Concepts Exam 1 (Chapter 5)

Evaluate the outcomes of practice decisions or changes using evidence.

"How does the intervention work?" "How effective was the intervention on the pts or clinical situation?" "Was the goal met?"

Steps of EBP

0. Cultivate a spirit of inquiry 1. Ask a clinical question in PICOT format 2. Search for the most relevant & best evidence 3. Critically appraise the evidence you gather. 4. Integrate all evidence with your clinical expertise & pt preferences and values. 5. Evaluate the outcomes of practice decisions or changes using evidence. 6. Share the outcomes of EBP changes with other.

What is the appropriate order for the following steps of evidence-based practice (EBP)? 1. Integrate the evidence. 2. Ask the burning clinical question. 3. Create a spirit of inquiry 4. Evaluate the practice decision or change. 5. Share the results with others. 6. Critically evaluate the evidence you gather. 7. Collect the most relevant and best evidence.

3,2,7,6,1,4,5

Nursing Research

A way to identify new knowledge, improve professional education & practice, & use nursing & health care resources effectively. This type of research improves the health & welfare of people. This type of research improves professional education and practice and helps nurses use resources effectively (e.g. how to best use human resources by determining the best practice mix of nurses and unlicensed personnel on a nursing unit.)

Which of the following statements about evidence-based practice (EBP) made by a nursing student would require the nursing professor to correct the student's understanding? A. "In evidence-based practice the patients are the subjects." B. "It is important to talk with experts and patients when making an evidence-based decision." C. "A nurse wanting to investigate the evidence to solve a problem starts by forming a PICOT question." D. "It is important to ask a librarian for help when searching for literature to help you answer your PICOT question."

A. "In evidence-based practice the patients are the subjects." (Multiple research studies, expert opinion, personal experience, and patient preferences create the data source for evidence-based practice. Patients are not the subjects of EBP; they are typically the subjects in a research study.)

A nurse is reading a research article. The nurse just finished reading a brief summary of the research study that included the purpose of the study and its implications for nursing practice. Which part of the article did the nurse just read? A. Abstract B. Analysis C. Discussion D. Literature Review

A. Abstract (An abstract is a brief summary that summarizes the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.)

A nursing student is preparing to read the methods section of a research article. What type of information will the student expect to find in this section? (Select all that apply.) A. How the researcher conducted the study B. A description about how to use the finding of the study C. The number and type of subjects who participated in the study. D. Summaries of other research articles that support the need for this study E. Implications for future research studies

A. How the researcher conducted the study. & C. The number and type of subjects who participated in the study. (The methods section explains how a research study was organized and conducted to answer the research question or test the hypothesis as well as how many subjects or people participated in the study.)

A researcher is studying the effectiveness of an individualized evidence-based teaching plan on young women's intention to wear sunscreen to prevent skin cancer. In this study, which of the following research terms best describes the individualized evidence-based teaching plan? A. Sample B. Intervention C. Survey D. Results

B. Intervention (An intervention is an action or treatment performed by a researcher on a sample.)

Cultivate a spirit of inquiry

Constantly questioning current clinical practices & believing in the value of EBP leads to the consistent use of EBP in clinical nursing practice.

A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? (Select all that apply.) A. Frequency of low blood sugar episodes in children at a local school B. The number of patients who develop a urinary tract infection from a Foley catheter C. Number of patients who fall and experience subsequent injury on the evening shift D. Number of sexually active adolescent girls who attend the community-based clinic for birth control E. Patient reported quality of life following coronary artery bypass graft surgery and cardiac rehabilitation

B. The number of patients who develop a urinary tract infection from a Foley catheter & C. The Number of patients who fall and experience subsequent injury on the evening shift (Nurse sensitive indicators are outcomes that are sensitive to nursing practice; these outcomes will improve if the quantity or quantity of nursing care improves.)

A nurse researcher wants to conduct historical research. Which of the following ideas for a study could the nurses conduct? (Select all that apply.) A. Determining the effect of unemployment on emergency room usage B. Understanding how Clara Barton shaped nursing in America C. Evaluating the effect of the Vietnam war on nursing leadership and practice D. Analyzing the evolution of nursing and patient care during recent disasters E. Investigating barriers to exercise in women who have become mothers in the past year

B. Understanding how Clara Barton shaped nursing in America, C. Evaluating the effect of the Vietnam war on nursing leadership and practice, & D.Analyzing the evolution of nursing and patient care during recent disasters (Historical studies are designed to establish facts and relationships concerning past events.)

A nurse researcher is collecting data following approval from the institutional review board (IRB). In which part of the research process is this nurse? A. Analyzing the data B. Designing the study C. Conducting the study D. Identifying the problem

C. Conducting the study (Conducting the study includes tasks such as obtaining necessary approvals and implementing the study protocol to guide data collection.)

