Foundations Chapter 5 Evidence-Based Practice
1, 2, 4 Once the nurse finds information supporting the use of herbal oils, the nurse should take steps to implement this change in practice and evaluate the outcomes. Following the evaluation, the nurse can recommend a related protocol. If the evidence is not strong enough, the nurse can conduct a pilot study to test the use of herbal oils in hair loss. If the PICOT question remains unanswered after evaluation, then a research study can be conducted. Following the outcome evaluation, the results should be shared with the staff to promote evidence-based practice. If the evaluation of the study shows that herbal oil is useful, then the nurse is allowed to recommend this change in protocol.
A 50-year-old patient complains of hair loss. A scraping of the patient's scalp shows a candida infection. The hair loss decreased with the use of a medicated shampoo and herbal oil. The nurse has developed a PICOT question and starts to search for the evidence. The nurse has reviewed many books and searched for information on the Internet. The nurse also consulted other health care professionals and found that herbal oils have an antifungal medicinal value. Which should be the nurse do next? Select all that apply. 1 Recommend a protocol if the evidence supports the use of herbal oil. 2 Conduct a pilot study if the evidence is not strong enough to support the use of herbal oils. 3 Keep all the data of the study confidential and share outcomes with staff who are affected by the results. 4 Conduct the research study even if the PICOT question goes unanswered after the study. 5 Avoid recommending any changes in the protocol, even if the study supports the use of herbal oil.
2, 3, 5 A well-focused question makes it easy to gather evidence. A PICOT question is very useful for evidence-based practice. The I in PICOT refers to intervention of interest. A well-framed PICOT question helps to keep the research question focused on intervention. A well-formed PICOT questions also helps to question the existing routines and identify knowledge gaps within a given clinical situation. The sequence of P, I, C, O, and T is not mandatory in developing the PICOT question. The components I, C, and T may not be suitable to be used in every PICOT question, so they can be skipped accordingly.
A 50-year-old woman complains of hair loss. When going through the medical records, the nurse finds that the patient underwent chemotherapy for breast cancer a few years ago. To determine a relationship between hair loss and chemotherapy, the nurse formulates a PICOT question. Which points should the nurse keep in mind when developing a PICOT question? Select all that apply. 1 The sequence of P, I, C, O, and T should be followed. 2 The I in PICOT refers to intervention of interest. 3 PICOT helps to ask an intervention-focused question. 4 The elements P and O can be skipped. 5 PICOT helps to identify knowledge gaps within a given clinical situation.
2, 4, 5 Informed consent means that the research subjects are given full and complete information about the study, including the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment. An informed consent implies that the information rendered by the patient will be kept confidential. The patient has the right to withdraw from the study at any point in time. If the patient is participating in the study, the family members are not required to sign the consent form. Signing a consent form does not mean that the patient has to participate until the end of the research. The patient can withdraw at any time.
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. 1 The patient and a family member should sign the consent form. 2 The patient should be capable of understanding the research procedure. 3 Once the patient has signed the forms, the patient must participate until the end of the research. 4 Informed consent ensures the patient that all the information of the study will be confidential. 5 The patient has the right to refuse to participate at any point of time in the research.
1, 3, 4 A case-control study requires two groups. One of the groups must have lung cancer, and the other should not have the disease. The hospital records are not sufficient for obtaining the evidence. It is not necessary that two groups should have different genders. Each group can have a mix of genders.
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. 1 Two groups are required. 2 Hospital records are sufficient for evidence. 3 One of the groups should have lung cancer. 4 One of the groups should not have lung cancer. 5 Two groups with different genders are required.
1, 4 A case-control study is performed to find out the cause for a disease. A retrospective study looks back in time to evaluate the available data and find the variables in a disease. Although randomized controlled trials can be used for investigating cause and effect, they are more suitable for exploring drug therapies. Historical studies are performed to confirm facts and relationships about a past event. Descriptive studies help to measure characteristics of persons, situations, or groups and the frequency with which certain events or characteristics occur.
