Research methods N262B midterm review
Case-control design
(Type of retrospective study) "cases" (those with Dx) are compared to "controls" (those without Dx) on prior potential causes
(a)_______________ are stronger than (b)________________ in supporting causal inferences—but neither is as strong as experimental designs.
(a) Prospective (b) Retrospective
1. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions?
Cochrane Database of Systematic Reviews (CDSR)
A nurse is providing care for a 73 yo client whose balance is compromised by a vestibular disorder. The nurse has advocated for the installation of balance bars & handholds throughout the client's home, but the client is reluctant, saying, "Those are for old people." Which of the following is the best guide for making the decision?
Existing evidence, the nurse's experience w the intervention, & the client's opinion
Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy?
Formulate a question and conduct a thorough search of the existing evidence
During a quality improvement initiative, nursing staff utilized the PDSA cycle. This cycle concludes w which of the following actions?
Revising, refining, and repeating the change that was implemented
Prospective study design
study that follow individuals or cohorts over time in order to observe selected outcomes
Histograms are used for
distributions of continuous data (frequency of occurrence)
skewed right
mean > median
measures of central tendency
mean, median, mode
asymmetrical distribution
skewed
Validity
The ability of a test to measure what it is intended to measure
Reliability
Ability of a test to yield very similar scores for the same individual over repeated testings
1. A nurse has noticed an increased number of students w recurrent otitis media in the elementary school & is concerned that the tx currently being used is not as effective as it once was. Which of the following should the nurse utilize to confirm a possible change in protocol is warranted?
Acquire confirming external evidence
A nurse is aware that clients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among clients with dementia or delirium is most likely to yield the greatest number of relevant results?
(delirium OR dementia) AND nutrition
Which of the following changes in practice would be most amenable to the PDSAcycle?
A change in the medical unit's schedule of turning immobilized clients
A quality improvement initiative at a large university hospital has referred to the National Quality Forum's list of 15 nursing standards for inpatient care (NQF-15). The NQF-15is which of the following?
An important processes and outcomes that are w/in the scope of nursing personnel
randomized control trial goal
Compare what happens after introducing an intervention; ensuring equivalent groups at outset
Chi-square
Involves categorical variables. Looks at 2 distributions of categorical data to see if they differ from each other.
Logistic regression significance
inferred by percent confidence interval MUST NOT cross zero
1. In the interest of efficiency, a nurse has limited a search of an electronic database to only those articles containing full text. What effect is this action likely to have on the results of the search?
Articles that are relevant may be excluded from consideration
Exploratory Trial goal
Compare groups - no intervention
A nurse has conducted a search of PubMed to answer the question, "What factors influence older adults' decisions to seek care from the emergency department rather than their primary care provider when experiencing fatigue?" The nurse is currently reviewing the results of the search in the order that they appear. What factor determines the order of the results in a search of PubMed?
Date the article was added to the database
While searching an online database for information on the use of drugs to treat hypertension, the nurse is unsatisfied with the quantity and quality of results after searching "B-blockers". How should the nurse proceed?
Identify the appropriate MeSH term.
1. Which of the following sources would best provide critical appraisal during a nurse's search for evidence on which to base practice?
a. A journal that provides assessments of notable articles recently published in other journals
1. A nurse remembered it had been a difficult day. They were short-staffed, and several elderly clients had been discharged to home. Two of those clients are now being readmitted d/t possible infections. The clients are telling the staff when they left they didn't know what they were to do. The hospital administration is upset because Medicare won't reimburse for their care. Which of the following would have best prevented this situation?
a. Adequate personalized discharge planning. (Explanation: Clients must be prepared for discharge with adequate education provided so they will know what they need to do once they are home. This care should also be individualized to meet their individual needs. Extending everyone's admission unnecessarily, using home health care when not needed, and just assuming it was unpreventable are not considered one of the barriers of client-centered care. )
A client has recently been diagnosed with non-Hodgkin lymphoma and is interested in knowing how other adults in her age bracket responded to regular chemotherapy vs chemotherapy combined with alternative therapy and whether they saw an improvement in their life span. Which of the following will best assist the nurse in answering this client's question?
a. Cohort studies (Explanation:Prognosis questions are best answered by searching for cohort studies. An RCT is a research question that works best w an intervention and dx question format. Qualitative questions are used to address meaning questions. )
descriptive statistics
numerical data used to measure and describe characteristics of groups. Includes measures of central tendency and measures of variation. (frequencies, percentages, means and SD)
A community health nurse wants to research for methods to encourage mammograms. Which of the following would be an appropriate type of foreground question to develop?
