Evidence Based Practice Final Exam

Transformational leadership

"find meaning and purpose in work" Idealized influence Inspirational motivation Intellectual stimulation Individualized consideration

Seven main experimental research designs

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Clinical research

Activities involving direct interaction by investigators with human subjects or material of human origin; generates knowledge on which practice should be based Patient participation viewed as optional. Aim is to generalize findings to a population wider than research subjects. Aim to disseminate findings for use outside of the organization.

Nonmaleficence

Addresses the importance of not harming patients

Scorecards

Show how indicators from different areas may be related to each other Operational, quality, and satisfaction levels If in the green --> within normal limits

Transferability in qualitative research

Theoretical generalizability Meaningful and applicable in other situations

Informed consent

Whether for research participation or for treatment, is a foundational component of clinical and research ethics

Clinical systems

Will vary with system - at minimum typically diagnostic test results and pharmacy data

Preserve energy sources

Engage support personnel Implement smaller, more manageable projects Anticipate setback and have patience and persistence

Three types of qualitative designs that are not solely descriptive in nature

Etinography Grounded-theory Phenomenology ...

Reliability

Does the instrument measure the construct consistently every time it is used?

Four steps used in the Health Outcomes Institute's Outcomes Management Model

First model to provide steps to guide measurement of the impact of new intervetions on improving healthcare outcomes 1. Define clinical problem 2. Compare appraised evidence 3. Educate all stakeholders 4. Close first data collection cycle

Create specific goals

Focus on short-term, attainable goals Establish only two to three goals at a time

Establish formal implementation teams

Integrate experts in change theory at the systems level, such as advance practice registered nurses Include expert staff members to ensure clinical applicability, feasibility, and adoption into practice Exhibit passion for the practice change Enlist local opinion leaders who can attest to the need for practice change Bring in outside speakers who have the potential to connect and inspire key stakeholders Create discomfort with the status quo

Availability of Healthcare Resources

Intervention may be too costly Resources become the dominant elements

Typical topics of a health policy brief

-Healthcare financing -Quality and safety of patient outcomes -Risk/benefit analysis of cost reduction alternatives -Lower rates of mortality and improved morbidity -The role of technology in health care -Human resource need -System change to improve services

Advantages and disadvantages of using a poster as a means of disseminating information about EBP

-Less info -No question answering, standard format -Allows for more interaction -Number of issues can be addressed -Displayed for longer periods

Strategies to increase success of panelist presentation

-Limit number of slides to prevent distraction from the topic and to highlight what is said. It is helpful to have a brief conversation with the other panelists and agree on a number of slides and timeframes -Develop a time clock system -Use active voice that holds the audience's attention and illustrate content with real-life examples -Identify the major theme of the presentation, and add three to five major points to support the thrust of the theme

Factors that need to be considered when determining which quantitative study design should be used to answer a clinical question

-Prior studies in the area -Significance of the problem -Innovation of the project -Feasibility -Setting for the study and access to potential subjects -Study team -Ethics of the study

Process that can be used for journal clubs that can assist the group with focusing on key point of the reported study

-Study objectives/hypotheses -Designs and methods -Data analyses, with rationale -Finding, relative significance -Conclusions of the study with clinical implications -Efficient critical appraisal (strengths and limitations)

Typical components of a health policy brief

-Title -Background of the issue -Historical pattern of response to the problem -Inherent limitations and problems -Why it remains a problem -Review and synthesis of the literature -Clinical outcomes of interventions -Cost-effectiveness -Applicability -Patient Privacy (HIPPA) -System changes -Services proposed -Population outcomes and health disparities

Useful questions to ask in determining the significance of a research question

-What is the incidence of this particular problem? -How many individuals are affected by this problem? -Will studying this problem potentially improve the care that is delivered to patients? -Will studying this intervention lead to better health outcomes in patients? -Will studying this problem assist clinicians in gaining a better understanding of the area so that more sensitive clinical care can be delivered? -"so what" will be the end outcome of the study?

