Chapter 5
Arrange the following steps of evidence-based practice (EBP) in the appropriate order:
1. Integrate the evidence. 2. Ask the burning clinical question. 3. Evaluate the practice decision or change. 4. Share the results with others. 5. Critically appraise the evidence you gather. 6. Collect the most relevant and best evidence. Answer: 2, 6, 5, 1, 3, 4. Rationale: Implementing EBP follows a logical progression of steps.
Case Study: Tracy is in her last semester of nursing school where she is taking a course in which her class learns about the importance of evidence-based practice. Dr. Minturn, the nursing professor who teaches the course, has asked the students to write a paper about a mock research study of their choosing. The students are to pose a clinical question and then map how they would create a research study around the question. They are not to actually carry out the research, but they are to envision what their study would look like and then map it on paper.
Chapter 5
Rick and the nursing staff decide to approach this practice change using evidence-based practice. What would be a PICOT question for this group to ask? Identify each part of the PICOT question.
Answer: For surgical patients who are incontinent (P) what is the incidence of pressure ulcers (O) when emollient wipes are used to clean patients (I) compared with the use of washcloths (C) during hospitalization (T)?
Rick and the staff on the postsurgical unit implemented a new skin care protocol for patients who are incontinent after surgery. The protocol has been implemented for 4 months. Rick needs to determine if this practice change has been effective. What outcome does Rick need to measure? Describe one method he could use to measure this outcome.
Answer: Rick needs to determine if the incidence of skin breakdown in patients who are incontinent following surgery has decreased since implementation of the new protocol. To measure the incidence of skin breakdown, Rick could complete a chart audit of all patients who have had surgery and are incontinent. He would then compare the number of patients who developed skin breakdown after surgery with those who did not. If the incidence of skin breakdown has decreased over the past 4 months, Rick and the staff could conclude that the new skin care protocol is contributing to the decreased occurrence of skin breakdown in these patients.
A nurse researcher decides to complete a study to evaluate how Florence Nightingale improved patient outcomes in the Crimean War. This is an example of what type of research? 1. Historical 2. Evaluation 3. Exploratory 4. Experimental
Answer: 1. Rationale: Historical studies establish facts concerning past events.
The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of "Do" from that model? 1. Implement the new skin care protocol on all medicine units. 2. Review the data collected on patients cared for using the protocol. 3. Review the QI reports on the six patients who developed ulcers over the last 3 months. 4. Based on findings from patients who developed ulcers, implement an evidence-based skin care protocol.
Answer: 1. Rationale: In the Do step, the nurse selects an intervention and implements it.
A group of nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. Their next step is to: 1. Conduct a literature review. 2. Share the findings with others. 3. Conduct a statistical analysis. 4. Create a well-defined PICOT question.
Answer: 2. Rationale: After completing an EBP project and evaluating its effectiveness, it is important to communicate the results with others.
A nurse researcher is developing a research proposal and is in the process of selecting an instrument to measure anxiety. In which part of the research process is this nurse? 1. Analyzing the data 2. Designing the study 3. Conducting the study 4. Identifying the problem
Answer: 2. Rationale: During study design the researcher selects instruments to measure variables.
A nurse researcher interviews parents of children who have diabetes and asks them to describe how they deal with their child's illness. The analysis of the interviews yields common themes and stories describing the parents' coping strategies. This is an example of which type of study? 1. Historical 2.Qualitative 3. Correlational 4. Experimental
Answer: 2. Rationale: The data in this study were collected during interviews; information from the interviews was used to describe common themes and experiences of the parents. These are characteristics of qualitative research.
A group of staff educators are reading a research study together at a journal club meeting. While reviewing the study, one of the nurses states that it evaluates if newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse's statement? 1. Introduction 2. Purpose statement 3. Methods 4. Results
Answer: 2. Rationale: The purpose statement includes research questions or hypotheses—predictions made about the relationship or difference between study variables (concepts, characteristics, or traits that vary within or among subjects).
A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? 1. Incidence of asthma among children of parents who smoke 2. Frequency of low blood sugar episodes in children at a local school 3. Number of patients who fall and experience subsequent injury on the evening shift 4. Number of sexually active adolescent girls who attend the community-based clinic for birth control
Answer: 3. Rationale: Nursing-sensitive outcomes are outcomes that are sensitive to nursing care.
A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? 1. PDSA 2. Six Sigma 3. Rapid-improvement event 4. A randomized controlled trial
Answer: 3. Rationale: Rapid-improvement events are appropriate to use when a serious problem that affects patient outcomes exists and needs to be resolved quickly.
A nurse who works in a newborn nursery asks, "I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding." In this example of a PICOT question, the I is: 1. Breastfeeding moms. 2. Infants. 3. Peaceful music. 4. The nursery
Answer: 3. Rationale: The Intervention in this PICOT question is playing peaceful music.
A research study is investigating the following research question: What is the effect of the diagnosis of breast cancer on the roles of the family? In this study "the diagnosis of breast cancer" and "family roles" are examples of: 1. Surveys 2. The sample 3. Variables 4. Data collection points
Answer: 3. Rationale: Variables are concepts, characteristics, or traits that vary within or among subjects.
