Claywell ch 8

20. Characteristics of a quantitative study include all of the following except: a. clarifies underlying assumptions. b. asks who, what, why, where, when, or how. c. describes the relationship between variables. d. is highly structured and controlled.

ANS: A A quantitative study asks the question who, what, why, where, when, or how and attempts to describe the relationship between one variable and another. A quantitative study plan is also highly structured and controlled. A qualitative study tries to clarify underlying assumptions that are vague or unclear by asking what the perceptions, beliefs, or tenets are within a particular setting.

2. The chief purpose of evidence-based practice is to: a. offer a problem-solving approach to systematically research clinical evidence directed toward a specific patient problem. b. prepare the nurse to conduct specific research in patient care practices. c. prepare the nurse for employment in an evidence-based research center. d. research clinical evidence that covers the entire aspect of a specific problem.

ANS: A Evidence-based practice (EBP) is the integration of the best available evidence, combined with clinical expertise, which enables health practitioners of all varieties to address health care questions with an evaluative and qualitative approach. EBP preparing the nurse to conduct specific research in patient care practices reflects too narrow a scope for research. EBP preparing the nurse for employment in an evidence-based research center has no basis for requiring evidence-based research. EBP to research clinical evidence that covers the entire aspect of a specific problem is incorrect.

14. A nurse manager attempts to explain why the greatest number of medication errors occurs during the evening shift. The nurse manager chooses a quasi-experimental design to study this relationship. Why did the nurse manager choose this type of research design? a. It does not allow for complete control over the variance. b. It allows for randomization. c. It allows for control over the independent variable. d. It requires manipulation of the variable.

ANS: A In quasi-experimental designs, strict control is not possible. Allowing for randomization and for control over the independent variable and requiring the manipulation of the variable are true of experimental studies.

9. The process of understanding and applying researched clinical evidence to nursing practice requires the nurse to become information literate. Which action by the nurse best describes the use of information literacy? a. Identifies a specific clinical problem, accesses appropriate resources, and assesses the relevancy of use of information for that particular patients problem b. Identifies a particular patient problem and immediately notifies the physician and family for treatment c. Identifies the lack of research skills and consults a librarian for a workshop on conducting research studies d. Identifies the lack of research skills and consults a scientific researcher to teach basic computer information

ANS: A Information literacy is a fundamental skill that the nurse must develop. Information literacy is defined as the ability to recognize when information is needed and have the ability to locate, evaluate, and effectively use the information. Identifying a particular patient problem and immediately notifying the physician and family for treatment address direct patient care rather than nursing research. Identifying the lack of research skills and consulting a librarian for a workshop on conducting research studies and identifying a lack of research skills and consulting a scientific researcher to teach basic computer information incorrectly focus on the lack of research skills.

1. The American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program for hospitals to address quality patient care. What is the significance of achieving magnet status? a. Excellence in quality patient care and recruitment and retention of nurses b. Excellence in research, patient care, and retention of physicians c. Excellence in recruiting nurses, early discharge, and effective billing d. Excellence in recruitment and retention of ancillary caregivers

ANS: A Magnet recognition is one of the many responses to the call for quality of care of the ANCCs Magnet Recognition Program. The significance of achieving Magnet status indicates a hospital that succeeded in creating an atmosphere that nurtures evidence-based practice in nursing practice. The nurses are free to exercise professional autonomy. The particular hospital becomes known for its excellence in quality effective and efficient nursing care. Physician retention, early patient discharge, effective billing, and ancillary caregivers are not criteria for Magnet status.

8. If you had access to the following databases for your research, which would you choose to review clinical trials on effective smoking cessation therapies? a. The Cochrane Library b. HealthStar c. Medline d. InfoPOEMS

ANS: A The Cochrane Database of Systematic Reviews is one of the most popular databases in the Cochrane Library. It evaluates individual clinical trials and condenses systematic reviews from more than 100 medical journals. The database provides an efficient method of interpreting the results of many studies. HealthStar includes published literature from journals, book chapters, and government documents on clinical and nonclinical aspects of health care delivery. Medline is the largest biomedical research literature database (more than 10 million references) for general information. Medline compiles information from Index Medicus, Index to Dental Literature, and International Nursing Index. InfoPOEMs (Patient-Oriented Evidence that Matters) is a clinical awareness system that allows health care practitioners to access the most current, concrete medical information available.

