nurse finds that the evidence is not strong enough to apply in practice. What should the nurse do to investigate the PICOT question?

Conduct a pilot study.

The nurse helps a researcher to conduct a study on human subjects. The researcher obtains approvals from an institutional review board (IRB). An IRB ensures that researchers follow ethical principles, including respecting the rights of human subjects. The nurse verifies that the subject has signed the informed consent. Which criteria regarding the informed consent will the nurse explain to the subject? Select all that apply.

Consent is voluntary. The subject understands how the researcher maintains confidentiality. The subject can withdraw from the study at any time.

The nurse is providing care to a patient who is experiencing major abdominal trauma following a car accident. The patient is losing blood quickly and needs a blood transfusion. The nurse finds out that the patient is a Jehovah's Witness and cannot have blood transfusions because of religious beliefs. The nurse notifies the patient's health care provider and receives an order to give the patient an alternative to blood products. Of what is this an example?

Consideration of patient preferences and values while providing care

Which type of research explores the interrelationships among variables of interest without any active intervention by the researcher?

Correlational research

The nurse researcher is developing a research proposal and is in the process of selecting an instrument to measure anxiety. The nurse is in which part of the research process?

Designing the study

The nurse is studying the process of nursing research. Which research should the nurse classify as qualitative research?

Effectiveness of psychological counseling on the perception of stress in patients with chronic illness

Which fundamental skill is required of the nurse for safe and effective evidence-based practice (EBP)?

Evaluate the strength and relevance of research findings.

The nurse designs and conducts an informational health campaign and then measures the outcomes of the campaign. Which type of research practice did the nurse perform?

Evaluation

A group of nurses implemented a well-designed health care program focusing on the importance of immunization across many regions in the state of California. These nurses are conducting research to determine the outcome of the program in terms of the number of children receiving vaccinations. Which type of research is this?

Evaluation research

Which method refers to the use of proof to guide clinical decision-making?

Evidenced-based practice

The nurse researcher decides to complete a study to evaluate how Florence Nightingale improved patient outcomes in the Crimean War. This is an example of which type of research?

Historical

What is meant by "Magnet status"?

Hospital which has met a set of criteria that measures the quality of nursing care

The nurse is developing a PICOT question that addresses the effectiveness of hot fomentation in comparison with nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve dysmenorrheal pain. Which is the intervention of interest in this research question?

Hot fomentation

A group of nurses are evaluating the results after applying research evidence in practice. Which question addresses this evaluation?

How effective was the practice change in the clinical setting?

The nurse is developing the protocol for a research study. The nurse is referencing various research articles to develop the procedures for the study. To which section of the research articles should the nurse refer?

Methods

A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which is a nursing-sensitive outcome that the nurses should consider measuring?

Number of patients who fall and experience subsequent injury on the evening shift

Which factor differentiates research use from evidence-based practice (EBP)?

Number of studies from which evidence is drawn Research use is a subset of EBP. It is the direct application of findings from a single study, one or two studies, or a very small group of studies, to patient care. EBP involves reviewing the literature and comparing evidence from a large number of studies, or all known studies within the study subject or category, to determine which evidence is the best evidence.

Summary of EBP

Nurses make many important decisions at the patient's bedside every day. Evidence-based practice is the integration of the best available evidence combined with the nurse's clinical expertise and the patient's preferences and values, to determine the best interventions to promote positive patient outcomes. Integrating EBP into practice requires nurses to be informed about the types, relevancy, and strength of evidence. Nurses can foster EBP by becoming involved in research, which fosters professional growth and collaboration. Through the application of EBP, nurses can affect practice and improve individual and population-wide patient health outcomes.

The nurse is researching articles for a research study. Why would the nurse prefer gathering evidence from peer-reviewed articles? Choose the best answer.

The articles are reviewed by experts in the subject matter of the article.

The nurse has conducted field research and is now writing a manuscript about the study. Which information should the nurse include in the section following the conclusion?

The explanation of the application of the results in clinical settings

A research study is investigating the question, "What is the effect of the diagnosis of breast cancer on the roles of the family?" In this study the terms diagnosis of breast cancer and family roles are examples of what?

Variables

Quality improvement and risk management data

When completed, researchers will know if the intervention leads to better outcomes than the standard of care.

Archie Cochrane

a British epidemiologist, criticized health professionals for the lack of evidence to support their treatment methods. Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services is recognized as being the impetus for evidence-based medicine. Named for Cochrane, the Cochrane Library is a collection of research databases for health care. This collection includes the Cochrane Reviews, which are systematic reviews and meta-analyses that interpret the results of medical research. This research, over time, is integrated into practice guidelines and becomes evidence-based practice.