When recruiting subjects to participate in a study about the effects of an educational program to help patients at home take their medications as ordered, the researcher tells the subjects that their names will not be used and no one but the research team will have access to their information and responses. This is an example of: A. Bias B. Anonymity C. Confidentiality D. Informed Consent

C. Confidentiality (Confidentiality guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.)

A nurse researcher wants to know what factors are associated with a person's decision to exercise. The nurse distributes a survey to people who recently joined an exercise wellness program and analyzes the data to determine what factors and characteristics are most significantly linked to the decision to start exercising. What type of a research study is this? A. Qualitative B. Descriptive C. Correlational D. Randomized Controlled Trial

C. Correlational: in this study the nurse researcher is correlating characteristics or factors with the decision to start exercising

Nurses in a community clinic have seen an increase in the numbers of obese children. The nurses who care for children are discussing ways to reduce childhood obesity. One nurse asks a colleague, "I wonder what the most effective ways are to help school-aged children maintain a healthy weight?" This question is an example of a/an: A. Hypothesis B. PICOT question C. Problem-Focused trigger D. Knowledge-Focused trigger

C. Problem-Focused Trigger (A problem-focused trigger is a clinical problem you face while caring for patients; the nurses in this question have identified a clinical problem which they desire to investigate further).

The nurses on a medical unit have seen an increase in the number of medication errors on their unit. They decide to evaluate the medication administration process based on data gained from chart reviews and direct observation of nurses administering medications. Which process are the nurses using? A. Evidence-Based Practice B. Research C. Quality Improvement D. Problem Identification

C. Quality Improvement (Quality improvement studies evaluate how processes work in an organization. The nurses in this example are evaluating the medication administration process.)

A group of nurses have identified that the elderly patients on their unit have a high incidence of pressure ulcers after they have a stroke. During a unit meeting, they discuss different interventions they think may reduce the development of pressure ulcers. What is the nurses' next step to investigate this clinical problem further? A. Conduct a literature review B. Share the findings with others. C. Conduct a statistical analysis D. Create a well-defined PICOT question

D. Create a well-defined PICOT question (In this case, the nurses need to develop a PICOT question next to search for appropriate evidence that might offer answers to this clinical problem. )

A nurse who works on a pediatric unit asks, "I wonder if children who interact with therapy dogs have reduced anxiety when they are in the hospital." In this example of a PICOT question, which of the following is the O? A. Children B. Therapy Dogs. C. The Prediatric Unit D. Anxiety

O stands for outcome; in this PICOT question, the outcome the nurse is concerned about is anxiety.

A nurse researcher studies the effectiveness of a new program designed to educate parents to promote the immunization of children. The nurse divides the parents randomly into 2 groups. One group receives the typical educational program & the other group receives the new program. This is an example of what type of study? A. Experimental B. Historical C. Qualitative D. Correlational

Experimental (in experimental studies, the subjects are randomly assigned into groups with one group receiving the standard treatment and the other group receiving the intervention.)

Evidence Based Practice

Helps you make effective, timely, & appropriate clinical decisions in response to the broad political, professional, & societal forces present in today's health care environment. (Use the best available evidence to provide the best possible care [quality, safety, outcomes, satisfaction, reduced costs].)

Integrate all evidence with your clinical expertise & pt preferences and values.

Incorporate the evidence that you found to be strong enough to apply to your pts and clinical situation into practice. Evidence is integrated through teaching tools, clinical practice guidelines, policies & procedures, and new assessment or documentation tools.

Table 5-2 Comparison of Steps of the Nursing Process with the Research Process.

NURSING PROCESS: 1. Assessment RESEARCH PROCESS: 1. Identify area of interest or clinical problem: **Review literature. **Formulate theoretical framework. **Reflect on personal practice and/or discuss clinical issues with experts to better define the problem. NURSING PROCESS: 2. Diagnose RESEARCH PROCESS: 2. Develop research question(s)/hypothesis NURSING PROCESS: 3. Planning RESEARCH PROCESS: 3. Determine how study will be conducted: **Select research design/ methodology. **ID plan to recruit sample, taking into consideration population, #, & assignment to groups. **ID study variables: specific interventions (independent variable) and outcomes (dependent variable). **Select data collection methods **Select approach for measuring outcomes: questionnaires, surveys, physiological measures, interviews, and observations. **Formulate plan to analyze data: statistical methods to answer research questions/hypotheses. NURSING PROCESS: 4. Implementation RESEARCH PROCESS: 4. Conduct the study: **Obtain necessary approvals. **Recruit and enroll subjects. **Implement the study protocol/ collect data. NURSING PROCESS: 5. Evaluation RESEARCH PROCESS: 5. Analyze results of the study: **Continually analyze study methodology. Is study consistently carried out? Are all investigators following study protocol? **Interpret demographics of study population. **Analyze data to answer each research question/ hypothesis. **Interpret results, including conclusions, or limitations. 5. Use of the findings: **Formulate recommendations for further research. **Determine implications for nursing. **Disseminate the findings; presentations, publications, need for further study, how to apply findings in practice.

