Research Test 1 Study Questions

Match the characteristics of the model or framework with the name on the right: 1.Three iterative, dynamic phases of evidence implementation including assessment, monitoring and evaluating impact. 2.Explains how the strength of the evidence, context and facilitation influence the probability that evidence will be implemented. A.Iowa B.OMRU C.PARIHS D.JBI

1) B. OMRU 2) C. PARIHS

Match the characteristics of the model or framework with the name on the right: 3.Describes evidence generation, synthesis, transfer and implementation leading to global health 4.A decision-making approach to using evidence A.Iowa B.OMRU C.PARIHS D.JBI

3) D. JBI 4) A. Iowa

Clinicians most frequently consult with another clinician when they need information. Therefore, digested, pre-appraised evidence sources should be as handy but has already judged the quality of the evidence. A. True B. False

A. True

Critical Appraisal is a process in which evidence is systematically evaluated in order to judge its quality and trustworthiness in informing practice change. A. True B. False

A. True

Meta-aggregation is the term used to describe the synthesis of qualitative studies. A. True B. False

A. True

Patients have a right to reject or accept a treatment option? A. True B. False

A. True

Shared decision making melds clinical expertise and patient preference. A. True B. False

A. True

The most important thing when choosing a critical appraisal tool is that the tool asks the right questions for the particular research methodology. A. True B. False

A. True

The purpose of rapid critical appraisal is based on the notion that clinicians should be able to quickly appraise evidence to determine its validity and applicability to practice. A. True B. False

A. True

What type of questions would you use the PICO format to ask? A.A question about the effect of arm exercise on dyspnea in patients with chronic obstructive pulmonary disease B.The experience of dyspnea in patients with chronic obstructive pulmonary disease Both questions would be appropriate

A.A question about the effect of arm exercise on dyspnea in patients with chronic obstructive pulmonary disease The PICO format is for questions of effect; PICo is for questions of the meaning of a phenomenon or how a patient experiences it.

Which of the following is a bibliographic database? A.CINAHL. B.Google Scholar C.UptoDate D.JBI Connect+

A.CINAHL The Cumulative Index to Nursing and Allied Health is one of several bibliographic databases that are searchable indexes of literature; Google scholar is a search engine but only points to scholarly articles; UptoDate and JBI Connect+ are online collections of evidence-based summaries and products.

When appraising qualitative research, what do you judge? A.Credibility and relevance to the people and context of the question B.Strength and magnitude of the evidence C.Appropriateness to the effect of interest D.All of the above

A.Credibility and relevance to the people and context of the question Strength and magnitude are important characteristics to judge when appraising quantitative evidence (questions of effect). Credibility is a fundamental quality characteristic of qualitative research. Context impacts how people experience a phenomenon and therefore, the relevance of any research to a particular situation.

Which developmental approach matches the following: Observations and information gathering generate the propositions and relationships. A. Inductive B. Deductive C. Theorizing D. Explaining

A.Inductive Inductive approaches build from smaller bits of information to create more general propositions

What is the purpose of the ANA's Social Policy Statement? A.It defines nursing and what the profession promises to do, its values and duties B.To list the scope and standards of nursing care C.To describe how nurses practice according to legal definitions D.All of the above

A.It defines nursing and what the profession promises to do, its values and duties.

When appraising qualitative studies how is dependability appraised? A.Judgment whether the results are logical, transparent, and consistent. B.Proof that the researcher made every effort to report an honest representation of the voices of the participants. C.Degree to which the results can be transferred to other contexts. D.None of the above

A.Judgment whether the results are logical, transparent, and consistent.

What statement best describes a pluralistic approach? A.Looking at all forms of evidence to inform clinical decision making B.To consider only research reports C.To consider only systematic reviews and randomized clinical trials D.To consider only quantitative research designs

A.Looking at all forms of evidence to inform clinical decision making

What are elements of the nursing metaparadigm? A.Person, health, nursing and environment B.Practice, illness, setting and people C.Theory, evidence, practice and professionalism D.Research, practice, setting and patients

A.Person, health, nursing and environment

Which of the following models/frameworks begins with a problem trigger and works through a series of decision-making steps? A.The Iowa Model B.Ottawa Model of Research Use C.PARIHS D.JBI Model

A.The Iowa Model The Iowa model begins with knowledge/problem triggers and proceeds in an algorithmic fashion.

