Chapter 5: Evidence-Based Practice

To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is A. A guide for nurses in making clinical decisions. B. Based on the latest textbook information. C. Easily attained at the bedside. D. Always right for all situations.

A. A guide for nurses in making clinical decisions.

The hospital's quality improvement committee has identified a problem on one of the units. In using the PDSA method to help determine ways to deal with the issue, the committee decides to do a literature review. This is an example of quality improvement a. Combined with evidence-based practice. b.With inability to make the right decision. c. With delay in the action needed. d. With no designated method for dealing with issues.

a. Combined with evidence-based practice.

The hospital quality improvement committee has noted that the incidence of needlestick injuries on a particular unit has increased. When faced with issues, the committee applies the PDSA model, a formal model for exploring and resolving quality concerns. Because the committee is multidisciplinary in nature, and few members are nurses, it is imperative that the committee first a. Plan. b. Do. c. Study. d. Act.

a. Plan.

In reviewing literature for an evidence-based practice study, the nurse realizes that the most reliable level of evidence is the a. Systematic review and meta-analysis. b. Randomized control trial (RCT). c. Case control study. d. Control trial without randomization.

a. Systematic review and meta-analysis.

In collecting the best evidence, the gold standard for research is a. The randomized controlled trial (RCT). b. The peer-reviewed article. c. Qualitative research. d. The opinion of expert committees.

a. The randomized controlled trial (RCT).

The nurse is developing a PICO question related to whether her patient's blood pressure is more accurate while measuring with the patient's legs crossed versus with the patient's feet flat on the floor. With P being the population of interest, I the intervention of interest, C the comparison of interest, and O the outcome, the nurse determines that this is a. A true PICO question, because the outcome always comes before the intervention. b. A true PICO question regardless of placement of elements. c. Not a true PICO question, because the comparison comes after the intervention. d. Not a true PICO question, because the outcome comes after the population.

b. A true PICO question regardless of placement of elements.

The hospital policy states that when starting an intravenous (IV) catheter, the nurse must first prepare the potential IV site with alcohol and dress it using a gauze dressing. The nurse has done a literature review and believes that evidence-based practice dictates the use of a transparent dressing to prevent catheter dislodgment. What should the nurse do? a. Begin to use transparent dressing instead of gauze dressings. b. Bring findings to the policy and procedure committee. c. Use transparent dressings on half of her IV starts and gauze on the other. d. Continue following hospital policy without saying anything.

b. Bring findings to the policy and procedure committee.

In conducting a research study, the researcher must guarantee that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. This concept is known as a. Anonymity. b. Confidentiality. c. Informed consent. d. The research process.

b. Confidentiality.

The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the a. Abstract. b. Introduction. c. Literature review or background. d. Results.

b. Introduction.

When evaluating quality improvement (QI) programs in relation to evidence-based practice (EBP), it is easy to note that a. Both are designed to improve performance. b. When implementing EBP projects, it is important to review QI data. c. EBP is not at all related to QI. d. Evaluation of processes is the realm of performance improvement (PI), not QI.

b. When implementing EBP projects, it is important to review QI data.

In caring for patients, it is important for the nurse to realize that evidence-based practice is a. The only valid source of knowledge that should be used. b. Secondary to traditional or standard care knowledge. c. Dependent on patient values and expectations. d. Not shown to provide better patient outcomes.

c. Dependent on patient values and expectations.

The first step in evidence-based practice is to ask a clinical question. In doing so, the nurse needs to realize that in researching interventions, the question a. Is more important than its format. b. Will lead you to hundreds of articles that must be read. c. May be easier if in PICO format. d. May be more useful the more general it is.

c. May be easier if in PICO format.

The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation for patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. What type of research is the nurse conducting? a. Evaluation research b. Experimental research c. Qualitative research d.Nonexperimental research

c. Qualitative research

The nurse is caring for a patient with chronic low back pain. In providing care for this patient, the nurse wonders whether the guidelines utilized for this type of pain are adequate. The nurse wants to determine the best evidence-based practice regarding these guidelines. What is the best database for the nurse to access? a. MEDLINE b. EMBASE c. PsycINFO d. AHRQ

d. AHRQ

The researcher is preparing to publish his study findings. In doing so, the researcher is aware of many ways that the study could have been done better, but that he did not have the ability to do. The researcher discloses these limitations in the manuscript, but they are most likely detected during which phase of the research process? a. Problem identification b. Study design c. Formulation of recommendations d. Analysis of data

d. Analysis of data

The quality improvement committee has been alerted to an increased number of falls in the hospital. Most of these falls have occurred at night and have involved patients who were trying to crawl over bedrails. A literature review brought out that most falls occur because patients are trying to go to the bathroom. The committee created a practice change that bedrails should be left in the down position, and hourly nursing rounds should be conducted. What is the committee's next step? a. Evaluate the changes in 1 month. b. Wait a month before implementing the changes. c. Implement the changes as a pilot study. d. Communicate to staff the results of this inquiry.

d. Communicate to staff the results of this inquiry.

The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurse's best option? a. Drop the idea of making the change at this time. b. Insist that management hire the needed staff to facilitate the change. c. Seek employment in another institution that may have the staff needed. d. Conduct a pilot study to develop evidence to support the change.

d. Conduct a pilot study to develop evidence to support the change.

The quality improvement committee is examining an increase in medication errors on a particular unit. In conducting its analysis, what should be the committee's primary focus? a. Nurses who administer the medications b. Pharmacy that prepares the medications c. Secretaries who enter the orders d. None of the above

d. None of the above

Qualitative nursing research is valuable in that it a. Excludes all bias. b. Uses randomization in structure. c. Determines associations between variables and conditions. d. Studies phenomena that are difficult to quantify.

d. Studies phenomena that are difficult to quantify.