Nurses on a pediatric nursing unit are discussing ways to improve patient care. One nurse asks a colleague, "I wonder how best to measure pain in a child who has sickle cell disease?" This question is an example of a/an: 1. Hypothesis. 2. PICOT question. 3. Problem-focused trigger. 4. Knowledge-focused trigger.
Answer: 4. Rationale: Knowledge-focused triggers are questions about information available on a specific topic.
A nurse is providing care to a patient who is experiencing major abdominal trauma following a car accident. The patient is losing blood quickly and needs a blood transfusion. The nurse finds out that the patient is a Jehovah's Witness and cannot have blood transfusions because of religious beliefs. He or she notifies the patient's health care provider and receives an order to give the patient an alternative to blood products. This is an example of: 1. A quality improvement study. 2. An evidence-based practice change. 3. A time when calling the hospital's ethics committee is essential. 4. Considering the patient's preferences and values while providing care.
Answer: 4. Rationale: Providing evidence-based practice requires that you take the patient's values and beliefs into consideration while providing care.
When recruiting subjects to participate in a study about the effects of an exercise program on balance, the researcher provides full and complete information about the purpose of the study and gives the subjects the choice to participate or not participate in the study. This is an example of: 1. Bias. 2. Anonymity. 3. Confidentiality. 4. Informed consent.
Answer: 4. Rationale: The process of informed consent includes providing research subjects full disclosure about the study and provides the subject the opportunity to participate or not to participate in the study.
A nurse researcher conducts a study that randomly assigns 100 patients who smoke and attend a wellness clinic into two groups. One group receives the standard smoking cessation handouts; the other group takes part in a new educational program that includes a smoking cessation support group. The nurse plans to compare the effectiveness of the standard treatment with the educational program. What type of a research study is this? 1. Qualitative 2. Descriptive 3. Correlational 4. Randomized controlled trial
Answer: 4. Rationale: This is a randomized controlled trial because patients are randomly assigned into the control or treatment group.
Tracy uses the six steps of evidence-based practice to help formulate her mock research study. Rank in order the six steps of evidence-based practice. A. Evaluate the practice decision or change. B. Ask a clinical question. C. Critically appraise the evidence you gather. D. Collect the most relevant and best evidence. E. Share the outcomes of evidence-based changes with others. F. Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.
Answer: B, D, C, F, A, E Rationale: The six steps of evidence-based practice are: ask a clinical question; collect the most relevant and best evidence; critically appraise the evidence you gather; integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluate the practice decision or change; and share the outcomes of evidence-based practice with others.
Tracy relies on PICOT to help her develop a clinical question for the research project. She knows that the "C" in PICOT refers to which of the following? A. Caring B. Clinical component C. Comparison of interest D. Compiled data E. Complicated patient
Answer: C Rationale: The "C" in PICOT refers to the "comparison of interest" that identifies the usual standard of care or current intervention used now in practice.
Rick conducts a literature search and gathers research articles about the PICOT question. He evaluates the scientific merit of each of the articles and determines that he has sufficient evidence to answer the PICOT question. Which step of the evidence-based practice process has Rick completed?
Answer: Critically appraise or critique the evidence.
Tracy writes her mock research purpose statement. In the purpose statement she includes a ___________ that predicts the relationship between the study variables.
Answer: hypothesis Rationale: A hypothesis or hypotheses are research questions found in the purpose statement of a research article that predicts the relationship or difference among study variables.
Tracy knows that the __________ is the foundation of research; thus she includes this in her mock research paper objectively test her hypothesis.
Answer: scientific method Rationale: The scientific method is the foundation of research and is the most reliable and objective of all methods of gaining knowledge.
Clinical Application Questions and Rationales The nursing staff on Rick's postsurgical unit have been reviewing their patients' medical records and have seen a steady increase in the incidence of pressure ulcers over the last 3 months, especially in patients who are incontinent. Rick speaks with the wound care specialist in the hospital about this issue. The specialist recommends that the nurses try using special wipes that include an emollient to clean patients who are incontinent.
Chapter 5
Chapter 5: Key Points
• A challenge in EBP is to obtain the very best, most current information at the right time, when you need it for patient care. • Using your clinical expertise and considering patients' values and preferences ensures that you will apply the evidence in practice both safely and appropriately. • The five steps of EBP provide a systematic approach to rational clinical decision making. • The more focused a PICOT question is, the easier it will become to search for evidence in the scientific literature. • The hierarchy of available evidence offers a guide to the types of literature or information that offer the best scientific evidence. • A randomized controlled trial is the highest level of experimental research. • Expert clinicians are a rich source of evidence because they use it frequently to build their own practice and solve clinical problems. • The critique or evaluation of evidence includes determining the value, feasibility, and usefulness of evidence for making a practice change. • After critiquing all articles for a PICOT question, synthesize or combine the findings to consider the scientific rigor of the evidence and whether it has application in practice. • When you decide to apply evidence, consider the setting and whether there is support from staff and available resources. • Research is a systematic process that asks and answers questions that generate knowledge, which provides a scientific basis for nursing practice. • Outcomes research is designed to assess and document the effectiveness of health care services and interventions. • Nursing research involves two broad approaches for conducting studies: quantitative and qualitative methods. • The research process usually consists of the following steps: identifying the problem, designing the study, conducting the study, analyzing the data, and using the findings. • A thorough analysis of QI data leads clinicians to understand work processes and the need to change practice.