Evidence-Based Nursing

first evidence-based practice journal, 1998

III

fith level Evidence obtained from well-designed, nonexperimental, descriptive studies, such as comparative studies, correlation studies, and case studies

IIb

fourth level Evidence obtained from at least one well-designed, quasi-experimental study (situation in which implementation of an intervention is outside the control of the investigators, but an opportunity exists to evaluate its effect)

priority for patient-centered care

is always focusing on the patient's physical and emotional safety

Common barriers to evidence-based-practice include

lack of knowledge about EBP and inadequate resources to support EBP research and practice changes.

The CDC's Guideline for Hand Hygiene in Health-Care Settings

provides a review of hand-washing in health care environments and makes recommendations for improving hand hygiene practices and reducing pathogenic transmissions. Such guidelines are now applied in health care facilities worldwide. This guideline demonstrates how research was conducted, evidence based on the research was accepted as effective, and the practice became evidence-based practice.

A 55-year-old patient is diagnosed with lung cancer and has a history of smoking. To find the association between smoking and lung cancer, the nurse decides to use a case-control study. Which are the requirements of a case-control study? Select all that apply.

Two groups are required. One of the groups should have lung cancer. One of the groups should not have lung cancer.

For EBP to be safe and effective the nurse,

evaluates the strength and relevance of research findings, reviews the nurse's clinical expertise, and considers unique patient characteristics and preferences.

What is the primary product derived from nursing research?

evidence

Magnet hospitals have these qualities

-Nurses are involved in data collection and decision making in the process of delivering patient care. -The relationship between nursing leaders and staff nurses indicates appreciation and respect. -Nurses are rewarded for advancing their nursing practice. -The hospital has an appropriate mix of personnel that allows for the best patient outcomes. -The administration involves staff nurses in research-based practice through ongoing open communication and collaboration between nurses and other members of the health care team.

Implementing EBP beyond Personal Practice/ Collaborative Practice

-On the nursing unit, for an entire department, at an informational program, or at the organizational level: Collaborate with colleagues to use research on the nursing unit to influence the clinical microsystem (i.e., small, functional unit where care is provided). -Educate unlicensed assistive personnel on the importance of EBP for positive patient outcomes before delegating care. -Collaborate with administrators to use research to the larger practice community. -Participate in collaborative research as a co-researcher or participant.

Research

-a diligent, systemic inquiry or study that validates and refines existing knowledge and develops new knowledge. -Nursing research generates evidence. -Research evidence must be evaluated and critically appraised to determine the value of the evidence

Implementing EBP in Personal Practice

-interpret and use research in clinical decision-making: Incorporate EBP into individual nursing practice, and assist colleagues to incorporate research findings into their individual practices. -Collaborate with colleagues to use research when caring for the same patient on various shifts and days.

Research Use

-is the application of research findings from a single study or set of research studies to clinical nursing care. -research use differs from evidence-based practice in that it is narrower in scope than EBP. EBP also integrates theoretical background, clinical judgment, and patient preferences. Research use is a subset of EBP.

Ia

1st/ highest level Evidence obtained from meta-analysis of randomized, controlled trials

Delay for Implementation

A barrier for EBP, Implementation of clinical research into practice takes an average of 17 years. For example, the research on sudden infant death syndrome conducted in the 1970s that led to the recommendation of placing infants on their backs for sleep was not relayed to parents until the early 1990s. Such situations highlight a need for better EBP resources and an improved process for disseminating results.

Funding

A barrier to EBP, Reluctance on the part of health care organizations to fund research and subsequently make potentially costly practice changes based on the best evidence practices that come from the research review.

Quantity of Research

A barrier to EBP, The proliferation of research available to health care providers has led to an increase in the quality and quantity of medical and nursing-related evidence. It is difficult to analyze the literature in an efficient and effective manner. Health care literature with clinically applicable findings is published at a rate that is impossible for individual health care professionals to keep up.

Knowledge of Conducting EBP

A common barrier to EBP use is limited skill in conducting EBP and the ability to determine the quality of research available for review.

The nurse has to read many articles while doing research. Studying the full text of a research article to determine whether the article is relevant to the nurse's own research can be tedious. Which section of a reference article would aid the nurse in learning about the study in brief?

Abstract

Which initiative demonstrates the commitment of Magnet hospitals to evidence-based practice (EBP)?

Allowing nurses autonomy in using evidence to improve quality of care

Which characteristic defines research and differentiates it from evidence-based practice (EBP)?

Generates evidence. Research involves systematic inquiry using disciplined methods to produce evidence that validates and refines existing knowledge or develops new knowledge.

While developing a research proposal, the nurse is in the process of devising research questions and a hypothesis. Which describes this part of the research process?

Identifying the problem

When recruiting subjects to participate in a study about the effects of an exercise program on balance, the researcher provides full and complete information about the purpose of the study and gives the subjects the choice to participate or not participate in the study. Of what is this an example?

Informed consent

The nurse understands the evidence-based articles and is critiquing the available evidence. Which characteristic feature should the nurse look for in a well-written literature review?