11. What is the relationship between the design and layout when creating a critical appraisal tool? a. Design and layout differ but measure the same areas. b. Design and layout differ, and reliability measures differ. c. Design, layout, and reliability are similar but relevancy differs. d. Design, layout, and reliability differ but trustworthiness is the same.

ANS: A The nurse remembers the three basic questions that are universal for any type of research study. Critique appraisal tools differ slightly in design and layout, but each tool asks these same questions of the research study: (1) Is it worth looking at the results of this study, and can I trust the results (reliability)? (2) What are the results? (3) Are the results relevant for the patient? Design and layout differ, and reliability measures differ and Design, layout, and reliability are similar but relevancy differs are incorrect because each critical appraisal tool asks the same questions of the research study. Design, layout, and reliability differ but trust worthiness is the same is incorrect because trustworthiness has nothing to do with appraising research studies.

3. Which statement reflects an important principle to be applied by the nurse who is developing a relevant clinical question regarding a specific patient concern? a. The type of question will determine which resources to access. b. A systematic approach determines which questions will be asked. c. The clinical question is formulated at the conclusion of the literature search. d. Background questions are identified at the conclusion of the literature search.

ANS: A The type of question helps determine the resources to access to answer the question. Developing the clinical question is the most important step in the evidence-based process. The RN must develop a clinical question that encompasses the key components to ensure that the question addresses an answerable concern that can be converted into relevant application. To find that research efficiently, the clinician must ask a well-designed clinical question with all the elements that will lead to finding relevant research literature. A systematic approach that determines which questions will be asked is incorrect. All evidence-based research is a systematic approach. Formulation of the he clinical question at the conclusion of the literature search and identification of the background questions at the conclusion of the literature search are stated in the wrong order of the research process.

5. Can you explain how the nurses use of PICO helps to formulate an effective clinical question? a. PICO organizes the elements that guide the clinical question. b. PICO formulates an answer to the clinical question. c. PICO explains the hierarchy of evidence. d. PICO identifies the strength of the evidence.

ANS: A Using the PICO approach allows for a systematic method of identifying important concepts when formulating the clinical question. Although every component of the PICO model may not be used in every case, PICO is an acronym used to describe a format of the four elements required to formulate a good clinical question (P, patient or problem; I, intervention; C, comparison; O, outcomes). PICO questions do not formulate answers, nor do PICO questions have anything to do with evidence.

2. What characteristics support evidence-based practice (EBP)? (Select all that apply.) a. The nurses clinical experience is fundamental to the evidence-based practice process. b. Evidence-based practice provides a theoretical framework for accuracy and safety in patient care. c. Evidence-based practice involves the use of a holistic approach to patient care in health care. d. Evidence-based practice is designed to create a generic plan of patient care in clinical settings. e. Evidence-based practice allows the nurse autonomy in patient care because research proves success.

ANS: A, B, C EBP is problem-solving in its approach, which takes into account the clinical experience of the nurse. Clinical experience refers to the nurses ability to use clinical skills and past experience to identify the patients health state, diagnosis, and the risks and benefits of the prospective interventions. EBP combines researched evidence with knowledge and theory. The use of patient-centered researched evidence allows for accuracy and precision of diagnostic tests and prognosis markers, in addition to the effectiveness and safety of therapeutic treatment. EBP allows for patients values to be expressed and incorporated into treatment regimens. Patients bring their individual preferences, concerns, and expectations to the clinical setting. The statement that EBP is designed to create a generic plan of patient care in clinical settings is incorrect because a patients plan of care should always be individualized and never generic. EBP does not authorize autonomy for any nursing professional.

3. Research studies must be scrutinized to be deemed credible and trustworthy. Choose all the strategies that may be used to critically appraise a research study. (Select all that apply.) a. Examine the validity of the research. b. Look at the reference list of the study. c. Look for criteria of inclusion. d. Look for use of PICO format. e. Examine the credentials of the authors. f. Look for a proper sample size.

