Chapter 2 NURS 320

A nurse working in a long-established hospital learned a specific approach to administering intravenous injections from the previous generation of nurses at the hospital. This is an example of which type of knowledge? Authoritative knowledge Traditional knowledge Philosophy knowledge Scientific knowledge

B Traditional knowledge is passed from one generation to another. Authoritative knowledge is passed from an expert, and scientific knowledge is provided by way of the scientific method. Philosophy is a specific type of knowledge, not a source.

Evidence-based care emphasizes decision making based on the best available evidence and: care based on pathophysiologic factors. cost efficiency of treatment models. use of outcome studies to guide decisions. evaluation by experts to direct care in specialty areas. SUBMIT ANSWER

C

The nurse is preparing to submit a research project to the institutional review board (IRB). The nurse understands that if the IRB were to reject the research project, it would most likely be for which reason? The estimated cost of conducting the research is excessive. The proposed data collection method is invalid. The project lacks sufficient safeguards to protect human subjects. The research is unlikely to be publishable in a peer-reviewed journal.

C Research involving human subjects needs approval by an IRB before implementation. The primary role of such boards is to ensure that the rights of participants are protected and ethical standards are maintained with research subjects. The IRB does not assess the proposed research project in terms of validity, cost, or publishability.

The use of E.B.P. mandates

analysis of research findings

Step 1 in EBP Process

ask a question

Step 2 in EBP Process

collect most relevant evidence

Step 3 in EBP Process

critically appraise the evidence

Step 5 EBP Process

evaluate the practice decision

Step 4 of EBP Process

integrate the evidence with clinical expertise, patient preferences and values in making a decision to change

Evidence based practice makes clinical decisions by

using the best evidence available

A nurse is developing a foreground question for nursing research using the PICO model. Which component would be represented by the statement, "a 45-year-old male with coronary heart disease and atrial fibrillation"? O C P I

C When using PICO, the "P" stands for the patient or problem and its delineation. The "I" signifies the intervention considered; "C" denotes comparison if appropriate, or it may be optional; and "O" represents the outcome of interest or relevant outcomes.

A group of nurses is planning to investigate the effectiveness of turning immobilized stroke clients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which element will the "O" in the team's PICO question refer to? The currently used turning schedule Turning clients more frequently Preventing skin breakdown Clients who have experienced a stroke

C Within the PICO question framework, the "O" denotes the outcome of interest. In this case, the desired outcome is the prevention of skin breakdown. Stroke clients are the "P," or population of interest, whereas turning clients more frequently is the "I," or intervention. The current turning schedule is the "C," referring to the comparison of interest.

The focus of nursing is always on which of the four common concepts in nursing theory? Health Environment Person Nursing

C All of these concepts are important in nursing theory; however, the focus of nursing is on the person (client).

Which aspect of the nursing research process addresses a client's understanding of the potential risks and benefits of the study? Obtaining the client's signature on a permission document Meeting with the hospital's institutional review board (IRB) Giving the client the opportunity to ask questions about the study Undergoing the informed consent process with the client

D

Evidence based practice combines __ and __ in order to achieve __

art science of nursing best patient outcomes

Which theory describes, explains, predicts, and controls outcomes in nursing practice? Systems theory Developmental theory Nursing theory Adaptation theory

C Nursing theory describes, explains, predicts, and controls outcomes in nursing practice. Systems theory describes how parts interact together. Adaptation theory describes adjustment of living things to other living things and the environment. Developmental theory describes maturation of humans through stages

A nurse is reviewing nursing theory for usefulness in a home healthcare setting. Which is the appropriate application of Dorothea Orem's Self-Care Model in a home healthcare setting? Monitor therapeutic interventions in the client's home. Counsel client on methods to adapt to current state to reduce stress. Match the client's self-care needs with appropriate supportive interventions. Assist the client to conserve and maintain principles of personal and social integrity.

C According to Orem's Self-Care Model, a nurse assists clients with self-care to improve or to maintain health, as well as to progressively maximize self-care potential. Helping a client find appropriate support at home demonstrates this theory. The other options do not demonstrate this model.