Applying evidence in practice can occur at multiple levels: with individual patients and their families, with groups of nurses, at the level of organizations and even entire countries. A. True B. False

A.True Applying evidence occurs on a continuum of care - as basic as making a shared decision with a single patient to making national-level health policy decisions.

The scope of a question refers to its breadth and scale refers to how much of the scope to address. A. True B. False

A.True Both the scope (the outside boundary of a problem often related to the population) and scale (the part of the scope defined by the question).

Clinical practice guidelines are a synthesized source of evidence but they may not always be rigorous in their approach. A. True B. False

A.True Clinical practice guidelines are ideally syntheses of syntheses. That is, high quality guidelines are based on systematic reviews or other forms of high level evidence. However, the methods for creating clinical practice guidelines have not yet been rigorously standardized. Some are excellent and others are not. Therefore, like other forms of evidence, users need to be able to recognize high quality from low quality guidelines.

Some in nursing feared that the EBP movement was atheoretical and reduced nursing to a cookbook mentality. A. True B. False

A.True Early on in the EBP movement many feared that EBP threatened nursing's holistic roots.

One of the theoretical argument against EBP was that EBP constrains nurses form defining their own values that guides the nursing person process. A. True B. False

A.True Gail Mitchell (1999) in a well known article worried that EBP would do the above.

According to how "health" is defined in the nursing meta-paradigm, a person may have chronic disease but view themselves as being well. A. True B. False

A.True Health exists on a continuum as a person subjectively experiences and defines their own sense of wellness and illness along a spectrum.

Nurses are obliged to use both theory and evidence to care for patients and to do the work of nursing. A. True B. False

A.True This is the fundamental promise of nursing according to the 2010 ANA Social Policy Statement.

There are clearly times and circumstance when the best available evidence points us in a direction that is not feasible or practical: A. True B. False

A.True This statement is true and speaks to consideration of available resources.

"What is the experience of healthcare practitioner's who care for dementia patients?" This would be a question of: A.Effectiveness B.Meaningfulness C.Appropriateness D.Feasibility

B. Meaningfulness Questions of meaningfulness explore how people experience an event.

Which of the following is an example of a synthesis? A.A randomized controlled trial B.A meta-analysis C.A cohort-controlled study D.A digest

B.A meta-analysis A and C are types of single studies; a digest can be a created from many types of evidence including systematic reviews and single studies.

What is an essential personal attribute for evidence based practice? A.An accepting attitude B.An attitude of inquiry C.Being efficient D.All of the above

B.An attitude of inquiry Being skeptical and curious about your practice and being willing to think self-consciously about practice is critical for developing questions of practice.

Which of the following describes best available evidence? A.Integrating clinical expertise with best external evidence B.Clinicians consider all evidence and use the highest level of evidence available to them. C.Consider only research reports to make clinical decisions D.All of the above

B.Clinicians consider all evidence and use the highest level of evidence available to them.

Which of the following best represents the relationship among theories, models and frameworks based on their scope? A.Theories can generate multiple conceptual frameworks; frameworks can generate multiple models B.Conceptual frameworks are very broad and can be generate different theories; many models can arise from a single theory C.Models are usually unrelated to a theory or conceptual framework D.All 3 are similar in scope and can explain the same phenomenon

B.Conceptual frameworks are very broad and can be generate different theories; many models can arise from a single theory See Figure 5-1 to see a visual representation of the relationship among theories, models and frameworks

For a PICO question, what is CO? A.Comparison of outcomes B.Context of the phenomenon or population C.Comorbid conditions D.Complications

B.Context of the phenomenon or population PICo questions are for asking how a particular group of patients experience a phenomenon. Context may refer to the context of the phenomenon (e.g., in a certain disease) or where the population experiences it (e.g., in an acute care hospital.