Meaning of: not all descriptive research is qualitative

-multiple purposes focus on understanding and meaning -openness and flexibility accommodate the unexpected -distinctive procedures assure depth, accuracy, and completeness -presentation of findings involves multiple reporting styles -conclusions are not based on prior assumptions -qualitative research is complete and nonhierarchial

Why is an ethics review mandatory before conducting a quality study?

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Seven important questions to be addressed before proceeding with a research study

1. Is this idea feasible and clinically important? 2. What is the "so what" factor 3. What is the aim of the study, along with the research question/hypotheses 4. What is the best design to answer the study question or test the hypotheses 5. What are the "so what" outcomes that are important to measure and potential sources of data? Are there valid and reliable instruments to measure the desired outcomes? 6. What should be the inclusion and exclusion criteria for the potential study participants? 7. What are the essential elements of the intervention, if applicable, and how will integrity of the intervention be maintained?

Four levels of measurement info which categorical and numeric data can fall under

1. Nominal 2. Ordinal 3. Interval 4. Ratio

Six areas of evaluation of evidence-based practice that are important to measure

1. Outcome measures 2. Quality care improvement 3. Patient-centered quality care 4. Efficiency of process 5. Environmental changes 6. Professional expertise

Four components that need to be considered in the clinical decision-making model of EBP

1. Patient preferences and behaviors 2. Clinical state, setting, and circumstances 3. Availability of healthcare resources 4. High-quality research evidence

Six sources of internal evidence that could be used in providing data to improve outcomes and demonstrate improvement

1. Quality management department 2. Finance department 3. Human resources 4. Clinical systems 5. Administration 6. Electronic Health Record

Seven types of sampling techniques that can be used when selecting research subjects

1. Random sampling 2. Stratified sampling 3. Cluster random sampling 4. Nonprobability or purposive samples 5. Heterogeneity sampling 6. Snowball sampling 7. Respondent-driven sampling

Three examples of how EBP quality improvement initiatives could conflict with ethical principles

1. Attempts to improve quality for some patients and may cause harm to others. 2. Strategies intended to improve quality that may turn out to be ineffective and waste scarce resources 3. Activities declared to be quality improvement that may be more accurately described as clinical research

Five main topical areas that should be included in an EBP poster

1. Background/significance 2. Clinical question 3. Search for evidence/accepted practice 4. Presentation and critical appraisal of evidence 5. Clinical practice presentation

Define four core ethical principles that guide healthcare practice

1. Beneficence 2. Nonmaleficence 3. Autonomy 4. Justice

Three organizations that incorporate EBP into the standards and/or expectations of leadership

1. Chief nursing officer/executive 2. Nursing directors 3. Unit-based nurse managers

Five interventions that are paramount to the success of behavior change and resultant consistent implementation of EBP by clinicians

1. Communication and relationship building 2. Knowledge of the healthcare environment 3. Leadership 4. Professionalism 5. Business skills

Four essential elements needed to create and evidence-based clinical environment

1. Create a vision for EBP 2. Engage Personnel and resources 3. Integrate EBP and Nourish the culture 4. Evaluate the evidence

Eight strategies for overcoming barriers to implementing EBP

1. Dealing with skepticism and misperceptions 2. Knowing individual personality styles and how best to motivate individuals 3. Formulating a well-written strategic plan with set goals 4. Communicating the vision and strategic plan 5. Interprofessional teamwork 6. Organizational context, including resources and administrative support 7. Overcoming resistance 8. Organizational culture and mentorship: key elements for sustaining organizational change Develop SMART goals

Six areas of information that should be gathered when aggregating research studies

1. Demographic and size of sample 2. Study setting 3. Research design used 4. Outcome variable measured 5. Major findings 6. Strengths and limitations

Six objectives and their related strategies that are essential for developing a vision for EBP

1. Develop a mental framework 2. Establish a motivating image for change 3. Create specific goals 4. Gain administrative support 5. Establish a leadership team 6. Involve experts and EBP mentors in clinical practice

Strategies that leaders can implement to address eight common barriers to creating an environment that supports EBP

1. EBP education and skills building 2. Operational budgets for EBP resources 3. Library services support 4. Job descriptions and performance evaluation tools 5. Clinical ladder requirements 6. Organizational mission, vision, and values statements 7. EBP mentors aligned within the organization 8. EBP mentor positions 9. Manager and leader accountability