ANS: A, B, C Examining the validity of the research, looking at the reference list of the study, and looking for criteria on inclusion are all strategies that can be used to appraise research studies critically. PICO is an acronym used to describe one format that includes four elements needed to construct a good clinical question. Looking for the PICO format and looking for a proper sample size are not strategies for critically appraising research studies.

5. What are the problems with variables? (Select all that apply.) a. Vary from subject to subject b. Determined through statistics c. Difficult to account for them d. Challenging to explain in relation to the study topic e. Testing whether a correlation exists between results

ANS: A, C, D A variable is a concept, idea, or attribute that is captured and defined within a research study. Variables vary from subject to subject, as with height and weight. Researchers attempt to control the variables, statistically account for them, or explain them in relation to what is being studied. Variables are not determined through statistics, nor do they test for correlations.

1. Which of the following are most responsible for the emerging use of evidence-based practice (EBP) in health care? (Select all that apply.) a. Accountability by consumers of governmental and health care agencies b. Introduction of national health care guidelines c. Shorter implementation time of new research d. Variability of care among health care practitioners and facilities e. Similarity with other science disciplines and their amounts of research f. Eligibility to receive government grants for research excellence

ANS: A, D Economic factors, the variability of care, and the rising cost of health care have been the driving force in the call for EBP. Consumers and governmental agencies are insisting on transparency, accountability for effectiveness, and efficiency in health care. EBP began before the introduction of national health care guidelines. Shorter implementation time of new research is irrelevant in the use of EBP. Similarity with other sciences and their amounts of research and eligibility to receive government funding for research excellence are incorrect.

7. The nurse wants to know how similar the 7-minute screen (7MS) is to the Mini-Mental State Examination (MMSE) in accurately screening for dementia. Can you distinguish the correct clinical question category for this type of question? a. Prognosis b. Diagnostic c. Harm/etiology d. Prevention

ANS: B Diagnostic questions emphasize how to select a diagnostic test or interpret the results of a particular test. Harm/etiology questions focus on what the harmful effects of a particular treatment are or how harmful effects can be avoided. Prognosis questions focus on the disease process, screening, and risk reduction. Prevention questions are interested in how to modify patients risk factors to reduce the risk of disease.

4. The nurse is interested in whether antibiotic therapy or observation only is most effective in the treatment of sinusitis in young adults. Which of the following best describes the type of question being considered? a. Background questions b. Foreground questions c. General knowledge questions d. Both a and b

ANS: B Foreground questions have four key components: (1) patient- or problem-centered focus on knowledge about managing patients with a disease, (2) intervention, (3) comparative intervention (an optional step, used only if relevant), and (4) clinical outcome. Ask for specific information about managing patients with a disease. Background questions seek general knowledge about a disease or disease process.

6. The nurse questions whether treatment with antibiotic therapy is as effective as observation in a 3-year-old boy with otitis media. What combination of information supports the proper order of information needed to compose a PICO statement? a. Effective treatment for otitis media; antibiotic therapy; observation; 3-year-old with otitis media b. Three-year-old with otitis media; antibiotic therapy; observation; effective treatment for otitis media c. Antibiotic therapy; 3-year-old with otitis media; effective treatment for otitis media; observation d. Observation; 3-year-old with otitis media; effective treatment for otitis media; antibiotic therapy

ANS: B PICO is an acronym used to describe a format of the four elements required to formulate a good clinical question (P, patient or problem; I, intervention; C, comparison intervention; O, outcomes). Three-year-old with otitis media; antibiotic therapy; observation; effective treatment for otitis media organizes the elements in the correct order. Effective treatment for otitis media; antibiotic therapy; observation; 3-year-old with otitis media, Antibiotic therapy; 3-year-old with otitis media; effective treatment for otitis media; observation, and Observation; 3-year-old with otitis media; effective treatment for otitis media; antibiotic therapy have the elements in the incorrect order.

16. A nurse evaluates the results of two different studies examining the relationship between time of day and sundowning in the geriatric setting. After 1 month, the nurse realizes that there is a difference of 1 hour in the instruments used for measurement. What conclusion can be drawn about the type of threat this causes the study? a. Validity b. Reliability c. Causality d. Truthfulness

ANS: B Reliability refers to measuring the instrument by asking how trustworthy it is at gathering the intended data. Validity measures the degree to which an instrument is measuring what it is supposed to measure. Causality and truthfulness are not criteria researchers use to determine whether research instruments give accurate results.