Which of the following is a remarkable characteristic of the OMRU model? A.It predicts that evidence implementation happens in a unidirectional sequence of linear steps B.Facilitators assess, monitor and evaluate during a phased but dynamic process C.It relies upon a sophisticated, transformational leadership style to guide evidence through its steps D.If inadequate evidence exists, clinicians can conduct research to fill in the gaps in knowledge

B.Facilitators assess, monitor and evaluate during a phased but dynamic process

Most complex nursing care issues can be broken down into their elemental pieces. A. True B. False

B.False Complexity is characterized by patterns, uniqueness, uncertainty; complex problems are more than the some of their parts because of interactions among the contributors.

Research provides proof that an intervention works. A. True B. False

B.False Many people mistakenly claim that research can create fact or proof. It cannot. All research is contingent. Quantitative research relies upon probability rather than certainty. Evidence based practice is about the best available evidence rather than finding proof.

Nurses should understand how to conduct comprehensive searches of all possible databases for the best available evidence without help from others. A. True B. False

B.False Pravikoff et al's 2005 study indicated that many nurses do not have confidence in their search skills of databases. Comprehensive searching requires sophisticated searching skills. While nurses should understand where to search for high quality evidence and how to use logic to conduct these searches, librarians have sophisticated search skills for comprehensive searching.

Evidence based practice has been part of the ANA Social Policy Statement since 1980. A. True B. False

B.False The 2010 revision was the first time that EBP became an explicit part of the social policy statement.

EBP is likely to lead to service that does not truly meet the complex individual needs of patients. A. true B. false

B.False This is not true as there is nothing in the EBP process that precludes the provision of patient centered care

The evidence based practice movement is atheoretical. A. True B. False

B.False While some argued in the early days that EBP ignored theory, the integration of models, frameworks and theory to guide implementation and thinking about EBP is inconsistent with the argument that it is atheoretical.

When you work to involve a patient in the clinical decision making process you are respecting what part of the EBP process? A.Clinical expertise B.Patient Preference C.Available resources D.Best available evidence

B.Patient Preference Patient preference refers to how involved a patient is in the clinical decision making process.

What words would p?ediatric capture? A.Pediatrics or pediatric B.Pediatric or paediatric C.Children or pediatric medicine D.Nothing, the ? cannot be interpreted in a database

B.Pediatric or paediatric Databases use a symbol called a wildcard to capture words that are spelled differently in American and the British English.

Which of the following characteristics differentiates a systematic review from a "casual" literature review? A.Literature reviews are excellent sources of evidence B.Systematic reviews are more rigorous because they are transparent and exhaustive in their methods. C.Literature reviews are more clinically relevant D.Systematic reviews are primarily focused on medical treatments not nursing

B.Systematic reviews are more rigorous because they are transparent and exhaustive in their methods Common, casual literature reviews are useful for background information or to gain an overview of a topic. They are not rigorous in their approach because they rarely follow a rigorous, transparent and exhaustive approach to how the authors search, appraise and extract information from the primary sources. Systematic reviews do that. There are many systematic reviews relevant to nursing care.

In the context of a meta-analysis, what does homogeneity mean? A.The samples in the studies in the systematic review were all from one gender B.The variability of results of individual studies is not widely different C.The samples of the individual studies were drawn from the same population D.All of the above

B.The variability of results of individual studies is not widely different Many factors can contribute to a lack of homogeneity (otherwise known as heterogeneity) but it is statistically tested based on the variability of the individual study results.

What would be an example of clinical expertise: A.Conducting a search for the best available evidence B.Using the best available research evidence C.Accurately assessing the context of a clinical situation

C. Accurately assessing the context of a clinical situation Clinical expertise is an overlay to all other components of evidence based practice.

How is the concept of patient preference considered in the EBP process? A.To what extent are patients involved in shared decision making. B.The right of patients to reject or accept an intervention. C.All of the above D.None of the above

C. All of the above

Order the following steps in the sequence that generally represents the problem solving process: A.Generating alternatives B.Carry out solutions C.Define problem and causes D.Select alternative solution E.Evaluate effects

C. Define problem and causes A. Generating alternatives D. Select alternative solution B. Carry out solutions E.Evaluate effects

Which of the following would be an example of clinical expertise? A.Conducting a search for the best available evidence B.Using the best available research evidence C.Accurately assessing the context of a clinical situation

C.Accurately assessing the context of a clinical situation Clinical expertise in an overlay to all other components of EBP

Why is it important to critically appraise evidence? A.There can sometimes be distortions in the research process (for instance data collection techniques) B.Studies are sometimes subject to bias and lead to a particular conclusion C.All of the above D.None of the above

C.All of the above It is important because there can sometimes be distortions in the research process (for instance data collection techniques) and also, studies are sometimes subject to bias and lead to a particular conclusion.