a. Intervention (Explanation: An intervention question asks what intervention most effectively leads to an outcome. A meaning question asks how an experience influences an outcome. An etiology question asks to what extent a factor, process, or condition is highly associated w an outcome. A prediction question asks what indicators are most predictive of or carry the most associated risk for an outcome. )
A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem?
a. Narrow the scope of the clinical question. (Explanation: A useful response to theproblem of information overloadis tonarrow and hone the clinical question. The strategy is likely to be more effective, and valid, than establishing a narrow date limit, going forward with only the recommendations of colleagues, or limiting a search to RCTs. )
Which of the following principles can help a nurse rank levels of evidence when answering clinical questions of all types and scopes?
a. Syntheses are the highest levels of evidence. (Explanation: Regardless of the type of clinical evidence,syntheses are considered to be the most reliable source of evidence. Quantitative research is not categorically superior to qualitative research, and answering clinical questions does not always require RCTs. Sources of evidence for the establishment of EBP are not always peer-reviewed publications and can include expert opinion and experience.)
Which of the following statements is true of foreground questions?
a. They focus on issues that can be addressed by applying scientific evidence. (Explanation:Foreground questions are those that can be answered from scientific evidence. These questions focus onspecific, not broad, knowledge. Practices on a particular clinical setting are considered background knowledge. While electronic resources are a common info source, answering a foreground question does not preclude the use of print resources. )
if your frequency distribution shows outliers, you might want to use the (a)______________ instead of the (b)______________.
a. median b. mean
Retrospective study design
an outcome in the present (e.g., depression) is linked to a hypothesized cause occurring in the past (e.g., having had a miscarriage)
In the process of advocating for EBP in the unit guidelines, a nurse has met with skepticism from other members of the nursing staff, with several stating, "Evidence-based practice is good in theory, but it's almost impossible to actually search hundreds of journals & find the evidence." What could the nurse recommend? a. Self-reflection on the nurses' current practices b. Accessing the Cochrane Library c. contacting the clinical nurse educator on the unit d. beginning with lay publication before progressing to peer-reviewed journals.
b. Accessing the Cochrane Library (Explanation: Databases such as the Cochrane Library and the National Guideline Clearinghouse can provide nurses with quick, easily retrievable, systematic reviews, and evidence-based guidelines to inform their practices. Self-reflection and contact with an educator may be useful measures but do not necessarily advance the cause of EBP. It would be inappropriate to recommend lay publications as a source of evidence.
When implementing a new, evidence-based infection control regimen, which should constitute the final step in the nurses' EBP? a. calculating the cost savings that will be realized by using the new regimen b. sharing their experience with other healthcare professional c. implementing enforcement measures to ensure compliance with the new regimen d. conducting a meta-analysis of other infection control measures
b. Sharing their experience with other healthcare professionals (Explanation: The final step in the EBP process is dissemination of the outcomes of the change. Financial considerations & enforcement measure are not components of the EBP process, and a meta-analysis would have been conducted much earlier in the process.)
Descriptive/Correlational Research
permits investigators to only describe patterns of behavior and discover links or associations between variables. Used when a researcher cannot manipulate the variables under study. Includes naturalistic observation, case study, and survey
A clinic is considering incorporating EBP that they have discovered. They believe it will improve the care they are providing to the clients & improve the health of the community. Which of the following should the staff keep in mind as they evaluate this EBP? a. The risks vs benefits of not proceeding with the changes b. the effect on payment from the third-party payers c.The guidance & preference of the clientele d. the knowledge base of the staff
c. The guidance & preference of the clientele (Explanation: Client-centeredness is an important aspect of EBP & even required. It is the integration of client preferences & values in evidence-based decision making. It should always guide all clinical decisions. The knowledge base of the staff will improve w cont education. Improving health care should improve the financial status of the clinic.
The certified nurse educator on a postsurgical unit has recently completed a client review after the implementation of a pilot program aimed at promoting early ambulation following surgery. Which of the following components of EBP is the nurse putting into practice? a. patient preferences b. research utilization c. experience d. Internal evidence
d. Internal evidence (Explanation: Internal evidence is generated from outcomes management or quality improvement projects, such as a pilot program testing an intervention in a particular care setting. Pt preferences, research utilization, and experience are not paramount in the nurse's activities.)
inferential statistics
numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population
Types of inferential statistics
• Correlation• T‐tests/ANOVA• Chi‐square • Logistic Regression
Which of the following considerations should be prioritized when choosing a client population during the formulation of a clinical question?
