Chapter 4 Evidence-Based Practice

Complete the statement. Nursing research is based on the _________________ method.

ANS: scientific Nursing research is based on the scientific method. It is the process in which the researcher, through use of senses, systematically collects observable, verifiable data to describe, explain, or predict events.

8. A nurse researcher is designing a research project. After identifying and stating the problem, the nurse researcher clarifies the purpose of the study. Which step in the research process should she complete next? 1) Perform a literature review. 2) Develop a conceptual framework. 3) Formulate the hypothesis. 4) Define the study variables.

ANS: 1 After identifying and stating the problem, the nurse researcher should clarify the purpose of the study. Next, the researcher should perform a literature search to find out what is already known about the problem. After the literature search, the researcher should choose a conceptual framework to guide the research, formulate the hypothesis or research question, and define the study variables.

13. While reading a journal article, the nurse asks herself these questions: What is this about overall? Is it true in whole or in part? Does it matter to my practice? What is this nurse doing? 1) Reading the article analytically 2) Performing a literature review 3) Formulating a searchable question 4) Determining the soundness of the article

ANS: 1 Analytical reading involves questioning the article to be sure you understand it and to determine whether it is applicable to your practice. Such reading asks these questions: What is this about as a whole? Is it true in whole or in part? Does it matter to my practice? A literature review is performed by searching indexes and databases and reading more than one article. Formulating a searchable question involves creating a PICO-type statement to guide a search of the literature. The nurse would determine whether the article is a research report by looking for the individual parts of the article to see if they were present in the form of research (e.g., title, problem, hypothesis, purpose, methods, data, data analysis, conclusions).

11. In his later work, Maslow identified growth needs that must be met before reaching self-actualization. These needs include 1) Cognitive and aesthetic needs 2) Love and belonging needs 3) Safety and security needs 4) Physiological and self-esteem needs

ANS: 1 In his later work, Maslow identified two growth needs that must be met before reaching self-actualization. They include cognitive (to know, understand, and explore) and aesthetic (for symmetry, order, and beauty) needs. The needs Maslow identified in his earlier work were physiological, safety and security, love and belonging, esteem, and self-actualization.

1. Which commonly accepted practice came out of the Framingham study? Use of 1) Mammography in breast cancer screening 2) Colonoscopy in colon cancer screening 3) Pap testing in cervical cancer screening 4) Digital rectal examination in prostate cancer screening

ANS: 1 One commonly accepted practice that came out of the Framingham study is the link between mammography and breast cancer. Before the Framingham study, mammography was considered an unreliable tool in breast cancer screening.

3. A patient complains of pain after undergoing surgery. The nurse forms a mental image of pain based on her own experiences with pain. This mental image is known as a(n) 1) Phenomenon 2) Concept 3) Assumption 4) Definition

ANS: 2 A concept is a mental image of a phenomenon, an aspect of reality that you can observe and experience. In the scenario above, the nurse forms a mental image of pain because of her past experiences with pain. Phenomena are the subject matter of a discipline. They mark the boundaries of a discipline. An assumption is an idea that is taken for granted. In a theory, the assumption is the idea that the researcher presumes to be true and does not intend to test with research. A definition is a statement of meaning of a term or concept that sets forth the concepts characteristics or indicators.

10. After suffering an acute myocardial infarction, a patient attends cardiac rehabilitation. This will help to gradually build his exercise tolerance. According to Maslows hierarchy of needs, cardiac rehabilitation most directly addresses which need? 1) Safety and security 2) Physiological 3) Self-actualization 4) Self-esteem

ANS: 2 Cardiac rehabilitation most directly addresses the patients physiological need for physical activity as well as for health and healing. Indirectly, of course, better physical condition might enable the patient to perform activities that would lead to higher self-esteem and even self-actualization.

9. The mother of a child participating in a research study that uses high-dose steroids wishes to withdraw her child from the study. Despite reassurance that adverse reactions to steroids in children are uncommon, the mother still wishes to withdraw. By withdrawing from the study, the mother is exercising which right? The right 1) Not to be harmed 2) To self-determination 3) To full disclosure 4) Of confidentiality

ANS: 2 The mother is exercising the right to self- determination. This refers to the right of the participant (or parent in the case of a minor) to withdraw from a research study at any time and for any reason. The right to not be harmed outlines the safety protocols of the study. All research participants also have the right to full disclosure. This guarantees the participants answers to questions, such as the purpose of the research study, the risks and benefits, and what happens if the patient feels worse as a result of the study. Moreover, participants also have the right to confidentiality. Typically that right is preserved by giving participants an identification code rather than associating them by name.