A 55-year-old patient is diagnosed with lung cancer and has a history of smoking. Which type of study would be initiated to find the association between smoking and lung cancer,? Select all that apply. 1 Case-control study 2 Randomized controlled trial 3 Historical research 4 Retrospective study 5 Descriptive research
2 After completing an evidence-based practice (EBP) project and evaluating its effectiveness, the next step is to communicate the results with others. Conducting a literature review and statistical analysis, and creating a well-defined PICOT question, come before evaluation and sharing findings.
A group of nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. What is their next step? 1 Conduct a literature review. 2 Share the findings with others. 3 Conduct a statistical analysis. 4 Create a well-defined PICOT question.
2 The purpose statement includes research questions or hypotheses—predictions made about the relationship or difference among study variables (concepts, characteristics, or traits that vary within or among subjects). The introduction lays the basics of the questions the researcher is asking and lays the groundwork of the study. Methods describe the steps taken to gather knowledge and test the variables. Results describe the findings of the research.
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? 1 Introduction 2 Purpose statement 3 Methods 4 Results
1, 4 Systematic, orderly procedures characterize the scientific method to limit the possibility for error, although it is not without fault. The scientific method minimizes the chance that bias or opinion by a researcher will influence the results of research and thus the knowledge gained. The scientific method is the foundation of research and is the most reliable and objective of all methods of gaining knowledge. Aspects of the scientific method help in conducting research. The scientific method is an advanced, objective means of acquiring and testing knowledge.
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? Select all that apply. 1 "The scientific method is without fault." 2 "The scientific method is the foundation of research." 3 "Aspects of the scientific method help in conducting research." 4 "The scientific method may influence the opinions of the researcher in the final outcome." 5 "The scientific method is an advanced, objective means of acquiring and testing knowledge."
2, 3, 5 Genetic risk factors are related to heredity and the genetic predisposition to an illness; physiological factors involve the physical functioning of the body. Certain physical conditions such as being pregnant or overweight place increased stress on physiological systems (e.g., the circulatory system), increasing susceptibility to illness in these areas. A person with a family history of coronary artery disease is at risk for developing the disease later in life because of a hereditary and genetic predisposition to the disease. Age, diet and lifestyle are not genetic or physiological risk factors.
The nurse assesses the following risk factors for coronary artery disease (CAD) in a male patient. Which factors are classified as genetic or physiological? Select all that apply. 1 Sedentary lifestyle 2 Father died from CAD at age 50 3 History of hypertension 4 Diet high in sodium 5 Elevated cholesterol level 6 Age of 44 years
2 AHRQ stands for Agency for Healthcare Research and Quality and provides clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. CINAHL stands for Cumulative Index of Nursing and Allied Health Literature; it includes studies in nursing, allied health, and biomedicine at a cost. EMBASE provides biomedical and pharmaceutical studies.
The nurse finds topics for research studies in different scientific literature databases. Which source is described correctly? 1 MEDLINE provides only biomedical and pharmaceutical studies. 2 AHRQ gives clinical guidelines and evidence summaries. 3 CINAHL offers free access to journal articles. 4 EMBASE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health.
2, 3, 5 The Agency for Healthcare Research and Quality (AHRQ) database includes clinical guidelines and evidence summaries. Cumulative Index of Nursing and Allied Health Literature (CINAHL) includes studies in nursing, allied health, and biomedicine. PubMed is the health science library at the National Library of Medicine and offers free access to journal articles. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies.
The nurse finds topics for research studies in different scientific literature databases. Which sources are correct for their respective database? Select all that apply. 1 MEDLINE contains biomedical and pharmaceutical studies. 2 AHRQ contains clinical guidelines and evidence summaries. 3 CINAHL contains studies in nursing, allied health, and biomedicine. 4 EMBASE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. 5 PubMed offers free access to journal articles
3 The clinical implication section follows the conclusion section and gives the information regarding the application of the research results in the clinical settings. The results section includes the information about the statistical analysis of the data acquired through research. The methods or design section of the research explains the process by which the research was carried out. The purpose statement of the research article provides information regarding relationships predicted between various variables of the study.