Four principles described by Ellwood that support outcomes management

1. Emphasizing practice standards that providers can use to select interventions 2. Measuring patient functional status, well-being and disease-specific clinical outcomes 3. Pooling data outcome on a massive scale 4. Analyzing and disseminating outcomes, in relation to interventions used, to appropriate decision makers and stake holders

Four objectives and their related strategies that are needed to develop staff engagement in the EBP practice process

1. Engage staff and stakeholders in assessing and eliminating barriers 2 Prioritize clinical issues 3. Evaluate the infrastructure 4. Develop experts in the evidence-based process

Eight basic steps in integrating EBP into the clinical environment and strategies that could be used to increase success

1. Establish formal implementation teams 2. Build excitement 3. Disseminate evidence 4. Develop clinical tools 5. Pilot test 6. Preserve energy sources 7. Allow enough time --> timeline for success 8. Celebrate success

Major steps in disseminating evidence through publication

1. Finding a mentor 2. Generating the idea 3. Planning the manuscript (title page, abstract, intro, manuscript narrative, conclusions and clinical implications) 4. Being organized 5. Deciding what to publish 6. Selecting a journal 7. Review of the literature 8. Developing a timeline 9. Writing strategies 10. Proofreading the manuscript

Eight activities that are necessary when designing a qualitative research study

1. Identify study question 2. Review the literature 3. Define the theoretical perspective 4. Select an appropriate research design 5. Formulate a purpose statement 6. Establish study significance 7. Describe the research procedures 8. Discuss study limitations

Six common barriers to implementation of EBP within a clinical environment

1. Inadequate knowledge and skills 2. Weak beliefs about the value of EBP 3. Poor attitudes toward EBP 4. Lack of EBP mentors 5. Social organizational influences 6. Economic restrictions

Kotter and Cohen's Model of Change eight steps

1. Increase urgency 2. Build the guiding team 3. Get the vision 4. Communicate for "buy in" 5. Empower action and remove barriers 6. Create short-term wins 7. Don't let up 8. Make change stick

Eight topics that should be included in a presentation of a research study

1. Introduction to the clinical problem 2. The purpose/primary aim of the study 3. The theoretical framework used to guide the study 4. Hypotheses or study questions 5. The design (description of interventions, same with inclusion and exclusion criteria, dependent and independent variables) 6. Findings from the study 7. Discussion of the findings, along with major strengths and limitations of the study 8. Implications (for future research and clinical practice)

Develop clinical tools

Anticipate tools and processes that staff will need to transform practice Revise patient care documentation records Ensure easy access to clinical resources Integrate alerts and reminders into workflow processes at the point of care Repeatedly expose the staff to evidence-based information

Inspired

Are socially oriented and like to have fun Show them that the change can be fun and exciting; have them assist in celebrations of success

Gain administrative support

Contact administrators responsible for clinical practice Create a presentation that reflects the need for transforming the culture into and EBP environment Seek administrators responsible for clinical practice

High-quality research evidence

Current data ex.) clear vs. gauze dressings Internal and external validity

Evaluate the infrastructure

Determine the individuals and committees who have decision-making authority Gain administrative support for adequate time and personnel for the initiative Enlist experts to lead EBP initiatives Ensure access to databases, search engines, and full-text articles

Develop a mental framework

Develop a written summary of what you want to accomplish Brainstorm with colleagues regarding the environment you want to create

Allow enough time

Develop incremental project steps Establish a timeline

Cluster (area) random sampling

Divide the large area into regions or clusters. From full list of clusters, randomly sample a sufficiently manageable number of clusters. Then individual subjects from each cluster can be randomly sampled

Stratified sampling

Diving the study population into two or more subpopulations, then sampling separately from each

Four major personality types identified by the DISC model

Drivers Inspired Supportive and steady Contemplators

Sowball sampling

Each subject is asked to recommend other potential subjects or to inform other possible subjects about the opportunity to participate in the study

Phase three of Health Outcomes Institute's Outcomes Management Model

Educate all stakeholders; assure that role models and resources are available for troubleshooting processes; monitor reliability and stability of measures and refine as needed; finalize the refined process and measurement methods; begin data collection

Engage staff and stakeholders in assessing and eliminating barriers

Engage stakeholders to identify educational content and strategies to learn about the practice change Seek information about attitude toward the affected practice directly from staff Involve influential staff and leaders in conducting discussions with colleagues

Innovative leader

Essence of innovation Innovation knowledge Self-knowledge and competence Collaboration Synthesis Formulation Managing knowledge Coaching

True or False: There is a lack of agreement regarding the question of whether ethical principles need to be applied to evidence-based quality improvement initiatives.