a. A specific and defensible rationale should exist for the choice of client population. (Explanation: Limiting the population to those in a certain age group or other special subgroup can be done if there is a valid reason. It would be erroneous to strive for as narrow a population as possible or to choose a population based on the subject populations found in existing research. The population in a clinical question should reflect the issue at hand, not necessarily the larger demographics of the nurse's geographic area. )
A meta-analysis will consist of the following? a. A statistical summary of the results from several different studies b. an examination of the theoretical and conceptual underpinnings of the issue c. an interdisciplinary analysis of the clinical question d. a qualitative study of different interventions related to the clinical question.
a. A statistical summary of the results from several different studies Explanation: A meta-analysis consists generates an overall summary statistic that represents the effect of the intervention across multiple studies. It is not a type of qualitative study nor does it primarily address the theory behind the question. It is not necessarily interdisciplinary in nature.
Which of the following sx could be clustered into a single outcome for the purpose of crafting a concise clinical question?
a. Dry mouth, tachycardia, & irritability (Explanation: When possible,it is preferable to use fewer outcomes whenever possible. An example includes the common sx of tachy, dry mouth & irritability that are indicators of dehydration. The other sx do not have an obvious commonality that would allow them to be placed under a single umbrella term. )
A nursing supervisor is evaluating different nurses to assist w implementing an EBP change on the unit. Which of the following individuals would be best to help teach the staff?
a. Nurse K, who has great organizational skills (Explanation: There are three areas of knowledge and skill sets that are important and necessary for the nurse to possess to be successful and best assist the client. These are clinical, technical, adn organizational. The organizational set includes knowledge, skills and experience related to teamwork, organizational design and development, and leadership. )
Cross-sectional design
data are collected at a single point in time
Odds Ratio (OR)
• If OR>1 : The outcome is that many times MORE likely to occur The independent variable may be a RISK FACTOR 1.50 = 50% more likely to experience event or 50% more at risk 2.0=twice as likely 1.33 = 33% more likely • If OR < 1 :The outcome is that many times LESS likely to occur• The independent variable may be a PROTECTIVE FACTOR • 0.50=50% less likely to experience the event • 0.75= 25% less likely
A nursing supervisor has been trying to encourage the staff to improve client care with the use of EBP. The supervisor has hung a poster with a slogan suggested by Berwick (2009) in the nurses' station as a reminder. Which of the following is a slogan developed by Berwick? a. doing the least harm b. every client is the only client c. promote harmony, involve the client and family d. only the best for the client
b. Every client is the only client (Explanation: Three slogans were developed by Berwick in 2009: (1) the needs of the client come first; (2) nothing about me without me; and (3) every client is the only client.
A nurse has heard from a colleague about a new approach to providing nursing care. In which of the following sources is this information most likely to appear first?
A journal article
Paired t-test
A test designed to determine the statistical difference between two groups' means where the participants in each group are either the same or matched pairs.
Process of Qualitative Research
Literature Review: Necessary! Develop research proposal Institutional Review Board review Obtain funding to conduct study Enter the field Recruit participants Plan observations, interviews, etc. Recruit partners in the field -theoretical, not strictly representational Sampling is usually purposive or Collect and analyze data Report findings in the literature
A recent viral outbreak has resulted in an epidemic in the community. The nurses are concerned and want to utilize the most effective EBP. Which of the following should be their first step?
Use pre-appraised literature for answers
The local hospital has decided to send out questionnaires to clients after their discharge to inquire about their overall experience while a client. One theme appeared frequently, and it raised concern. Which of the following comments could be seen as a barrier to adequate care?
a. "I wish I had a better idea of what to do once I got home" (Explanation: Researchers have identified four themes as barriers in the discharge process. One of them is that the clients did not feel prepared for discharge and post discharge care was not individualized. The client may not have had the choice in food, going home sooner, or a private room d/t their overall medical condition & treatment. )
Which of the following factors provides the most important rationale for the consistent implementations of EBP? a. EBP provides for the most cost-effective client care b. EBP is accessible to all healthcare clinicians c. EBP provides consistency in care across healthcare settings d. EBP improves client outcomes
d.. EBP improves client outcomes (Explanations: The goal of health care is to improve the lives of the clients by either helping them maintain good health or helping them heal. While EBP does contribute to all choices, the most important is to improve client outcome. )
When is qualitative research appropriate?
