EBP Test #3 - Vocabulary

I

"___" - USPSTF concludes evidence is insufficient. This is an example of grading recommendations of EBPGs.

D

"___" - USPSTF recommends against providing this service. This is an example of grading recommendations of EBPGs.

C

"___" - USPSTF recommends against routinely providing this service. This is an example of grading recommendations of EBPGs.

B

"___" - USPSTF recommends service: High certainty that net benefit is moderate or moderate certainty that net benefit is substantial. This is an example of grading recommendations of EBPGs.

A

"___" - USPSTF recommends service: High certainty that net benefit is substantial. This is an example of grading recommendations of EBPGs.

6 EBP Evaluation Indicators

1. Outcome measures 2. Quality care improvement 3. Patient-centered quality care 4. Efficiency of processes 5. Environmental changes 6. Professional expertise

CPGs

1While the volume and complexity of research or lack of skill may present impediments to many clinicians, the primary rationale for the use of __________ [plural] is to minimize variations in practice. Both practice guidelines and systematic reviews are often considered to be level I evidence.

A

A USPSTF "___" recommendation means that the USPSTF found good evidence that the action improves important health outcomes and concludes that benefits substantially outweigh harms. It does not mean that the recommendation is based exclusively on RCTs or that it has been deemed "authoritative." The absence of harm is an important consideration, but the primary criterion is the improved health outcomes that can result from the implementation of the recommendation.

shared mental framework

A _________ __________ ________________exists when a group of individuals shares a common commitment to values and ideals that have the ability to catalyze change. It is not an explicit statement of goals, an action plan, or a mission statement, though it may provide the foundation for these. [3 word answer].

Outcome Measurement

A generic term used to describe the collection and reporting of information about an observed effect in relation to some care delivery process or health promotion action.

a, e

A graduate nurse is excited to finally be able to provide care for clients. After a few weeks on the unit, she is becoming increasingly frustrated with an older nurse who is doing things differently and always correcting her. After discussing the situation with the supervisor, which of the following should the supervisor suggest? Select all that apply. a) The supervisor should remind the new nurse that developing clinical expertise takes time and the older nurse knows more. b) The supervisor will discuss the situation with the other nurse and instruct her to stop. c) Assign the two nurses to different shifts so they aren't working at the same time. d) Tell the new nurse to just ignore the older nurse and continue doing what she was taught. e) Encourage the two nurses to discuss the situation

c, d, e

A nurse has consistently evaluated his skills based on the most current EBP he can find. Which of the following should the nurse keep in mind as he works through this process? Select all that apply. a) He should encourage others to make the same change. b) He should try the changes and then decide if he likes them. c) He should look for external evidence to support his beliefs. d) He should ensure any change will benefit his clients. e) If he doesn't understand the evidence, then he should not change.

Meta-Analysis

A process of using quantitative methods to summarize the results from the multiple studies, obtained and critically reviewed using a rigorous process (to minimize bias) for identifying, appraising and synthesizing studies to answer a specific question and draw conclusions about the data gathered. The purpose of this process is to gain a summary statistic (i.e., a measure of a single effect) that represents the effect of the intervention across multiple studies.

Level of Evidence

A ranking of evidence by the type of design or research methodology that would answer the question with the least amount of error and provide the most reliable findings. Leveling of evidence, also called hierarchies, vary by type of question asked. An example is provided for intervention questions.

a, b, d, e

A small focus group has been assigned to explore the use of EBP in the organization; however, they are having difficulties agreeing on the projected outcome. Which of the following objectives should the group adopt to facilitate their moving forward? Select all that apply. a) Develop a written summary describing what they hope to achieve. b) Ask the administration for input as to which concern to address first. c) Assign additional focus groups so all concerns will be covered. d) Establish only two or three goals at a time. e) Focus on short-term attainable goals.

a, b, d

A small group of nurses in a small community are frustrated by the slow progress to implement EBP in the local clinic. Which of the following are potential barriers that can prevent EBP being put into use? Select all that apply. a) Social influences. b) Economic restrictions. c) Local EBP mentors. d) Misunderstanding about the values of EBP. e) Lack of medical librarian.

Systematic Reviews

A summary of evidence, typically conducted by an expert or expert panel on a particular topic that uses a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific clinical question and draw conclusions about the data gathered.

Randomized Controlled Trial (RCT)

A true experiment (i.e., one that delivers an intervention or treatment in which subjects are randomly assigned to control and experimental groups); the strongest design to support cause-and-effect relationships.

Class II

American College of Cardiology (ACC) and the American Hospital Association (AHA) examples of grading recommendations include: "________ __" - Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of an intervention.

Class I

American College of Cardiology (ACC) and the American Hospital Association (AHA) examples of grading recommendations include: "________ __" - Evidence and/or general agreement that an intervention is useful and effective.

Class III

American College of Cardiology (ACC) and the American Hospital Association (AHA) examples of grading recommendations include: "________ __" - Evidence or general agreement that the intervention is not useful/effective and may be harmful.

Class IIb

American College of Cardiology (ACC) and the American Hospital Association (AHA) examples of grading recommendations include: "________ ___" - Usefulness/Efficacy is not well established.

Class IIa

American College of Cardiology (ACC) and the American Hospital Association (AHA) examples of grading recommendations include: "________ ___" - Weight of evidence/opinion is in favor of intervention.