False It is broadly agreed that ethical principles are an important consideration in the application of EBP and EBQI initiatives. The real debate is whether all of the requirements that are placed on clinical research also need to be applied to EBQI initiatives

Involve experts and EBP mentors in clinical practice

Identify clinical experts and EBP mentors focused on the area Engage clinical expert support

Establish a leadership team

Identify key personnel with a passion for EBP Conduct a small focus group meetings

Ethical implications with EBQI and clinical research

If efforts are not made to improve quality through EBQI, principles of beneficence and nonmaleficence may be violated If EBQI does not offer the same treatment strategies to all patients, then the principle of justice and autonomy may be violated, especially if patient consent is not obtained.

Validity

Is the instrument actually measuring what it is supposed to measure?

Innovators

out-of-the-box thinkers and readily recognize innovative opportunites

Performing

Level of interaction is high; performance increases; team members are comfortable with one another; there is optimism and confidence

Drivers

Like to take charge and are highly task oriented Give them opportunities to lead specific tasks

Early adopters

Opinion leaders, encourage others to adopt innovations

Clinical expertise

Practitioner's experience and skills Essential for avoiding the mechanical app. of care maps, decision rules, and guidelines Will influence the following: quality of initial assessment, problem formulation, substantiate a new approach, exploration of patient preferences, delivery of the clinical intervention, evaluation of the outcome

Factors that are impacted by the practitioner's clinical expertise

Quality of the initial assessment of the client's clinical state and circumstances Problem formulation Decision about whether the best evidence and availability of healthcare resources support a new approach Exploration of patient preferences, delivery of the clinical intervention, evaluation of the outcome for that particular patient

Difference between experimental studies and quasi-experimental studies, including main threat to validity

Quasi may be more practical and feasible, they are weaker than true experimental design in the ability to establish cause and effect influences

Several reasons for an institution to develop an evidence-based clinical environment

Regulatory initiatives and insurance-mandated outcomes Three aims of the National Quality Strategy: better care, healthy people/healthy communities, affordable care Magnet recognition program

Scientific validity

Research projects must be methodologically sound enough to ensure valid and generalizable findings; poorly designed or implemented EBP or EBQI projects waste resources and the time of those involved

Favorable risk- benefit ratio

Research, EBP, and EBQI should be committed to minimizing the risks and maximizing the gains of all studies and projects

Storming

Resistance to different approaches; competitiveness and defensiveness; tension and disunity

SCOT Analysis

S - strengths in the system that facilitate the success of a new project C - challenges in the system that may hinder the initiative O - opportunities for success (external) T - threats or barriers to the project's completions (external)

IOM Quality Dimensions

Safety Effectiveness Patient-centeredness Timeliness Equity Efficiency

Describe how the four core ethical principles can be seen as the foundation for the Institute of Medicine's (IOM's) core dimensions of quality

Safety: nonmaleficence Effectiveness: Benefience Patient-centeredness: Autonomy Timeliness: Beneficence and nonmaleficence Equity: Justice Efficiency: Beneficence and nonmaleficence

Ratio

Same data characteristics as interval-level data, but also has an absolute zero value Ex. Kelvin temperature scale

EBP competencies that are relevant to registered nurses and advanced practice nurses

See page 245

Several questions about the audience and presentation logistics that need to be addressed prior to planning a podium/oral presentation

See page 392 What is the educational level and practice specialty? What is the audience's current knowledge of the material to be presented? Is the content for an audience with limited knowledge of the evidence-based topic?