The nurse researcher would like to gather data about the attitudes of young adults on spirituality and health care. What is the most effective form of research on this topic? Quantitative research Methodologic survey Delphi study Qualitative research

D Attitudes on spirituality and health care require the nurse to interview clients or informants to obtain qualitative research. Qualitative research involves the systematic collection and analysis of more subjective, narrative materials using procedures in which there tends to be minimal researcher-imposed control. Quantitative research is based more on collecting numerical data and would not be suitable for this type of study. Delphi is a type of quantitative research that would also not produce the desired data. Methodologic surveys focus on method and not on the subjects' experience.

What nursing activity forms the bridge between theory and practice? Case management Theoretical writing Client-focused care Evidence-based research

D Evidence-based research is translational research that forms the bridge between theory and practice. Theoretical writing focuses on theory. Client-focused care and case management are focused on practice.

A nurse researcher must decide on the method for conducting the research. The researcher that plans to emphasize collection of numerical data and analysis would select which method of research? Basic research Applied research Quantitative research Qualitative research

D Quantitative research utilizes numerical values and statistical analysis of data. Basic research is utilized to generate or refine theory. Applied research is utilized for its application in clinical practice. The stem of the question did not provide information as to the application of the study. Qualitative research utilizes words or narrative for data rather than numbers.

A nurse is discussing dietary issues with a Latino client in the clinic. The client states, "My grandmother always told me that I needed to include beans in my diet so that my muscles would grow." The information that the client is expressing is known as what? Scientific knowledge Authoritative knowledge Philosophical knowledge Traditional knowledge

D Traditional knowledge is known as knowledge that is passed down from one generation to the next. A grandmother passing information is an example of traditional knowledge. Authoritative knowledge is information that is gleaned from an expert based on their perceived experience. Scientific knowledge is derived through the scientific method. Philosophy is the study of wisdom and one perceptions of life.

A research nurse approaches a client about the possibility of being in a clinical trial. After the nurse explains the research procedure, the client asks, "What will happen if I get the placebo and not the treatment?" Which response by the nurse is best? "You will receive the same care regardless of whether you get the placebo or the treatment." "You will be entitled to more tests and examinations than the group that gets the treatment." "Less people are in the placebo group and more people will receive the treatment." "People who receive the placebo will receive extra compensation from the researchers."

A A clinical trial often consists of two groups, one that receives the treatment and the other that receives a placebo. People who receive the placebo receive the exact same care as people who are receiving the treatment. Neither the research nurse nor the subject knows who gets the treatment or the placebo. People receiving the placebo do not receive extra compensation, nor are they entitled to more tests than the other group. Treatment and placebo groups are generally equal in number.

When the nurse researcher informs the participant that the participant's identity will not be linked with the information that is collected, the researcher is ensuring the participant's: anonymity. protection from harm. confidentiality. ability to withdraw.

C

Which theory emphasizes the relationships between the whole and the parts, and describes how parts function and behave? Adaptation theory Developmental theory Nursing theory General systems theory

D General systems theory describes how to break whole things into parts and then learn how the parts work together in "systems." Nursing theory attempts to describe, explain, predict, and control desired outcomes of nursing care practices. Adaptation theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. Developmental theory outlines the process of growth and development of humans as orderly and predictable.

Nurses in an ICU noticed that their clients required fewer interventions for pain when the ICU was quiet. They then asked a researcher to design a study about the effects of noise on the pain levels of hospitalized clients. How does this demonstrate the ultimate goal of expanding the nursing body of knowledge? Nursing research involves clients in their care while hospitalized. Nursing research explains ongoing medical studies to clients, and asks for participation. Nursing research draws conclusions about the quality of client care. Nursing research helps improve ways to promote and maintain health.

D Nursing research expands knowledge to learn improved ways to promote and maintain health. The other answers are incorrect because they are not the primary purpose of nursing research.