What is a nursing standard? A.The intervention aspect of a nursing plan of care B.A rule that must be followed C.An authoritative statement describing responsibilities for which a nurse is accountable D.All of the above

C.An authoritative statement describing responsibilities for which a nurse is accountable Being accountable for responsibilities are key; standards are not rules but definitive statements about what professionals commit to.

In which of the following databases would you be most likely to find the most systematic reviews? A.CINAHL B.PubMed C.Cochrane Library D.All of these databases house similar numbers of systematic reviews

C.Cochrane Library While you may find systematic reviews in the general literature, searchable via bibliographic databases, the Cochrane library is devoted to publishing systematic reviews. That being said, Cochrane systematic reviews are now indexed in Medline and therefore would be searchable from PubMed.

What of the following is the most important criterion for deciding if you will use a conceptual framework or model? A.Its simplicity B.Whether it has a schematic picture C.Coherence of the fit with the problem D.The authority of the author(s)

C.Coherence of the fit with the problem A model must fit the problem in order for it to be helpful; the other characteristics may have some utility but are not always useful and not as important as fit.

A researcher follows a group of 5th grade boys with Type I diabetes and a group without diabetes and measures their growth in height over 10 years. What study design does this describe? A.Qualitative comparison B.Case-control C.Cohort with control group D.Randomized controlled trial

C.Cohort with control group

What steps of the research process is described by this passage: "A randomized controlled trial of a 450 patients with chronic obstructive pulmonary disease conveniently recruited from a Midwest VA pulmonary clinic..." A.Design and data collection B.Sampling method and population C.Design, sample size, method and participants D.Population, sample size and data collection

C.Design, sample size, method and participants Randomized controlled trial=design; 450 pts in the Midwest with COPD=sample size and participants; convenience=sample design/method. Population is the term for who the sample represents; participants (subjects) are who is in the study itself.

Which of the following would be considered a primary source? A.Hopp & Rittenmeyer, Introduction to Evidence Based Practice B.Hopp & Walker, "Effect of Arm Exercise on Dyspnea in Patients with COPD: A Systematic Review" C.Hopp, LJ. "Test-retest reliability of a measure of respiratory muscle endurance: a repeated measures study". D.None of the above -- there is no way to detect the type of source

C.Hopp, LJ. "Test-retest reliability of a measure of respiratory muscle endurance: a repeated measures study" Answer A is your textbook and is based on a synthesis of many primary sources; Answer B is a systematic review and by its nature is a secondary source, though ideal for EBP; and Answer C is a research study.

Which of the following are keywords that could be captured using this strategy: medic* OR drug ? A.Pills, medicine, drug intervention B.Antibiotic therapy, medications, antidepressants C.Medication, medicine, medical, medics, drug D.Medication, drug rehabilitation, antithrombolytic agent

C.Medication, medicine, medical, medics, drug "OR" means that either word could be found. Truncation (*) means that any word with letters after the letter before the symbol will be found. The other answers contain synonyms that would only be found if medic* or drug was a controlled language term (MeSH or CINAHL heading) for the specific drug or synonym like pill.

If a researcher want to combine the results of several quantitative studies they would use what statistical technique? A.Meta-aggregation B.Meta-synthesis C.Meta-analysis D.All of the above

C.Meta-analysis Meta-analysis is the statistical method that allows for the combination of the results of several studies in order to aggregate data that is stronger than a single study.

Which of the following models/frameworks would predict that evidence implementation is more likely when the evidence and context are strong and facilitators enable others? A.The Iowa Model B.Ottawa Model of Research Use C.PARIHS D.JBI Model

C.PARIHS PARIHS is expressed as SI=f(E, C, F) where SI is successful implementation, E is evidence, C is context and F is facilitation.