-When studying perceptions of participants -Desire to understand how or why, not yes/no -When the goal is narrative, rather than efficacy or statistical evaluation -Often when there is little known on an aspect of the situation -May provide information that stands alone or can be studied quantitatively in future projects
Ordinal data example
1=tallest, 2=next tallest, 3=third tallest
Logistic Regression
A statistical analysis which determines an individual's risk of the outcome as a function of a risk factor. (strength and direction of two variable) The outcome of interest has two categories. Reported with: The odds of an event occurring The probability of the outcome event occurring divided by the probability of it not occurring
Interval/ratio distributions
Bell shaped curve
A nurse is seeking evidence on the most effective ways to promote urinary continence among older adults with dementia. Which of the following sources is most apt to provide timely answers to guide her interventions?
National Guideline Clearinghouse
independent samples t-test
a hypothesis test used to compare two means for a between-groups design, a situation in which each participant is assigned to only one condition
measures of dispersion
variance and standard deviation and standard error of the mean
A focus group is tasked with finding the most recent EBP to help prevent skin damage in clients with fiberglass casts. To assist with the process, which of the following steps should the group implement during their search?
Utilize reference management software (RMS)
correlational design
A research design in which the investigator gathers information on individuals without altering their experiences and then examines relationships between participants' characteristics and their behavior or development. Does not permit inferences about cause and effect.
skewed left
A skewed distribution with a tail that stretches left, toward the smaller values (median>mean).
A nurse has recently marked 10 years of practice on a medical unit. Which of the following aspects of "experience" is most likely to result in improved practice on the part of a nurse? a. increased years of practice in a consistent clinical environment b. exposure to more client interactions and conduction of more interventions c. Examination of interactions and events in the clinical context. d. engagement with a greater variety of clients and client populations
c. Examination of interactions and events in the clinical context. (Explanation: Experience should be considered to be not merely the passage of time or the accumulation of interactions with a larger number and variety of clients. Rather, it is characterized by thoughtful reflection and examination that results in change. )
The family of an elderly client who is being treated for a DVT is concerned about the quality of care the client is receiving. The client has been improving, although more slowly than anticipated and now the family has overheard staff discussing asking the physician to discharge the client to a skilled-nursing facility because they need the bed. When confronted by the family, how should the staff respond? a. apologize and promise not to discuss with the physician. b. apologize and make sure future conversations among staff are done in private c. apologize for the inconvenience but explain the desperate need for the bed for a client who is sicker. d. apologize and recognize that the client comes first and should not be discharged until ready.
d. Apologize and recognize that the client comes first and should not be discharged until ready. (Explanation: Sometimes the discharge process is affected by the pressure for the use of the available beds. Client-centered means the client comes first. Making promises or explaining that other clients are more important would not be appropriate. All conversations should always be conducted in private to avoid confidentiality issues.
On an acute medicine unit, the results of a pilot program that implemented a new screening tool for drug & alcohol abuse have been shown to be effective at identifying clients who may require intervention. In light of these results, the unit has included the screening tool in the nursing assessment of every client who is admitted to the unit. The nurses on this unit have made this change in practice based on which of the following?
Internal evidence
A pediatric nurse provides care for many children who present to the ED w s/sx of asthma. Which of the following questions is a background questionthat the nurse can utilize in the process of providing EBP?
a. Are nebulizers provided to clients in the ED more often than MDIs? (Explanation: Before assessing theforeground questions that address the effectiveness of nebulizers vs MDIs, the nurse should be aware of thebackground question of what is currently being done in the practice setting. This type of question regarding current practice is an example of background knowledge.)
After reading an online news article about the surprising role that chewing gum may play in facilitating healing after bowel surgery, a nurse has Googled the subject. How should the nurse best interpret the results of this search?
The nurse must carefully evaluate the results of this search.
A hospital educator has been commissioned with identifying evidence to inform a revision of the hospital's policy on the use of physical restraints. During the search, how should the nurse approach publication data parameters for this search?
The nurse should prioritize the quality and comprehensiveness of the evidence over its date of publication.
1. An oncology nurse is engaged in the quality of EBP that is provided on the cancer unit of the local hospital. Which of the following questions would the nurse consider to be an adequate & useful?
a. "Does guided imagery reduce the anxiety of clients who undergo bone marrow biopsy?" (Explanation: Asking about the effectiveness of a particular intervention(guided imagery) in preventing an outcome (anxiety)exemplifies a useful foreground question.Questions about current practice and the prevalence or incidence of clinical interventions are examples of background questions. Questioning the clinical accuracy or rationale for a particular lab testwould also be considered a background question. )
Which of the following clinical questions would be considered to be a "meaning" question?
a. "How do pregnant women w high-risk pregnancies who have been prescribed bed rest perceive their situations? (Explanation: A PICOT question that focuses on the meaning of a health issue explores the personalized significance & sense makingof the issue, such as the meaning of having to remain on bed rest during a pregnancy. Explorations of the factors that underlie a dx or health decision or a test of the effectiveness of an intervention are not categorized as "meaning" questions.)