A nurse who works in a pediatric practice assesses the developmental level of children of various ages to determine their psychosocial development. These assessments are based on the work of: Watson. Maslow. Rogers. Erikson

D rik Erikson based his theory of psychosocial development on the process of socialization, emphasizing how individuals learn to interact with the world. Erikson recognized the role of social, biologic, and environmental factors in development, and defined specific tasks or conflicts that people accomplish or overcome during what he defined as the eight stages of life, based on chronologic age. Abraham Maslow developed his theory of human needs in terms of physical and psychosocial needs considered essential to human life, rather than by chronologic age as Erikson did. Maslow defined five levels of need in a hierarchy, with different needs existing simultaneously. Jean Watson is a nursing theorist who is known for her focus on caring. The central theme of her work is that nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. Caring is universal and is practiced through interpersonal relationships. Martha Rogers is a nursing theorist who is known for her theory of the individual client being central to the discipline of nursing. Nursing interventions are directed toward repatterning human environment fields or assisting in mobilizing inner resources.

A nursing theory differs from a theoretical framework in which way?

Concepts and propositions are more specific

A group of objects with relationships is which? Concept Theory Deductive reasoning Inductive reasoning

A A concept is a group of abstract ideas or objects and their relationships to one another. Theory is a group of concepts and the relationships among them. Deductive reasoning provides a basis for theory development, as one studies a general idea to more specific properties. Inductive reasoning is derived from consideration of specific properties to make conclusions about a general idea.

A community health nurse has been visiting a diabetic client whose morning fasting glucose levels are constantly elevated. Upon further assessment, the nurse determines that the client's spouse does not understand how to prepare meals following the prescribed diabetic diet. Using Dorothea Orem's Self-Care Theory, how can the nurse help meet the needs of this client? Arrange an evaluation appointment with a dietitian. Set up diabetic home meal delivery for the client. Authorize an unlicensed nursing personnel to cook for the client. Assist the spouse with online grocery shopping.

A According to Dorothea Orem's theory, the role of the nurse is to facilitate self-care to sustain life and health, to recover from disease or injury, or to cope with its effects. Arranging an evaluation appointment with a dietitian facilitates self-care because the nurse is providing a service that assists the client and spouse to progressively maximize their self-care potential. People learn behaviors that they perform on their own behalf to maintain life, health, and well-being. The other options are providing care for the client, not facilitating self-care.

A nurse observes that the past five clients referred from a community clinic have been treated for drug and/or alcohol overdose. Based on this information, the nurse assumes that the clinic specializes in the treatment of substance use. This is an example of what type of reasoning? Nursing process Inductive reasoning Deductive reasoning General systems theory

B Inductive theory describes how to break whole things into parts and then to learn how the parts work together in "systems." It emphasizes relationships between the whole and its parts and describes how parts function and behave. Reasoning is when the research builds from a specific idea or action to conclusions about general ideas. Deductive reasoning is the opposite of inductive reasoning. Deductive reasoning is research where a general idea is the starting point, then considers specific actions or ideas. General systems theory is an example of an interdisciplinary base for a nursing theory. The nursing process is a five step systematic method used to direct the nurse and client as they work together to develop a plan of care.

What type of research study would a hospital conduct to explore clients' and families' perceptions of receiving care? Nonscientific Qualitative Ordinal Quantitative

B Qualitative research is designed to seek the perceptions that the clients' and families' perceptions of receiving their care that the hospital desires. Quantitative researchers tend to use deductive reasoning, logic, and measurable attributes of human experience, whereas qualitative researchers tend to use dynamic, individual aspects of the human experience in a holistic approach. Ordinal and interval refer to types of variables associated with quantitative research analysis. Qualitative research is considered to be scientific even though it is not experimental.

A nurse researcher develops a foreground question in preparation for conducting a research study. The question is: "In clients with intravenous catheters, how does replacing administration sets every 72 hours (h) compared with other frequent intervals (24h, 48h, or 96h) decrease infection rates?" Applying the PICO framework, which part of the statement reflects the "O"? Replacing administration sets every 72 hours Replacing administration sets at other intervals Clients with intravenous catheters Decrease infection rates

D The "O" of PICO indicates the outcome, which in this instance is "decrease infection rates." The "P" refers to patients, who in this case have intravenous catheters; "I" refers intervention, which in this case is replacing the administration set every 72 hours; "C" refers to comparison or control group, which in this case is those who have the administration set replaced at other frequencies.