Heterogeneity sampling

Select a sample of people unlike each other to ensure a broad spectrum of subjects

Prioritize clinical issues

Select clinical issues of direct interest and responsibility of clinician stakeholders Choose issues with solid empiric evidence to begin an organizational area's EBP endeavors

Late majority

Spends additional time watching how the innovation is progressing and are more cautious in its adoption

Human resources

Staff turnover and education levels; hours by pay/labor category; contract labor use; provider skill mix; staffing ratios

Case-control studies

Studies in which one group of individuals with a certain condition is studied at the same time as another group of individuals who do not have the condition to determine an association between one or more predictor variables and the condition

Respondent-driven sampling

Studying a population that is generally "hidden"

EBQI

Systematic and continuous actions that lead to improvement in health services and the health status or health outcomes of targeted patient gorups

Evidence-based quality improvement (EBQI) initiatives

Systematic, evidence-based activities designed to immediately improve healthcare delivery in specific settings All patients receive the same evidence-based intervention as part of routine care. Aim is to improve care of patients in a specific organization/setting. Aim is to provide internal data to practitioners to guide further practice changes.

Build excitement

Team members that exhibit passion Building a "burning platform" to drive change

Outcomes management

Technology of patient experience designed to help patient, payers, and providers make rational medical care-related choices based on better insight into the effect of these choices on patient life

Concept of patients having some ethical responsibility in the process of improving health care

The necessity of changing health care means that the voices of patients must be heard. Patients have an ethical responsibility to engage with improvement processes. The responsibility of patients to cooperate in healthcare improvement activities is justified by the benefits that each patient receives because of the cooperation of others in the collective enterprise.

Norming

Trust and respect develops; satisfaction increases; feedback is provided to others; responsibilities are shared; decisions are made

Servant leadership

Trust, empathy, and caring focused on others Listening Empathy Healing Awareness Persuasion Conceptualization Foresight Stewardship Commitment to the growth of people Building community

Supportive and steady

Typically reserved and like to be led Emphasize that they are important to the project, but do not have to lead

Establish a motivating image for change

Use creativity to capture attention of the clinical staff Take advantage of real clinical scenarios to stress the need for changes in practice

Survey research

Using self-report data and are typically collected to assess a certain condition or status

Develop experts in the evidence-based process

Utilize leaders within the organization or form an academic partnership to provide expertise in research, EBP design, and evaluation Provide formal classes and/or small-group sessions on finding and evaluating evidence Mentor staff in critically appraising research studies and formulating practice recommendations

Disseminate evidence

Utilize multifaceted strategies to overcome knowledge deficits, skill deficits, and skepticism Promote experience sharing to emphasize the need for change and positive outcomes of change Provide time to assimilate new practices

Contemplators

Very analytical and detail oriented Show them all of the details; consider giving them a leadership role in tracking processes and outcomes

Five methods to ensure quality and consistency in the delivery of the intervention used in an experimental stud

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Five areas that need to be addressed when designing the procedures that will be used in a qualitative study

1. Sample and sampling strategy 2. Ethical considerations 3. Data collection and data management 4. Data analysis and interpretation 5. Standards of quality and scientific rigor

Three ethical controversies related to EBQI initiatives

1. Should EBQIs require the same standards of patient consent as clinical research? 2. Is it ethical to implement EBP in one setting while continuing with traditional (and possibly substandard) practice in another? 3. Should informed consent be obtained from the patients receiving traditional care?

Seven ethical requirements that have been proposed as the ethical foundations upon which clinical research should be based.

1. Social or scientific value 2. Scientific validity 3. Discuss the concept of patients having some ethical responsibility in the process of improving health care 4. Fair subject selection 5. Favorable risk-benefit ration 6. Independent review 7. Respect for potential and enrolled subjects 8. Informed consent

Five stages of the Change Curve Model

1. Stagnation (lack of lead, failred initiative, few resources) 2. Preparation (anxiety, hope, dec. productivity) 3. Implementation (readiness for change) 4. Determination (highest chance of failure) 5. Fruition (positive outcomes can be seen)

Eight commonly used models that facilitate the integration of evidence into clinical practice