A new graduate nurse is excited to finally be working with clients now that he is finished with school. He has suggested an evidence-based practice (EBP) that he has learned in school but is having difficulties convincing the administration. Which of the following should the nurse emphasize in his discussions with the administration? a. It will decrease cost b. it will increase our competitiveness with the other providers in the community c. it will increase our client satisfaction d. it puts the emphasis on client values
a. "It puts an emphasis on client values." (Explanation: Client-centeredness is required for the integration of client preferences and values in EBP making. Client values should guide all clinical decisions to incorporate EBP.
How should a nurse best understand the concept of clinical expertise?
a. Clinical expertise is enhanced by holistically knowing clients as individuals. (Explanation: Good judgement, and clinical expertise, depends on knowing the client; understanding his or her concerns, preferences, history, and understanding of the illness; and possessing the best relevant scientific knowledge. This scientific knowledge neither supersedes nor replaces clinical expertise, as both are necessary and each complements the other. Clinical expertise is not demonstrated simply by an increased level of formalized knowledge. )
A student nurse is feeling a little overwhelmed on her clinicals. The unit is short-staffed d/t illness. All beds are filled w clients requiring moderate to extensive care, and one of the student supervisors is also ill. The student is trying hard to complete all the necessary tasks & provide proper care for her clients. In prioritizing her tasks, which of the following is the most important for her to remember? a. Document everything as it happens. b. always put the needs of the client first c. keep a list of what she doesn't get done and pass it on to the next shift. d. keep working until everything is completed, even if she needs to stay a little longer.
b. Always put the needs of the client first (Explanation: The nurse should always put the needs of the client first. This can be demonstrated by one of the slogans developed by Berwick "the needs of the client come first." Documentation is important, but not as important as caring for the client. Passing her tasks off to someone else & staying late may not be an option as per the unit's policies. If she is not completing her tasks, then she should speak w the clinical supervisor & determine ways to help her complete her tasks.
A nurse is conducting a literature review on the evidence regarding the use of vacuum dressings on pressure ulcers. After locating a recent study that appears to be relevant, which of the following questions would the nurse consider first when critically appraising the study? a. "are the findings of this study cost-effective in our clinical context?" b. "how would the implementation of this intervention affect our staffing needs?" c. "were the clients in the study similar to the clients on my unit?" d. "are the findings of the study significantly different from what we are currently doing on the unit?"
c. "were the clients in the study similar to the clients on my unit?" (Explanation: Questions regarding the similarity between sample and the nurse's clients address the important issue of applicability. The question would need to be considered prior to assessing the impact on cost or staffing levels. The difference between the study and current practice on the unit are not directly related to critical appraisal. )
A nurse is searching for recent information concerning the most effective follow-up method for clients following bariatric surgery to maintain weight loss. Which of the following questions is appropriate for the nurse to consider when appraising a study? a. were there control groups from my area? b. did the studies cover at least a year in follow-up c. Were the subjects randomly assigned to a group? d. will these methods be effective for everyone?
c. Were the subjects randomly assigned to a group?" (Explanation: Validity, reliability, and appraisal are the three key questions of the rapid critical appraisal process when evaluating a study. Validity includes determining whether the study of a subjects of a study were randomly assigned to a treatment or control group. )
A nursing supervisor is encouraging the increased use of EBP. Part of the plan is to encourage searching for appropriate reports to reference. This nurse is encouraging which of the following components of EBP? a. Patient preference b. internal evidence c. external evidence d External evidence
d. External evidence (Explanation: External evidence refers to the most relevant & best research. Internal evidence comes from one's own clinical expertise & outcomes of projects that are conducted by the facility. Pt preference & value is the third component inherent to the definition of EBP.
1. A new nurse to the unit insists that the technique being used by several of the nurses when discontinuing IV lines is "outdated." The staff does not feel it is wrong for them to continue with what they are doing and see no need to change. The staff explains that they made changes a few years ago and see no reason to change now. Which of the following is MOST important to remember in this situation? a. the staff should be willing to update their skills and care to the most recent EBP b. the new nurse should respect the older staff and not push changes. c. the new nurse should be allowed to present the information and everyone then decide if they want to do it. d. There is no requirement that the staff should always be looking for the most current EBP without a reason.