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? 1 The statistical analysis of the data obtained in the research 2 The procedure or design of the research 3 The explanation of the application of the results in clinical settings 4 The explanation of the relationships predicted between various variables of the study
1, 3, 5 Informed consent is needed to ensure that the subject is given sufficient information about the research to enable the subject to either consent voluntarily to participate or decline to participate. The subject should understand the confidentiality of the data obtained. The subject has the right to withdraw from the study when desired. Informed consent does not limit the subject's ability to decline participation; the subject can decline participation anytime in the course of the study. The informed consent does not allow the subject to choose his or her own treatment.
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. 1 Consent is voluntary. 2 The subject cannot refuse to participate in the research. 3 The subject understands how the researcher maintains confidentiality. 4 The subject is allowed to choose the treatment modality. 5 The subject can withdraw from the study at any time.
1, 2, 3 Scientific databases are appropriate for searching evidence on a research question. A medical librarian may help by suggesting the type of databases appropriate to the question and different key words for refining the search. Different combinations of key words should be checked to find studies relevant to the subject. If the key words do not match the words used in the research studies, the results of the search may cause some confusion. Agency policies and procedures manuals and clinical practice guidelines are good sources of information, but they do not help in searching scientific databases.
The nurse is conducting research on the effect of imagery on pain perception. Which actions should the nurse perform when searching the scientific databases for evidence? Select all that apply. 1 Seek the assistance of a medical librarian. 2 Enter and manipulate different key words. 3 Be prepared for some confusion with the evidence obtained. 4 Refer to agency policies and procedures manuals. 5 Refer to existing clinical practice guidelines.
3 The nurse refers to the methods or design section of relevant research to develop methodologies for new research. The methods or design section of the research explains the process by which research is carried out. The abstract provides a brief overview of the entire research and does not specifically give detailed information about the procedures followed. The introduction states the purpose of the study and provides brief supporting evidence that explains the importance of the topic. This section does not provide detail about the procedures followed. The results section includes the statistical analysis that provides a detailed explanation of whether the research question was answered. This section does not give any information about the procedures followed by the researchers.
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? 1 Abstract 2 Introduction 3 Methods 4 Results
2 When a randomized controlled trial (RCT) is completed, the researcher will know if the intervention leads to better outcomes than the standard of care. In a case control study, the researchers determine if there is an association between a predictor variable and a condition. A case control study is one in which researchers study one group of subjects with a certain condition at the same time as another group of subjects who do not have the condition.
The nurse is helping a researcher conduct a randomized controlled trial (RCT). Which characteristic differentiates the RCT from other types of studies? 1 Researchers will test a new drug with the usual standard of care. 2 When completed, researchers will know if the intervention leads to better outcomes than the standard of care. 3 Researchers will study two groups of subjects—one with the disease and another without the disease. 4 When completed, researchers will determine if there is an association between one or more predictor variables and the condition.
4 This example illustrates a situation in which the health care providers take the patient's values and beliefs into consideration while providing care. This is not an example of a quality improvement study or change in practice based on evidence. Although ethics is a critical consideration in this instance if the patient's life is in danger and the patient refuses treatment, the provider orders an alternative to blood products, which in itself is not an ethical dilemma.
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? 1 A quality improvement study 2 A change in practice based on evidence 3 A time when calling the hospital's ethics committee is essential 4 Consideration of patient preferences and values while providing care
1 If the evidence acquired through varied research is not strong enough to apply in practice, the next option for the nurse is to conduct a pilot study. A pilot study is research done on a small scale. Conducting systematic reviews or randomized controlled trials involves tedious processes and takes a long time to obtain results. Even though these methods provide high quality evidence, they are less likely to be performed by the nurse working in a clinical setting. The nurse does not apply the predicted results of research in clinical settings without suitable evidence.