1. The Stetler Model of EBP 2. The Iowa model of EBP to promote quality care 3. The model for EBP change 4. The advancing research and clinical practice through close collaboration (ARCC) model for implementation and sustainability of EBP 5. The promoting action on research implementation in health services (PARIHS) framework 6. The clinical scholar model 7. The Johns Hopkins Nursing EBP model 8. The ACE Star Model of knowledge transformation

Six essential elements necessary for successful organizational change

1. Vision and goals 2. Belief 3. A well-formulated strategic plan 4. Action 5. Persistence 6. Patience

Six factors that can influence the implementation of EBP by clinicians

1. beliefs and attitudes about EBP 2. Knowledge about EBP 3. Organizational commitment to EBP 4. Organizational support for EBP 5. A culture responsive to change 6. Supported EBP ideas/initiatives

Six basic underlying assumptions of the Change Curve model

1. highly emotional process 2. requires individual change 3. no fundamental changes take place without strong leadership 4. leader must be willing to change 5. large and more drastic --> more difficult 6. More involved --> tougher the change

Identify the eight commonalities that are inherent in all models for the implementation of EBP

1. identifying a problem that needs addressing 2. Identifying stakeholders or change agents who will help make the change happen in practice 3. Identifying a practice change shown to be effective through high-quality research that is designed to address the problem 4. Identifying and, if possible, addressing the potential barriers to the practice change 5. Using effective strategies to disseminate information about the practice change to those implementing it 6. Implementing the practice change 7. Evaluating the impact of the practice change on structure, process, and outcome measures 8. Identifying activities that will help sustain the change in practice

Similarities and differences among research, EBP, and QI that have implcations for human subjects review

1. research is not an integral part of routine clinical practice 2. EBQI is an integral part of the ongoing management of clinical care delivery (EBP) 3. Research often carries risks for patients 4. Risks with EBQI activities are usually very low; sometimes the risks may be greater if the EBQI activities are not implemented. 5. Generally, research is focused on generating evidence for practice, whereas EBQI is focused on implementing evidence in practice

Cronbach's Alpha

A Cronbach's alpha of .80 or greater usually indicated that an instrument should perform reliability each time that it is used

Celebrate success

Acknowledge the staff instrumental in process Ensure recognition by supervisors and administration Recognize the staff in presentations

Autonomy

Acknowledges that patients have the right to make decisions about their health, lives, and bodies

Two methods of reporting outcomes data to organizational stakeholders

All parties involved in the process of practice change should have an opportunity to understand the results achieved Two methods of presenting data in an understandable way: Scoreboards and dashboards

Purpose of using a theoretical/conceptual framework to guide the design of a research study

Attempt to describe, explain, and/or predict a phenomenon Purpose is to provide a framework for selecting the study's variables, including how they related to one another, as well as to guide the development of the intervention (s) in experimental studies

Five basic steps in developing a podium/oral presentation

BOPPS model Bridge Objectives Pretest Participatory learning Post-test Summary

Beneficence

Captures the importance of doing good for patients

Finance department

Charges for tests, medications, equipment, or supplies, patient days, readmission rates, patient demographics, patient diagnosis coding

Pilot test

Choose pilot sites with consideration to unit leadership strength, patient population diversity, acuity, and geographic location Address the root causes of problems Decide to adopt, adapt, or abandon at the end of the pilot

Phase four of Health Outcomes Institute's Outcomes Management Model

Close first data collection cycle; analyze results and disseminate to stakehodlers; identify opportunities for further improvement (return to phase 2 to begin refinement of improvement)

Phase two of Health Outcomes Institute's Outcomes Management Model

Compare appraised evidence with traditional practice; engage stakeholders; negotiate adoption of new practice; develop methods to support new practice; adopt new standard

Recommendations in assistance in developing a good slide presentation

Dark backgrounds Simple/few words Simple fonts btw 24-32

Ordinal

Data can be ranked in order, but the absolute difference between each level is not equal Ex. likert scales (Strongly agree- strongly disagree)

Nominal

Data sorted into categories; any numbers assigned to categories used only for labeling Ex. gender, presence or absence of a quality (e.g., disease)

Justice

Declares that resources should be distributed fairly among people and without prejudice