Consider this scenario: a group of nurses on a unit assesses the leadership style, the unit culture and how the quality improvement officer helps them measure their nursing care. They consult a librarian to help them find high quality evidence. They work with the clinical nurse specialist to guide and coach how they approach making the evidence-based change. Which model or framework most likely guided this work? A.The Iowa Model B.Ottawa Model of Research Use C.PARIHS D.JBI Model

C.PARIHS The group assessed the elements of the model (evidence and context) and used facilitation to guide uptake.

In the following question, what is an example of the P of a PICO question: What is the effect of participating in a support group versus not participating on anxiety in patients receiving chemotherapy? A.Participating in a support group B.Patients who are anxious C.Patients receiving chemotherapy D.All of the above

C.Patients receiving chemotherapy Look for the person focus of the question; it can be easy to confuse other characteristics of patients that reflect other parts of the question.

Which of the following is the best definition of a model? A.An umbrella term that prescribes the direction and nature of relationships about a fairly narrow concept B.A logical set of rules that provides hypotheses to be tested C.Schematic representations of quite precise in their description of concepts D.A set of variables that describe what needs to be examined to explain a phenomenon

C.Schematic representations of quite precise in their description of concepts

What is your interpretation of the following statement: The mean difference in blood pressure was 25 mm Hg with a 95% confidence interval of 23.5 and 26.5 mm Hg. A.The measurement of the mean difference is quite precise B.If the study was repeated many times, 95% of the time the mean difference in blood pressure would fall between 23.5 and 26.5 mm Hg C.There is a 5% chance that the mean difference is outside of the range of 23.5-26.5 mm Hg D.All of the above

D. All of the above

What major forces need to be present in order to make shared decision-making a part of mainstream practice? A.Access to evidence based knowledge about treatment options. B.Help in weighing the pro's and con's of various treatment options C.A culture that facilitated patient engagement D.All of the above

D. All of the above

Which of the following would need to be present if a shared decision model was being employed? A.Respect for the patient values and expressed needs B.Open communication and cultural competence C.Belief in patient empowerment and autonomy D.All of the above

D. All of the above

According to the Joanna Briggs Institute hierarchy of evidence of meaningfulness, which of the following would rank highest? A.A qualitative study with unequivocal findings B.A meta-synthesis of text/opinion with credible synthesized findings C.A meta-analysis of randomized controlled trials D.A meta-synthesis of research of credible synthesized findings

D.A meta-synthesis of research of credible synthesized findings

Which of the following is the best definition of a conceptual framework? A.An umbrella term that prescribes the direction and nature of relationships about a fairly narrow concept B.A logical set of rules that provides hypotheses to be tested C.Schematic representations of quite precise in their description of concepts D.A set of variables that describe what needs to be examined to explain a phenomenon

D.A set of variables that describe what needs to be examined to explain a phenomenon

Which of the following fueled the debate about EBP in nursing? A.Worry that the wishes of the patient would be ignored B.Fear that the art of nursing would be lost. C.Narrow definitions that only emphasized randomized clinical trials as the gold standard of evidence did not fit nursing's epistemology D.All of the Above

D.All of the Above (A) Worry that the wishes of the patient would be ignored, (B) fear that the art of nursing would be lost, and (C) narrow definitions that only emphasized randomized clinical trials as the gold standard of evidence did not fit nursing's epistemology are all fears expressed by some in nursing.

Which of the following is the aim of critical appraisal? A.To assess if the study is valid or of high enough quality to consider using to inform practice change B.To determine if the results fit into a local context (your own) C.To judge whether the results will actually help your patients D.All of the above

D.All of the above

Which of the following is an example of a nursing action? A.Using relaxation to treat anxiety prior to surgery B.Collaborating with a social worker to find services for elderly frail patients living independently C.Taking vital sign measurements and analyzing them D.All of the above

D.All of the above Each represents some aspect of the nursing process or a central role of nursing such as advocacy; each is within nursing's scope of practice.

What concepts were added to the earlier definition of EBP that eased the debate? A.Patient preference B.Clinical expertise C.Available resources D.All of the above

D.All of the above Expanding the definition of EBP to include patient preference, clinical expertise and available resources eased the debate that EBP was atheoretical.