d. There is no requirement that the staff should always be looking for the most current EBP without a reason. (Explanation: There are several central themes of evidentialism that support the use of evidence in clinical practices. One of them is that beliefs are based on current evidence, and there is no requirement that an individual must pursue more evidence without a reason. Everyone should show each other respect by not demanding that changes be made. The other choices are important but not the MOST important. )
In the context of PICOT format for formatting clinical questions, which of the following may be considered to be an "I"?
a. Decreasing occupational exposure to airborne silicon dust (Explanation: An intervention may supersede the conscious application for a clinical treatment to include environmental and occupational exposures. The incidence and prevalence of a health problem may be an issue is not considered to be an intervention. The level of hygiene in a facility would be considered an outcome rather than an intervention. )
Which of the following should occur first in the steps of EBP? a. conducting an electronic search of the literature and ranking individual sources b. creating buy-in from the other clinicians who provide care at the facility c. Developing an inquisitive & curious mindset d. assessing whether the practices in question may, in fact, be evidence based
a. Developing an inquisitive & curious mindset (Explanation: Step 1 in the process when someone develops an inquisitive and curious mindset. At this point, the assessment of the practice and conducting the search can occur.)
Which of the following clinical questions would be most justified in lacking a comparison?
a. A study on the perceived meaning of hope among palliative clients (Explanation:Assessing the effectiveness of an intervention, such as prenatal care, cool bathing, or rehydration therapy WOULD benefit from comparison with an alternative or established intervention.A qualitative study on the subjective meaning of a phenomenon such as hope, is not amenable to comparison. )
In light of the large number of gallbladder clients recently admitted to the unit, a nurse is searching PubMed for literature related to cholecystitis, cholecystectomy, cholelithiasis, and cholecystography. Which of the following terms should the nurse enter into the search field?
a. Chole*
interval/ratio data
Level of data where the gaps between the measurement points are equal e.g. 1-2 is same as 89-90. Ratio data has a zero point such as height while interval data can extend below zero such as temperature.
A nurse is searching for relevant EBP for a male client who has breast cancer. The search reveals copious articles dealing with breast cancer. Which of the following should the nurse do to assist with this search?
Set inclusion criteria
Which of the following groups would most likely be considered a self-selected cohort?
a. Cigarette smokers (Explanation: Because smoking is w/in the locus of control of individuals & would be unethical to prescribe for the purposes of research, this group is likely to be considered a self-selected cohort. Sex, age, and ethnic group are not self-selectable, and a person's drug regimen is not normally under the individual control of that client.)
Some of the staff in the ED are having difficulties w a new nurse. The new nurse has been using some techniques she learned while serving in a combat situation; however she cannot produce enough research to prove that her method is okay. Which of the following statements supports her use of these techniques?
a. "I know this worked best in the field situation and resulted in better client outcome" (Explanation: One of the central themes of evidentialism that support the use of evidence in the clinical practice is that experiences that a person has had can be counted as evidence. Since this nurse has firsthand knowledge of the success of the technique, it can count as evidence. Doing something the same way, experimenting on clients and using techniques without proven results would not be appropriate, possibly unethical, and may actually hurt the client. )
Management of a county hospital has been resistant to providing time, facilities, and subscriptions to allow nurses to conduct online searches near the point of care. Which of the following arguments can the nurses present to strengthen their case for these tools?
a. "Providing for literature searches has been shown to save money and shorten client stays."
A nurse who provides care on a renal unit has posed a number of clinical questions in an effort to implement evidence-based practice (EBP). Which of the following questions could those nurses best answer by consulting a textbook?
a. "What are the anatomical characteristics and physiologic functions of the kidneys?"
Which of the following clinical questions can be best addressed by a meta-synthesis of qualitative studies?
a. "What is the meaning of spiritual support in hospice clients who are younger than 50?" (Explanation: Aclinical question that focuses on meaningis likely to bebest addressed through a systematic review or meta-synthesis of qualitative studies. The effectiveness of particular treatments or interventions is better gauged by other levels of evidence that are often quantitative
A nurse is concerned that cases of a viral infection are not being recognized or accurately diagnosed. In developing an appropriate foreground question, which of the following types would be most appropriate?
a. Diagnosis (Explanation: Adx questionasks what mechanism or test will most accurately diagnose an outcome. Anetiology questionasks what extent a factor, process, or condition is highly associated w an outcome. Ameaning questionasks how an experience can influence an outcome.Prediction questionsask what indicators are most predictive of or carry the most associated risk for an outcome. )
The nurses on a postpartum unit want to create uniform guidelines for promoting breastfeeding on the unit. Which of the following sources is most likely to provide the best evidence? a. Evidence from a RCT that had more than 2,500 participants b. Evidence from a study that is widely regarded as a classic w/in the obstetrical nursing community c. Evidence from a systematic review of breastfeeding promotion studies that one of the nurses identified in an electronic database. d. the consensus opinion of the most senior nurses on the unit.