Phase one of Health Outcomes Institute's Outcomes Management Model

Define clinical problem, including structure/process contributor and descriptive and confounding variables; identify desired outcomes and related measures; build database; measure baseline

Descriptive studies

Describe, observe, or document a phenomenon

Correlational studies

Describing a relationship btw or among two or more variables

Three main types of nonexperimental study designs

Descriptive studies Case control studies Cohort studies

Magnet recognition program

Expectations for transforming a nursing culture into an environment that promotes superior performance through EBP

Cohort studies

Follows a group of subjects longitudinally over a period of time to describe the incidence of a problem or to determine the relationship between a predictor variable and an outcome

Early majority

Follows the lead of the early adopters in implementing the innovation

Social or scientific value

For research, EBP, or EBQI to be ethical, it should be worth doing

Stages of team formation

Forming Storming Norming Performing

Dashboards

Graphic displays of information that are often used at the unit level to compare performance indicators for the population being cared for on the unit

Authentic Leadership

High moral character Balanced processing Internalized moral perspective Relational transparency Self-awareness

Quality management department

Incident reports, patient satisfaction scores, data collected for regulatory or accreditation bodies

Fair subject selection

Inclusion and exclusion criteria for recruiting study participants should be based on scientific rationale, not convenience or vulnerability Patients involved in EBP or EBQI project should be determined by the population of patients served by the organization rather than the ability to generalize outcome findings

Independent review

Independent review of research is ethically required because of potential conflicts of interests and resultant human rights violations

The Transtheoretical Model of Health Behavior Change

Individuals can participate in the initiative, even if they are not ready to take action -Precontemplation -Contemplation (know there is something wrong but are not doing anything about it) -Preparation (going to do something) -Action -Maintenance

Laggards

Individuals who are fairly steeped in tradition and have much difficulty with change

10 factors that determine the news values of research evidence

Interest Relevance Other events Availability Exceptionality Compatibilities Quotability Visual appeal High-profile affiliations Human interest Clarity and applicability Cost

Similarities between EBQI and clinical research

Involve human participants May use similar data collection procedures to evaluate outcomes (e.g., surveys and physiological measurements) Both may use the same data analysis methods to manage and process data

Nonprobability or purposive samples

Not random

Interval

Numeric data with equal and consistent mathematical values separating each discrete measurement point, however, lacks an absolute zero Ex. Fahrenheit temperature scale

Administration

Patient complaints

Electronic health record

Patient-level information captured through documentation of clinical care

Respect for potential and enrolled subjects

The well-being of the individual research subject takes precedence over all other interests; refusal of EBP treatment is always the patient's right

Importance of acknowledging the five categories of adaptors described in Roger's theory of diffusion

Tipping point for success occurs between the early adopters and the early majority. Want to target the innovators, early adopters, and early majority 1. Innovators 2. Early adopters 3. Early majority 4. Late majority 5. Laggards

Forming

anxiety, excitement, testing, dependence, exploration, and trust

Controversy about ethical principles as applied to EBQI versus clinical research is seen most clearly in which of the following domains of ethics? a. Scientific validity b. Social or scientific value c. Fair subject selection d. Independent review

d. Independent review There is significant controversy surrounding the question of the need for independent ethical review for EBQI, with many experts citing a different standard for clinical research than evidence-based practice changes. It is generally agreed that questions of scientific validity, social or scientific value, and fair subject selection should be applied in similar degree to both; however, the need to have EBP initiatives brought before an ethical review committee is still unclear.

The nurses on a nephrology unit wish to implement an evidence-based change in the assessment and management of patients' arteriovenous fistulas. Which of the following should perform the first (and possibly only) review for the ethical considerations of this change? a.) The hospital's ethics review board b.) The state board of nursing's ethics committee c.) Expert nurses on the unit d.) The leadership and management of the unit

d. The leadership and management of the unit Rationale: The first review should be performed by the unit management and supervisors to critically examine the strength of the evidence on which the change is based to assure the project's scientific value and validity and to assure that the risk-benefit ratio is appropriately low. The review also assures that resources are available and are fairly distributed.

Patient preferences, actions, clinical state, setting, and circumstances

ex.) home visits