Who is considered to be the first nursing theorist who conceptualized nursing in terms of manipulating the environment

Florence Nightingale Florence Nightingale conceptualized the nurse's role as manipulating the environment to facilitate and encourage the reparative process. This would be accomplished by attending to ventilation, warmth, light, diet, cleanliness, and noise. Sister Callista Roy, CSJ is an American nun, nursing theorist, professor and author. She is known for creating the adaptation model of nursing. Dorothea Orem was a nursing theorist and creator of the self-care deficit nursing theory, also known as the Orem model of nursing. Lydia Hall was a pioneer in nursing autonomy and nurse-driven care.

The nurse is reading about nursing theorists for a class. The theory reveals the following, "Individuals who use self-care to sustain life and health, to recover from disease or injury, or to cope with its effects." Which individual developed this theory? Dorothea Orem Florence Nightingale Sister Callista Roy Virginia Henderson

A Dorothea Orem wrote the Self-care theory, referring to individuals using self-care to sustain life and health, recover from disease or injury, or cope with its effects. Sister Callista Roy, Virginia Henderson, and Florence Nightingale wrote other theories.

Which events in the history of nursing research occurred in the 1970s and 1980s? Select all that apply. The nursing process was studied. Research was focused on clinical practice, including clinical interventions. Primary client care led to research investigating outcomes and quality of care. The National Institute of Nursing Research came into existence. Concerns of nursing education involved student-learning experiences and clinical evaluation

A, B,C, E The National Institute of Nursing Research came was established in 1993 rather than in the 1970s or 1980s. All of the other choices are correct regarding nursing research developments in this time frame.

A conceptual framework is defined as: an explanation of nursing and nursing practice. a set of concepts and propositions. a set of phenomena and related abstractions. a foundation for nursing skills and care.

B A conceptual framework or model is defined as a set of concepts and the propositions that integrate them into a meaningful configuration. A conceptual framework is not an explanation of nursing and nursing practice, a set of phenomena and related abstractions, or a foundation for nursing skills and care.

A parent has brought a 6-year-old child into the clinic. The parent is concerned that the child does not seem to skip as well as the other children in the child's class. In planning assessments and care for this child, the nurse would be best served by choosing which theory as a foundation for decision making? Maslow's theory Developmental theory Adaptation theory General systems theory

B Developmental theory is concerned with growth and development across the lifespan and would provide a foundation for assessment and care of this child. None of the other theories listed is concerned with the maturation of the child.

Knowledge gained from someone with a great deal of perceived experience is which type of knowledge? Scientific knowledge Traditional knowledge Philosophy knowledge Authoritative knowledge

D Authoritative knowledge comes from an expert or someone who has perceived experience. Traditional knowledge is passed from one generation to another, and scientific knowledge is provided by way of the scientific method. Philosophy is a specific type of knowledge, not a source

A nurse develops the following foreground question using the PICO format in preparation for a research study: "In overweight clients, how do chromium supplements compared to no supplements help with weight loss?" Which part of the question reflects the intervention? No supplements Chromium supplements Weight loss Overweight clients

B In this question, the intervention (I) would be the use of chromium supplements. The population (P) would be overweight clients. The comparison (C) would be no supplements. The outcome (O) would be weight loss.

What was the focus of nursing research during the first half of the twentieth century,? Treatment issues Client care Nursing education Available nurse supply

C Between 1900 and 1940, research in nursing centered on education, methods of teaching, and methods of evaluating how nurses learned. During and after World War II, research interest turned to supply and demand for nurses, as the need for nurses to serve in both the military and civilian sectors increased. Client care and treatment issues are common areas of interest in current nursing research.

The process of considering an idea as a whole and then dividing it into smaller, more specific ideas is which? Theory Concept Deductive reasoning Inductive reasoning

C Deductive reasoning involves looking at an idea as a whole and then considering more specific ideas. Theory is a group of concepts and the relationships among them. Concepts are abstract ideas or objects and their relationships to one another. Inductive reasoning is derived from consideration of specific properties to conclusions about a general idea.