Search for the most relevant & best evidence

Once you have a clear & concise PICOT question, you are ready to search for evidence. *TABLE 5-1 SEARCHABLE SCIENTIFIC LITERATURE DATABASES & SOURCES PG. 55* AHRQ: Agency for Healthcare Research & Quality; includes clinical guidelines & evidence summaries. CINAHL: Cumulative Index of Nursing & Allied Health Literature; includes studies in nursing, allied health, & biomedicine. (1 of the best known online databases to search for scientific knowledge in health care) MEDLINE: Includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, & allied health. (1 of the best known online databases to search for scientific knowledge in health care) EMBASE: Biomedical & Pharmaceutical studies. PsycINFO: Psychology & related health care disciplines. Cochrane Database of Systematic Reviews: Full text of regularly updated systematic reviews prepared by the Cochrane Collaboration; includes condensed version of guideline for viewing. (a valuable source of high-quality evidence. It includes the full text of regularly updated systematic reviews & protocols for reviews currently underway.) NGC: (National Guidelines Clearinghouse) Repository for structured abstracts (summaries) about clinical guidelines & their development; also includes condensed version of guidelines for viewing. (database supported by the AHRQ. contains clinical guidelines, which are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific pt population. Examples include care of children & adolescents with type 1 diabetes & practice guidelines for the treatment of adults with low back pain.) PubMed: Health science library at the National Library of Medicine; offers free access to journal articles. WORLD VIEWS ON EVIDENCE-BASED NURSING: Electronic journal containing articles that provide a synthesis of research and an annotated bibliography for selected references.

Ask a clinical question in PICOT format

Question what does NOT make sense to you & what needs to be clarified. Think about a problem or area of interest that is time consuming, costly, or not logical. ("How can I reduce falls on my unit?" or "What is the best way to prevent UTI's in postoperative pts?") *BOX 5-1 DEVELOPING A PICOT QUESTION PG. 54* P = PATIENT POPULATION OF INTEREST. (Identify the pts by age, gender, ethnicity, & disease or health problem.) I = INTERVENTION OF INTEREST. (Which intervention is worthwhile to use in practice [e.g. a treatment, diagnostic test, prognostic factor]?) C = COMPARISON OF INTEREST. (What is the usual standard of care or current intervention used now in practice?) O = OUTCOME. (What result do you wish to achieve or observe as a result of an intervention [e.g. change in pt behavior, physical finding, or pt perception]?) T = TIME. (What amount of time is needed for an intervention to achieve an outcome [e.g. the amount of time needed to change quality of life or pt behavior]?)

Share the outcomes of EBP changes with other.

Share outcomes with the rest of the nursing unit.

Scientific Method

This is the foundation of research and the most reliable and objective of all methods of gaining knowledge. Researchers use this to understand, explain, predict, or control a nursing phenomenon.

Outcomes Research

This type of research helps pts, health care provider, and those in health care policy make informed decisions on the basis of current evidence. It also typically focuses on the benefits, risks, costs, and holistic effects of a treatment on pts.

Quantitative Research

Type of nursing research that is the study of nursing phenomenon that offers precise measurement and quantification (e.g. a study dealing with a new pain therapy quantitatively measures participants' pain severity.) This type of research is the precise, systematic, objective examination of specific concepts. It focuses on numerical data, statistical analysis, & controls to eliminate bias in findings. (metrics and surveys)

Qualitative Research

Type of nursing research that is the study of phenomena that are difficult to quantify or categorize such as patients' perceptions of illness or quality of life. This research method describes info obtained in a nonnumeric form (e.g. data in the form of transcribed written transcripts from a series of interviews. Researchers of this type aim to understand patients' experiences with health problems and the contexts in which the experiences occur. Pts have the opportunity to tell their stories and share their experiences in these studies.

Critically appraise the evidence you gather.

When critiquing evidence. 1st evaluate the scientific merit & clinical applicability of the findings of each study. After critiquing the evidence you will be able to answer the following questions. "Do the articles offer evidence to explain or answer my PICOT question?" "Do the articles show support for the reliability & validity of the evidence?" "Can I use the evidence in practice?" (Randomized Controlled Trials (RCT) are the "Gold Standard" they are the highest level of evidence available to answer your PICOT questions.)