c. Evidence from a systematic review of breastfeeding promotion studies that one of the nurses identified in an electronic database. (Explanation: The rating system for the hierarchy of evidence consists of seven levels with the top being l. Level l is evidence from a systematic review or meta-analysis of all relevant RCTs. Level ll consists of evidence obtained from well-designed RCTs. Level Vl consists of evidence from a single descriptive or qualitative studies, such as the classic study. Level Vll is evidence from the opinion of authorities and/or reports of expert committees, such as the opinion of most senior nurses on the unit. )
A nurse is having difficulties making a decision about a particular client care technique. The nurse believed that this technique was the best approach based on evidence, but another nurse is questioning this decision. How should the nurse proceed? a. find more evidence to back the decision b. find newer evidence describing a newer approach c. consult with the nursing supervisor before proceeding d. Continue using the technique until it proves ineffective.
d. Continue using the technique until it proves ineffective. (Explanation: One of the themes of evidentialism is that beliefs are based on what we know at this moment, and there is no requirement to pursue more evidence at any particular time without a reason. Just because someone else is questioning the technique is not reason enough to discontinue unless the effectiveness, ethics or safety is being questioned. )
Which of the following components of a clinical question represents the "P" in the PICOTformat for asking clinical questions?
a. Individuals who require peritoneal dialysis. (Explanation: the "P" in the PICOT format denotes the population of interest, such as patients who undergo regular peritoneal dialysis. Preparation for intervention, the comparison of two different interventions, and a particular medical diagnosis are not components of the "P" field. )
The nurses on a geriatric, subacute medicine unit have agreed on a goal of reducing the incidence of pressure ulcers by 50% over the next 10 weeks. This goal represents which component of the PICOT format for asking clinical questions?
a. O (Explanation: The specific goal of reducing the incidence of pressure ulcers represents the "O", or expected outcome of the clinical scenario. The "P"represents thepopulation, and the "I" represents the intervention, and the "C" represents the comparison for treatment. )
A nurse has found his work at the hospice very rewarding and at times very difficult. The most frustrating part is when he sees a client "give up" and refuse treatment he feels will help them. How can this nurse best help his clients?
a. Respect their wishes, allowing them to decide what they want. (Explanation: The nurse can best help these clients by respecting their wishes and decisions. He should continue to be available to answer questions but should not pressure the client or family to make the decision the nurse wants. Client-centered care is providing care that is respectful of and responsive to the individual preferences, needs and values. )
A nurse is working on a literature review using a laptop computer while in a cafe that provides wireless Internet access but will not allow for connection to the hospital's library server that provides the nurse's normal access through the hospital's database subscription. Which of the following resources is likely to be unavailable to the nurse through this public Internet connection?
EMBASE
A nurse is caring for an elderly client whose family has been very involved in her care. The client is alert, oriented, and aware of what is happening. Her eldest son has been very insistent that everything is discussed with him first and he will then decide if the client should know. The nurse recognizes this is based on their cultural value; however, it is a conflict for providing the best care of this client. How should the nurse respond? a. Recognize the son's position, but explain that the decisions must come from the client. b. instruct the son to geta medical power of attorney to bypass the client c. withhold information from the client per the son's request d. compromise by agreeing to only discuss information with the son is present.
a. Recognize the son's position, but explain that the decisions must come from the client. (Explanation: "Nothing about me without me" is a slogan developed by Berwick. Clients must be allowed to make the decisions about their care as long as they are mentally competent. To acknowledge the son's request would be unethical. The client must also give the nurse permission to discuss her medical info w the son as per HIPAA.
A 78 yo woman w Alzheimer's has fallen at her care facility & suffered a hip fracture. The orthopedic surgeon has recommended a hip replacement & aggressive PT. The family is concerned & questions whether this is the best tx based on past experience w another family member who had the procedure but has done poorly ever since. Which of the following types of research would be the best for the nurse to research first to provide answers in this situation?
a. Synthesis of cohort studies (Explanation: Thefirst level of evidence for a prognosis or predictive question is a synthesis of cohort study or case-control studies. The other choices can be used, but should be considered after the synthesis of cohort studies. )
The primary care provider of a 49 yo male client has examined and briefly explained the evidence that supports beginning regular digital rectal exams. Which of the following factors would justify not performing digital rectal exams in this client's care? a. The client is vehemently opposed to undergoing digital rectal exams b. clinical practice guidelines for prostate care have not been published c. the clinician has been unable to find any large RCTs in a literature review d. the clinician has previously waited until clients are 55 to begin regular digital rectal exams.
a. The client is vehemently opposed to undergoing digital rectal exams (Explanation: Pt preference, such as opposition to a particular assessment or intervention, should be implemented in clinical decision making. The lack of a large RCT or clinical practice guidelines does not independently justify rejecting the assessment. Likewise, the clinician's previous practice traditions do not provide sound justification.