18. Which step does a researcher first use when starting a new study? a. Data collection b. Refining an abstract idea c. Literature review d. Statistical analysis

ANS: B The first step in the nursing research process is refining an abstract idea by developing an answerable question that is focused on a specific patient-centered concern. Data collection, literature review, and statistical analysis occur later in the research process.

4. Which goals best justify the need for evidence-based practice (EBP) in nursing? (Select all that apply.) a. Redesign the health care system and recruit more nurses. b. Improve patient outcomes with evaluations that track outcomes. c. Introduce national health care guidelines and standards. d. Restructure health care delivery and improve quality of health care. e. Apply clinical experience to improve patient care.

ANS: B, D The initial intent of EBP was to improve patient outcomes by evaluating and tracking outcomes, including qualitative reports by patients, and to redesign health care delivery and improve the quality of health care. (EBP has nothing to do with nurse recruitment or national health care guidelines and standards. Applying clinical experience to patient care is not a goal of EPB. Clinical expertise is a factor used in research.

12. Nursing practice is guided by Carpers four fundamental patterns of knowing. Which of the four patterns of knowing supports the nurses use of the evidence-based practice process? a. Ethics b. Personal knowing c. Empirical knowing d. Aesthetic knowing

ANS: C Carper identified four fundamental patterns of knowing to provide excellent patient care. These four ways of knowing are (1) empirical knowing, (2) ethics, (3) personal knowing, and (4) aesthetic knowing. Empirical knowing is ideal for use in the evidence-based practice process in that it focuses on methods of critically appraising and applying available data and research to understand and inform clinical decision-making.

19. Which of the following is an example of direct research utilization? a. Advocating for a change in policy b. Basing practice on current research available c. Implementing new techniques for practice d. Critiquing a research study

ANS: C Direct research utilization describes applying research findings directly to change practice. Advocating a change in policy based on research findings such as when working on a policy and procedure committee is persuasive research utilization. Basing practice on current research available and critiquing a research study are examples of indirect research utilization.

10. Assess the given levels of evidence and choose the one most important when evaluating the strength of a research study. a. Level 3 evidence indicates that specific-quality criteria were met. b. Level 1 evidence implies an association with specific criteria. c. Level 1 evidence indicates that specific-quality criteria were met. d. Level 2 evidence implies a reliable association with specific criteria.

ANS: C Level 1 evidence represents the most valid reports addressing patient-oriented outcomes. A level 1 ranking also indicates that specific-quality criteria were met based on the study type. Level 3 evidence represents reports that are not based on scientific analysis of patient-oriented outcomes. Level 2 evidence implies an association with specific criteria rather than reliable evidence.

15. The nurse manager wants to determine the cause of an increase in medication errors over the past 6 months. This is an example of which type of research? a. Experimental b. Trial and error c. Quality assurance d. Scientific

ANS: C Quality assurance research uses data not only to determine whether procedures are being done per protocol, but also to determine whether patient outcomes are being met, and if charting is complete. Experimental research is a type of study design. Trial and error is not proper research methodology. Scientific research is what all evidence-based research demonstrates.

17. Which question should the nurse ask in order to judge the validity of a research study? a. What reliability information has been provided? b. Are the instrument measures applied consistently? c. Does the instrument measure what it is supposed to measure? d. How much random error exists?

ANS: C Validity measures the degree to which an instrument is measuring what it is supposed to measure. Reliability measures whether the device, technique, or instrument accurately collects the intended data. How consistently the measurements are applied and what amount of random error exists have nothing to do with testing validity.

13. Several sections are included in a research article. For example, the methods section describes the research study and what assessment quality and criteria were used. What information does the abstract or introduction section include? a. An evidence summary from the results of several other studies b. An outline of the number of studies retrieved and excluded and respective reasons for their inclusions or exclusions c. A discussion about whether the results are heterogeneous with possible reasons d. A clearly stated review question

ANS: D The review question should be clearly stated in the title, the abstract, or final paragraph of the introduction. The summary section provides an evidence summary from the results of several studies. The results section outlines the number of studies retrieved, excluded, and why. The data/analysis section states whether the results are heterogeneous and discusses possible reasons.