Nurse researchers use both quantitative and qualitative research in their practices. Which actions are examples of the use of qualitative research? Select all that apply. The nurse examines cause-and-effect relationships between variables in a lab. The nurse examines the effect of nursing interventions on client outcomes. The nurse explores events in real-life situations to generate new knowledge. The nurse discovers how people describe the effect of illness in their lives. The nurse investigates past nursing trends to understand the current profession. The nurse examines nursing issues related to Native American/First Nation clients.

F, E, D Qualitative research focuses on words and narratives of the subjects, not numbers. Examining nursing issues related to Native American/First Nation clients is an example of ethnography qualitative research. This type of research examines issues of a culture. Investigating past nursing trends to understand the current profession is historical qualitative research. Discovering how people describe the effect of illness in their lives is an example of phenomenological qualitative research. Phenomenology is used to describe experiences as they are lived by the subjects being studied. The exploration of real-life situations and events to generate new knowledge, the examination of the effect of nursing interventions on client outcomes, and the examination of cause-and-effect relationships between variables in a lab are all characteristics of quantitative research.

To ensure that a research study is ethical, a nurse researcher must observe which human rights for participants? Select all that apply. Privacy Self-determinism Fair treatment Cure for illness Anonymity

A,B,C,E The five rights outlined in 1985 by the ANA human rights guidelines (self-determinism, privacy and dignity, anonymity and confidentiality, fair treatment, and protection from discomfort and harm) apply to all people involved in research projects and continue to be the standard today. A cure for illness is not a right of research study participants.

What is the best explanation for the way evidence-based practice (EBP) has changed the way nursing care is delivered? Nurses now have to take part in research. Nursing care now incorporates research studies into client care. Nurses now spend time looking up the best way to give nursing care. Nursing care now uses EBP as a means of ensuring quality care.

D The facilitation of EBP involves identifying and evaluating current literature and research, as well as incorporating the findings into client care as a means of ensuring quality care. The other answers are incorrect; they were used even before EBP became a major force in the delivery of nursing care.

The researcher must critically appraise evidence following a literature review. Which questions should the researcher pose in this appraisal? (Select all that apply.) 'Will the results of each study improve client care?" "Are the results of each study valid and reliable?" "How many studies were found during the review?" "Where was each study conducted?" "What were the results of each study?" SUBMIT ANSWER

A,B,E Although the number of studies found and where the studies were conducted could be important to the researcher, they are not the basis for a critical appraisal of the evidence. The critical appraisal should focus on the results of studies, the reliability and validity of those studies, and the importance of the studies to client care.

A novice nurse is sharing a newly published research article which outlines a different approach in preventing a wound infection after surgery with a colleague and states the nurse is going to try this new method. Which is the best response from the colleague? Wait until the method is analyzed to ensure it will be appropriate for their clients. Help share the information with other staff members so all can use the new technique. Suggest they conduct their own research to determine if it will work with their clients. Agree the method should be used immediately with their own clients.

A Before adopting any new practices presented in research or a study, nurses should take time to ensure it will be appropriate for their clients and suitable for their situation. The nurse should not assume that just because something has been published, it will be appropriate for their situation. It must be analyzed by their facility to ensure it has been properly analyzed and approved for use before implementing. There is no need for the nurses to conduct their own research before implementing the changes.

Which is a focus of medical research rather than nursing research? Drug metabolism Health appraisal Prevention of trauma Promotion of recovery

A Drug metabolism is an example of a focus of medical research. Nursing research is defined as a systematic inquiry into the problems encountered in nursing practice and into the modalities of client care such as health appraisal, prevention of trauma, promotion of recovery, and coordination of health care (Gortner, 1975).

One of the primary reasons for conducting nursing research is to: generate knowledge to guide practice. determine outcomes for clients. prevent further disease and death. quantify outcomes related to clients.

A One of the major reasons for conducting nursing research is to generate knowledge to guide practice. The other answers pertain to other aspects of nursing practice but not to nursing research

When looking at a model for evidence-based practice, what is the final step of the process? Evaluating practice change Formulating a clinical question Searching the literature Appraising evidence

A The fifth and final step in the process of implementing evidence-based practice is to evaluate and critically appraise the change in practice. Formulating a clinical question and searching and appraising the literature precede this step.