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? Choose the best answer. 1 Conduct a pilot study. 2 Conduct a systematic review. 3 Conduct a randomized controlled trial. 4 Implement the change that the nurse predicts in clinical settings.
2 The effectiveness of psychological counseling on the perception of stress in patients with chronic illness is the outcome variable. This variable cannot be measured; thus the study is a qualitative study. In the statement regarding the effectiveness of aspirin to reduce fever in patients with viral infections, fever is the main outcome variable. Changes in temperature can be measured; thus this study is an example of quantitative research. In the statement regarding the effectiveness of relaxation techniques in decreasing pain severity in cancer patients, pain severity is the main outcome variable. Changes in pain severity can be measured using the visual analogue scale; thus this study is an example of quantitative research. In the statement regarding the effectiveness of loop diuretics in increasing urine output in patients with chronic renal failure, urine output is the main outcome variable. The change in urine output can be measured; thus this study is an example of quantitative research.
The nurse is studying the process of nursing research. Which research should the nurse classify as qualitative research? 1 Effectiveness of aspirin to reduce fever in patients with viral infections 2 Effectiveness of psychological counseling on the perception of stress in patients with chronic illness 3 Effectiveness of relaxation techniques in decreasing pain severity in cancer patients 4 Effectiveness of loop diuretics in increasing urine output in patients with chronic renal failure
4 This is a randomized controlled trial because patients are randomly assigned into the control or treatment group. The researcher will measure the effectiveness of the standard treatment with the educational program, which is a quantitative measure, not qualitative. This research is also not descriptive, which measures people, situations, or groups and the frequency with which certain events or characteristics occur. Correlational research explores the interrelationships among variables of interest without any active intervention by the researcher.
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? 1 Qualitative 2 Descriptive 3 Correlational 4 Randomized controlled trial
1, 3, 5 The PICOT (Patient, Intervention, Comparison, Outcome, Time) format is used when asking a clinical question and looking for related evidence. The PICOT format helps to refine the focus of the question by dividing the question into different components of PICOT. The evidence can be searched through key words of a PICOT question, which helps to refine the search and to identify gaps in the clinical situation in terms of missing evidence. It is not necessary to follow the sequence of PICOT; the components can be used in any order. The PICOT format allows the nurse to ask questions that are focused on intervention, rather than theory.
The nurse understands that using a PICOT format for clinical questions helps in refining the search for evidence. Which are the best reasons to follow the PICOT format? Select all that apply. 1 It helps to ask a more focused question. 2 It is necessary to follow the sequence of PICOT. 3 It prevents wandering when searching for evidence. 4 It allows the researcher to ask questions that are focused on theory. 5 It helps to identify knowledge gaps within a clinical situation.
4 A well-written literature review offers an argument about what led the author to conduct a study or report on a clinical topic. The literature review also provides a detailed background of the level of science or clinical information that exists about the research study. An abstract is a short summary that contains brief information about the study. An introduction contains more information about the purpose of the article. A manuscript narrative provides information regarding new therapy or new technology.
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? 1 It mentions the purpose of the article. 2 It includes a short summary that contains brief information about the study. 3 It explains a new therapy or new technology. 4 It includes an argument about what led the author to conduct a study or report on a clinical topic.
3 Randomized control studies are the most precise form of experimental studies and the gold standard of research. These studies provide the most reliable evidence. A descriptive study, case control study, and controlled trial without randomization are much lower in the hierarchy of evidence.
The nurse wants to determine the effectiveness of a behavioral therapy intervention in adolescents with conduct disorder. Which type of research should the nurse conduct in order to acquire the most reliable evidence? 1 Descriptive study 2 Case control study 3 Randomized controlled trials 4 Controlled trial without randomization
1, 4 Using the PICOT format helps to ask a focused clinical question. P stands for population of interest, I stands for intervention of interest, C stands for comparison of interest, O stands for outcome, and T stands for time. Patients with cervical cancer represent the population of interest, and rating the quality of life represents the outcome. The question does not contain the other three elements: intervention of interest, comparison of interest, and time.