Which of the following clinical questions demonstrates understanding of and best exemplifies the PICOT format? a. what effect does parent's smoking have on the smoking habits of their children, aged 13-16? b. Among pts w cancer, what role does meditation, as compared with the use of benzodiazepines, have on anxiety levels during the 7 days following hospital admission? c. Among undergrad college students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new gonorrheal and clamydinl infections reported to the campus med. center? d. In clients aged 8-12, is the effectiveness of a pain scale using faces superior to a numeric rating scale in the ER context?
b. Among pts w cancer, what role does meditation, as compared with the use of benzodiazepines, have on anxiety levels during the 7 days following hospital admission? (Explanation: Only the answer concerning pts w cancer contains the PICOT elements of Patient population, Intervention or Issue of interest, Comparison intervention or group, Outcome, and Time frame. The answer concerning smoking lacks and intervention, comparison, or time frame while the answer concerning undergraduate college students lacks a comparison. The answer concerning clients aged 8 - 12 lacks a specific outcome or time frame.
A nurse paged the attending physician because a postmastectomy client became somewhat agitated and tachypneic in recent hours. Despite the other nurses' assertion that the client was simply experiencing some anxiety, the nurse suspected a more serious etiology. The physician prescribed a single dose of a benzodiazepine, which was largely ineffective. Due to the nurse's persistence, diagnostics were performed, leading to a diagnosis of pulmonary embolism. Which of the following did the nurse exhibit? a. EBP b. Clinical expertise c. client-centered care d. best practice
b. Clinical expertise (Explanation: The nurse demonstrated aspects of clinical expertise, including engaging in detective work, recognizing qualitative distinctions, and recognizing changing clinical relevance. EBP may have formed the foundation of the nurse's actions, but they did not directly exemplify EBP. Client-centered care and best practice are not concepts that are specifically demonstrated by this scenario, )
Which of the following is emphasized by the Institute of Medicine's Roundtable on Evidence-Based medicine? a. Ensuring that external evidence, rather than internal evidence, is integrated into care b. Fostering the level of learning that exists in the American healthcare system. c. Issuing clinical guidelines to ensure best nursing practices d. comparing the implementation of EBP in the US with that of other Western countries
b. Fostering the level of learning that exists in the American healthcare system (Explanation: The Roundtable is charged w accelerating the progress toward a learning healthcare system, generating new evidence to support which healthcare strategies are most effective, and improving public health awareness and understanding about EBP. Comparison w other countries, issuing specific practice guidelines, and denigrating internal evidence are not components of its role
Nurse L provides care on a busy medical unit of an inner city hospital. Which of the nurse's actions best exemplifies clinical grasp? a. Nurse L is committed to reading and integrating the most recent, published evidence b. Nurse L is able to identify subtle changes in client condition that are often not obvious to other clinicians. c. nurse L has responded appropriately to clients in cardiac or respiratory arrest. d. nurse L makes a concerted effort to get to know clients' families.
b. Nurse L is able to identify subtle changes in client condition that are often not obvious to other clinicians. (Explanation: An aspect of clinical grasp is the ability to identify subtle transitions in client condition. Gathering evidence, providing good care during an emergency, and getting to know clients' families are all aspects of sound nursing care but do not directly exemplify the notion of clinical grasp.
1. A new administrator for a health clinic is concerned that some treatments are not as effective as they could be. After conducting a survey among the staff, it is discovered that the general consensus is the EBP process is not effective. Which of the following would be the best step for the administrator to do next? a. Leave the current treatments in place b. Present real-case scenarios in which EBP resulted in better care and long-term results. c. change one treatment at a time until EBPs are implemented d. assign small focus groups to research EBP to implement.
b. Present real-case scenarios in which EBP resulted in better care and long-term results. (Explanation: Healthcare providers who do not believe EBP results in improved care and client outcomes need to be exposed to real-case scenarios in which evidence-based care resulted in better outcomes than care steeped in traditional practices. If the staff does not believe it will be a benefit, they will not be receptive to the changes or implement them. Leaving the current treatments in place does not benefit the clients in the long term.