What is a worldview? A.A frame of reference developed from many factors including culture, family, profession, etc B.A system of symbols that allows us to see how we fit in the world C.How we think about the world, cultures, other people D.All of the above

D.All of the above Many factors influence how we understand how we fit in the world. Our worldview changes with our experiences and it is difficult to describe concretely.

Assessing the success of evidence implementation could include which of the following? A.Reassessing a patient's response to an evidence-based intervention B.Auditing whether or not a health professional has used an evidence-based assessment technique C.Evaluating how a group of patients have responded to an evidence-based strategy D.All of the above

D.All of the above The "assess" stage of the EBP process refers to all of these aspects of evaluation -- whether or not the intervention happened (audit of health professional activity) and if it worked (assessing responses to treatment in individuals and groups).

In the following question, what is the I in this PICo question: What is the experience of being present during resuscitation in ICUs from the perspective of health professionals and families? A.Health professionals B.Families of patients undergoing resuscitation C.ICUs D.Being present during resuscitation

D.Being present during resuscitation The phenomenon often follows the words "experience".

What statement is most true about clinical decision making. A.Clinical decision are made by placing the most weight on the preference of the patient B.Clinical decisions are made placing the most weight on the research evidence C.Clinical decisions are made by placing the most weight on the expertise of the clinician D.Clinical decisions are made within the perspective of giving equal weight to all of the above.

D.Clinical decisions are made within the perspective of giving equal weight to all of the above.

You would like to find the best available evidence to help inform a policy change on prevention of falls in your unit. Which of the following would be excellent ways to work with your hospital's librarian? A.Send the librarian an email that you are looking for information about falls B.Ask the librarian to print everything that he/she can find on prevention of falls in the elderly C.Request to borrow a book on medical surgical nursing and search for falls in the index D.Craft a PICO question and schedule an appointment with the librarian to refine your search

D.Craft a PICO question and schedule an appointment with the librarian to refine your search Be respectful of the librarian's time and use a PICO question to help communicate the focus and type of evidence you seek.

A multi-disciplinary team have the goal of the effectiveness and cultural appropriateness of HIV/AIDS care in a country using systematic review, short documents to aid knowledge transfer and audit and feedback during implementation. Which model or framework most likely guided this work? A. The Iowa Model B. Ottawa Model of Research Use C. PARIHS D. JBI Model

D.JBI Model The JBI Model is a macro model that uses evidence synthesis, transfer and utilization to achieve global health.

Which of the following is most often ranked at the top of hierarchies of effectiveness evidence (meaning most ideal and trustworthy)? A.Randomized controlled trials B.Meta synthesis of credible qualitative studies C.Clinical practice guidelines D.Systematic reviews with meta-analysis

D.Systematic reviews with meta-analysis RCTs are highly ranked but systematic reviews with statistical synthesis via meta-analysis are the ideal evidence sources for questions of effectiveness. Meta-syntheses are appropriate for questions of meaningfulness rather than effectiveness.

What criterion is most important for ranking of studies in most evidence hierarchies of effectiveness? A.Sampling method B.Skill of the researchers C.The reputation of the publication source D.The ability of the design to control all sources of bias

D.The ability of the design to control all sources of bias While the first three criteria may enter into the decision to consider a source of evidence, for questions of effectiveness the most important of these criteria is the ability of the design to control all types of bias. That being said, there is no perfect study that controls every possible source of bias with certainty.

Order the following steps in the sequence that generally represents the research process. A.Research question B.Collect and analyze data C.Interpret findings D.Design research methods E.Problem identification

E. Problem identification A. Research question D. Design research methods B. Collect and analyze data C. Interpret findings

In considering research data what would a healthy skeptic ask? A.How do I judge the quality of the research? B.How much confidence can I have that the evidence is of high enough quality to merit practice change? C.When should I be seeking further evidence? D.What criteria should I be using to make these judgments? E.All of the above

E.All of the above A healthy skeptic should ask all of the above questions. Students need to learn that all research is not created equal.

Which part of the nursing process is parallel to the "Apply" step in the EBP process? A.Assessment B.Diagnosis C.Outcome identification D.Plan E.Implement F.Evaluate

E.Implement Implementing nursing interventions is very parallel to applying evidence -- it is the taking action portion of each process. Of course, evidence can inform each step of the nursing process; review Table 7-2.