A nurse is planning to conduct a nursing research study and is seeking federal funding. Which institution would be most helpful for the nurse to contact regarding acquiring funding? ANA Cabinet on Nursing Research National Institutes of Health Institute of Medicine National Institute of Nursing Research

A The nurse would most likely contact the National Institute of Nursing Research (NINR), which was established under the National Institutes of Health in response to a 1983 study by the Institute of Medicine. The institute's purpose was to place nursing securely in the sphere of scientific investigation and to support research and training in client care, health promotion, and disease prevention, as well as the mitigation of effects of acute and chronic disabilities. The NINR has continued to fund and support nursing research and is instrumental in the support and dissemination of seminal work in nursing. The ANA Cabinet on Nursing Research was responsible for establishing priorities for nursing research.

A nurse subscribes to the Basic Needs theory. Which action by the nurse exemplifies this theory? Assisting the client in coping with a new diagnosis Assisting the client to the bedside commode Assisting the client in recognizing signs of infection and changing dressings Assisting the client in finding a clean, well-lit residence

B The Basic Needs theory subscribes to the concept that a nurse assists in performing activities that the client would perform if the client could. Therefore, assisting the client to the bedside commode is an example of an action that supports the Basic Needs theory. The other actions do not support this theory.

Which activity best helps the nurse apply theory to practice? Case management Client-focused care Evidence-based research Theory development

C Evidence-based research is translational research that forms the bridge between theory and practice. Theory development is how desirable change in society is best achieved. Client-focused care is care provided to a client that maintains the client as a functional component of healthcare team. Case management is when care is provided to an individual client by a healthcare provider.

A nurse is planning to participate in a research project and is looking for information about what is already known about the topic. The nurse is involved in which step of the research process? Problem area identification Problem statement formulation Scientific literature review Identification of theoretical framework SUBMIT ANSWER

C The nurse is engaged in a review of the scientific literature to find out what is already known about the subject and to prevent duplication of effort if the subject is already well studied. Identifying the problem area is completed first. This then guides the literature review. From there the nurse identifies the theoretical framework as a guide to identify and study systematically the logical relationships between variables. The problem statement identifies the direction the project will take.

A nursing theorist examines a hospital environment by studying each ward and how it works individually, and then relates this information to the hospital as a whole working entity. This is an example of the use of which theory? General systems theory Psychosocial theory Developmental theory Adaptation theory

A General systems theory is an example of an interdisciplinary base for a nursing theory. This theory describes how to break whole things into parts and then to learn how the parts work together in "systems." It emphasizes relationships between the whole and the parts and describes how parts function and behave. Another example of an interdisciplinary base for nursing theory is the adaptation theory. Adaptation theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. A third interdisciplinary base for nursing theory is developmental theory. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. Erikson's theory of psychosocial development is one type of developmental theory.

A nurse is preparing to conduct a research study and uses the PICO format to develop the foreground question which is: "In adults, does reducing salt intake, compared to no change in salt intake, lower blood pressure?" The nurse identifies the "P" as: no change in salt intake. adults. reducing salt intake. lower blood pressure.

B Using the PICO format, "P" refers to the population, which in this case is adults. "I" refers to the intervention, which is reducing salt intake. "C" refers to comparison, which is no change in salt intake. "O" refers to the outcome, which would be lower blood pressure.

Which statement best explains the importance of theoretic frameworks? Theoretic frameworks advance nursing knowledge and practice. Theoretic frameworks advance the ethical aspects of practice. Theoretic frameworks guide psychosocial nursing care. Theoretic frameworks guide physiologic nursing care.

A Theoretic frameworks are important to the advancement of nursing knowledge and professional practice. The other statements describe that theoretic frameworks guide specific types of nursing care, of which these are only two examples. Research is known to take many years to impact clinical practice, so the possibiliity of advancing the ethical aspects of nursing practice would be a very long term goal without a guarantee.