7. According to Maslow's hierarchy of needs, which patient need should the nurse address first? 1) Protecting the patient against falls 2) Protecting the patient from an abusive spouse 3) Promoting rest in the critically ill patient 4) Promoting self-esteem after a body image change

ANS: 3 According to Maslows hierarchy of needs, basic physiological needs should be met first. They include the need for rest, food, air, water, temperature regulation, elimination, sex, and physical activity. Therefore, the nurse should address the critically ill patients need for rest first.

2. Which theorist developed the nursing theory known as the science of human caring? 1) Florence Nightingale 2) Patricia Benner 3) Jean Watson 4) Nola Pender

ANS: 3 Dr. Jean Watson developed the nursing theory known as the science of human caring. Her theory describes caring from a nursing perspective. Florence Nightingale developed the theory that stated that a clean environment would improve the health of patients. By changing the care environment, she dramatically reduced the death rate of soldiers. Dr. Patricia Benners theory described the progression of a beginning nurse who learns to be an expert nurse. Nola Penders theory on health promotion became the basis for most health-promotion teaching done by nurses.

4. Hildegard Peplau was a nursing theorist whose major contribution to nursing was 1) Transcultural nursing 2) Health promotion 3) Nurse-patient relationship 4) Holistic comfort

ANS: 3 Hildegard Peplau was a psychiatric nurse who showed that developing a relationship with psychiatric patients made their treatment more effective. From her work, she developed the theory of interpersonal relations, which focuses on the nurse-patient relationship. This theory is in use every day in nursing.

5. The nurse and other hospital personnel strive to keep the patient care area clean. This most directly illustrates the ideas of which nursing theorist? 1) Virginia Henderson 2) Imogene Rigdon 3) Katherine Kolcaba 4) Florence Nightingale

ANS: 4 Florence Nightingale was instrumental in identifying the importance of a clean patient care environment. During the Crimean War, Nightingale dramatically reduced the death rate of soldiers by changing the healthcare environment. Virginia Henderson identified 14 basic needs that are addressed by nursing care. Imogene Rigdon developed a theory about bereavement of older women after noticing that older women handle grief differently than do men and younger women. Katherine Kolcaba developed a theory of holistic comfort in nursing.

12. The PICO question reads, Is TENS effective in the management of chronic low-back pain in adults? Which part of this question comes from the I in PICO? 1) Adults 2) Management 3) Pain 4) TENS

ANS: 4 TENS is the intervention (I) in the PICO system. Adults comes from patient (P). Management comes from the outcome (O). There is no comparison intervention (C) in this PICO question.

6. A patient who emigrated from India is admitted to the medical step-down unit with a bowel obstruction. A nasogastric (NG) tube is inserted to decompress her stomach. She asks the nurse if her daughter can bring in garlic to administer through her NG tube. The nurse tells the patient that she will ask the physician when she makes rounds. This nurse is utilizing the theory developed by which nurse theorist? 1) Betty Neuman 2) Dorothea Orem 3) Callista Roy 4) Madeline Leininger

ANS: 4 The nurse is utilizing the theory developed by Madeline Leininger. Leiningers theory focuses on the values of cultural diversity. According to her theory, the nurse must make cultural accommodations for the health benefit of the patient.

True/False 1. Institutional review boards were created to protect the rights of research participants.

ANS: T Every healthcare facility and university that receives federal funding must have an institutional review board to protect the rights of research participants.

A 56-year-old patient diagnosed with an acute myocardial infarction (heart attack) makes inappropriate sexual comments to the licensed practical nurse (LPN). The LPN is visibly upset. The registered nurse (RN) assigned to the patient informs the patient that his behavior is unacceptable and will not be tolerated. Is the RN demonstrating holistic or mechanistic nursing?

ANS: mechanistic The nurse is demonstrating the mechanistic nursing approach, which focuses on getting the task done.

Complete the statement The unit council in the intensive care unit is designing a research study to see if they are meeting the spiritual needs of their patients. The study will involve patient interviews after discharge. After the interview process, the staff will examine patient statements for recurring themes. The unit council is conducting _____________________ research.

ANS: qualitative The unit council is conducting qualitative research, which focuses on the lived experiences of people.

A 23-year-old athlete decides to donate bone marrow for a child who requires a bone marrow transplant to fight leukemia. According to Maslows later work, this athlete is fulfilling his need for ________________________.

ANS: self-transcendence Self-transcendence is the drive to connect to something beyond oneself and to help others recognize their potential. Donating bone marrow to someone to improve his or her life fulfills the need for self-transcendence.