It includes an argument about what led the author to conduct a study or report on a clinical topic.

Which statement correctly describes the literature review section in a scientific paper?

It offers detailed background of the level of science that exists about the topic.

Nurses on a pediatric nursing unit are discussing ways to improve patient care. One nurse asks a colleague, "I wonder how best to measure pain in a child who has sickle cell disease?" Which type of question is this?

Knowledge-focused trigger

The nurse who works in a newborn nursery asks, "I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding." In this example of a PICOT question, which represents "I"?

Peaceful music

A group of nurses are studying the research on nursing-sensitive outcomes. Which outcomes are nursing sensitive? Select all that apply.

Prevalence of restraint use Prevalence of pressure ulcers Patient falls with injury

What is the goal of evidence-based practice (EBP)?

Promote positive patient outcomes

A group of staff educators are reading a research study together at a journal club meeting. While reviewing the study, one nurse states that the study evaluates whether newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse's statement?

Purpose statement

The nurse researcher interviews parents of children who have diabetes and asks them to describe how they deal with their child's illness. The analysis of the interviews yields common themes and stories describing the parents' coping strategies. This is an example of which type of study?

Qualitative

The nurse administrator wants to implement evidence-based practices in a hospital and is searching for evidence on nursing practices that improve health care quality. The nurse has been referring to both research-based and non-research-based evidence. Which should the nurse administrator study in order to get non-research-based evidence?

Quality improvement and risk management data

When a hospital is awarded Magnet status, what is being recognized?

Quality nursing care

The nurse researcher conducts a study that randomly assigns 100 patients who smoke and attend a wellness clinic into two groups. One group receives the standard smoking cessation handouts; the other group takes part in a new educational program that includes a smoking cessation support group. The nurse plans to compare the effectiveness of the standard treatment with the educational program. Which type of research study is this?

Randomized controlled trial

The Cochrane Library is a collection of what type of materials?

Research databases for health care

Which statement describes research use in nursing?

Research evidence from one or two studies is applied to clinical nursing care

Which factors are integrated in evidence-based practice (EBP)?

Research findings, Delivery of quality, cost effective care, Clinical nursing expertise, and Patient preferences

Which obstacles prevent evidence-based practice (EBP) from being implemented in a health care facility?

Slow dissemination of findings Staff lack of knowledge Inadequate resources Large volume of literature

Which statement shows the steps of the research process in the correct order?

State the research problem, review the literature, and clarify operational definitions.

Which statement describes a Cochrane Review?

Systematic review or meta-analysis that interprets the results of medical research

A 55-year-old patient is diagnosed with lung cancer and has a history of smoking. To find the association between smoking and lung cancer, the nurse decides to use a case-control study. Before proceeding to implementation, the nurse should obtain informed consent from the study subjects. Which are involved in informed consent? Select all that apply.

The patient should be capable of understanding the research procedure. Informed consent ensures the patient that all the information of the study will be confidential. The patient has the right to refuse to participate at any point of time in the research.

Which topic is best suited for quantitative research?

The percentage of cardiac illness in men between 40 and 60 years of age

The nurse is learning about the characteristics of different types of research studies. Which is the chief characteristic of a case control study?

The study is performed on two groups of subjects

Evidence classification

classified by level, which refers to the strength and relevance of research findings. Levels of evidence strength are listed in descending order, meaning that the systematic review or meta-analysis of randomized, controlled trials are the highest level of evidence. For EBP to be safe and effective, nurses must be able to evaluate the strength and relevance of research findings.

Evidence-based practice

nursing practice in which the nurse systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical nursing decisions. the integration of best possible evidence with: Clinical nursing expertise, Patient values and needs, Delivery of quality, cost-effective health care

Magnet status is

recognition of quality nursing practice provided by the American Nurses' Credentialing Center (ANCC), an affiliate of the American Nurses Association (ANA). To receive this recognition, hospitals must satisfy a set of criteria designed to measure the strength and quality of nursing practice. A Magnet hospital is characterized by excellent patient outcomes based on nursing care, a high level of nursing job satisfaction, a low nurse turnover rate, and appropriate resolution of any grievances. The Magnet Recognition Program supports an evidence-based environment, which includes the nurses' autonomy to improve quality of care by using evidence. Research and EBP are, therefore, integral parts of nursing care in Magnet hospitals.

Evidence for the practice of nursing is derived from

research in nursing, medicine, health care, and disciplines outside of health care.

Ib

second level Evidence obtained from at least one randomized, controlled trial

IV

sixth/ lowest level Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities

IIa

third level Evidence obtained from at least one well-designed, controlled study without randomization.

What is the goal of evidence based practice?

to promote positive outcomes for patients. along with keeping nursing practices current and increase nurse confidence in professional nursing decisions.