The nursing student has posed a PICOT clinical question for a research study. The question that has been posed is, "How do patients with cervical cancer rate their quality of life?" Which PICOT elements does this question contain? Select all that apply. 1 Patient population of interest 2 Intervention of interest 3 Comparison of interest 4 Outcome 5 Time
2, 3 An abstract is a short summary of a study or an article that highlights the main features of the article, including the objective of the article, methods used, results obtained, and conclusions made. The introduction explains the purpose of the article and the evidence to support it. The abstract and introduction together would indicate whether the article is relevant to the PICOT question being researched. Reading the article in detail is time-consuming. Literature reviews involve thorough search of the relevant scientific studies done in the past to consolidate the purpose of the present study. Reading manuscript narratives is time-consuming and unnecessary if the article is not relevant to the PICOT question.
The nursing student is collecting useful information for a research project. The student has collected more than 100 articles and needs to sort the articles that are similar to the project's PICOT question. Which advice should the professor give the student? Select all that apply. 1 "Read all the articles in detail." 2 "Read abstracts of the articles." 3 "Read the introductions to the articles." 4 "Read literature reviews about the articles." 5 "Read manuscript narratives of the articles."
1 Quantitative nursing research is the study of nursing phenomena that offers precise measurement and quantification. It focuses on numerical data, statistical analysis, and controls to eliminate bias in findings. Qualitative research focuses on nonnumeric data. Qualitative research methods include ethnography, phenomenology, and grounded theory. Qualitative research provides an opportunity for patients to share their experiences.
The registered nurse is teaching a group of student nurses about quantitative nursing research. Which statement made by a student indicates effective learning? 1 "It focuses on statistical analysis." 2 "It focuses on nonnumeric data." 3 "It includes research methods such as grounded theory." 4 "It provides an opportunity for patients to share their experiences."
2 Quality improvement sometimes requires IRB (institutional review board) approval. Therefore, datum 2 is accurate. Researchers may or may not be employed by the health care agency and usually are not a part of the clinical health care team, so datum 1 is inaccurate. Funding sources for evidence-based practice are usually internal, from the health care agency, so datum 3 is inaccurate. The purpose of evidence-based practice is to determine safe and effective nursing care with the goal of improving patient care and outcomes, so datum 4 is inaccurate.
The student nurse is documenting the similarities and differences among evidence-based practice, research, and quality improvement. Which datum documented by the student nurse is accurate? 1 Datum 1 2 Datum 2 3 Datum 3 4 Datum 4
4 The process of informed consent includes providing research subjects full disclosure about the study and the opportunity to participate or not to participate in the study. Bias is opinion by a researcher that will influence the results of research. 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. Anonymity guarantees that any information a subject provides will not be reported in any manner than identifies the subject and will not be accessible by anyone, including the research team.
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? 1 Bias 2 Anonymity 3 Confidentiality 4 Informed consent
4 The first step of the research process is to state the research problem. The correct order of steps is to state the research problem, review the literature, develop a theoretical construct, identify variables, and then clarify operational definitions.
Which statement shows the steps of the research process in the correct order? 1 Review the literature, state the research problem, and develop a theoretical construct. 2 Review the literature, state the research problem, and select the research strategy. 3 Select the research strategy, collect data, and analyze data. 4 State the research problem, review the literature, and clarify operational definitions.
3 Quantitative research involves analysis of numbers, such as the percentage of women diagnosed with acute myocardial infarction and what age groups the women belong to. The survey design examines opinions, attributes, behaviors, or characteristics of a population. Qualitative research describes information in a nonnumeric form. Evaluation research determines how well a program, practice, or policy is working.
Which type of research design would be helpful to determine the percentage of women who are diagnosed with an acute myocardial infarction between the ages of 40 and 60 years? 1 Survey 2 Qualitative research 3 Quantitative research 4 Evaluation research