Clinical grasp

An aspect of ________ _______ is the ability to identify subtle transitions in client condition. Gathering evidence, providing good care during emergencies, and getting to know clients' families are all aspects of sound nursing care but do not directly exemplify the notion of ________ _______ (same as first set of blanks).

practice

CPGs can be a valid and reliable method of translating research into _____________. Personalization of care is not a component of guidelines themselves, though they do not necessarily preclude this. Increased accountability and increased pace of change are not noted to be central benefits of CPGs.

External Evidence

Evidence generated from rigorous research.

Internal Evidence

Evidence generated within a clinical practice setting from initiatives such as quality improvement, outcomes management, or EBP implementation projects.

Experiential Learning

Experience requiring a turning around of preconceptions, expectations, sets, and routines or adding some new insights to a particular situation; a way of knowing that contributes to knowledge production; should influence the development of science.

before

Inclusion and exclusion criteria must be determined ________ beginning the literature review that will form the basis of a CPG. It would be inappropriate, and likely biased, to form preliminary guidelines at this very early stage. Likewise, it would be premature to create an adoption strategy or weigh evidence sources by their potential acceptance by clinicians. In order to foster objectivity, peer reviewers would not be consulted at this early stage of development.

Quality-Care Improvement Indicators

Indicators used to demonstrate the effectiveness of symptom management interventions. Often, they demonstrate the existence of a clinical issue as well as provide information about the successful evidence implemention and change.

Context of Caring

Integration of the concepts of patient preferences and values and clinical expertise in combination with evidence from well-conducted studies are part of everyday decision making—whether inserting a urinary catheter or simply holding a hand during a painful procedure.

Clinical Expertise

Is more than the skills, knowledge, and experience of clinicians; rather it is expertise that develops from multiple observations of patients and how they react to certain interventions, with the central aspects of experiential learning and clinical judgment as main contributors and products.

f

Is the following statement true or false (t/f)? An evidence-based practice guideline that is adopted by an institution will be a permanent addition to the organization's policy and procedure documentation.

f

Is the following statement true or false (t/f)? EBPGs are a valid guide to practice because they encompass not only research evidence, but also patient preferences and clinical expertise.

t

Is the following statement true or false (t/f)? Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines.

f

Is the following statement true or false (t/f)? Implementation of EBP is the responsibility of graduate-prepared nurses and members of the nursing leadership.

t

Is the following true or false (t/f)? Evidentialism is the framework for understanding how research evidence can be combined through the practitioner's experience with patients' concerns, history, family and cultural context, and disease trajectory to develop an evidence-based plan of care.

f

Is the following true or false (t/f)? Evidentialism is the process by which an evidence-based clinical decision is reached solely on external evidence.

B

Level of evidence ____ is based on evidence from a single randomized trial or nonrandomized study.

C

Level of evidence ____ is based on expert opinion, case studies, or standards of cares.

A

Level of evidence ____ represents the recommendation is based on evidence from multiple RCTs or meta-analyses.

finalization

Peer review should follow the ______________ of recommendations and should precede dissemination and testing. Comparison of the guideline with existing evidence should have occurred much before this stage and should have been foundational to the entire process.

Evidentialism

Provides a framework for understanding the evidence as well as the process a clinician undertakes in considering that evidence influences subsequent decisions. It helps in understanding how we establish the credibility of the information we use in making clinical decisions.

Patient Centeredness

Required for the integration of patient preferences and values in evidence-based decision making. This concept is not new in the delivery of healthcare. Early work was in the areas of skills, attitudes, and knowledge of physician's in training, components, and drivers of patient satisfaction; dysfunction and improvement strategies in doctor-patient communication; and deeper understanding of what patients want to know and how to help them discover what they want to know. System-wide use of this concept leads to patient-centered care, which is imperative for evidence-based decision making.

e

Searching Google® using the term "practice guideline" will yield numerous sources, including: a) NGC b) CMA c) RNAO d) USPSTF e) All of the above

Environment

Surroundings.

Integrative Reviews

Systematic summaries of the accumulated state of knowledge about a concept, including highlights of important issues left unresolved.

Clinical Practice Guidelines

Systematically developed to assist clinicians and patients in making decisions about care; ideally, the guidelines consist of a systematic review of the literature, in conjunction with consensus of a group of expert decision makers, including administrators, policy makers, clinicians, and consumers who consider the evidence and make recommendations.

Appraisal of Guidelines for Research and Evaluation

The AGREE instrument acronym stands for what?

U. S. Preventative Services Task Force

The USPSTF stands for what?

NGC

The ______ was developed by the AHRQ in partnership with the AMA and AAHP. They intended to create a comprehensive database of up-to-date English language EBPGs. [Use the abbreviation for this answer]

AGREE

The __________ instrument is used specifically for the critical appraisal of guidelines. The USPSTF and PubMed are sources of guidelines rather than tools or instruments for critical appraisal. The ANA is not noted to be a primary source for appraisal tools.

Context

The conditions in which something exists; milieu; the environment & culture.

Evidentialism

The following are Central Themes of what? - 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, ethnics, or safety is being questioned. - 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. - 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.

a, b, e

The nurse manager is attempting to implement the use of EBPGs in the clinic. The nurse recognizes that which of the following will be critical to ensure success of making the necessary change? Select all that apply. a) Create a positive milieu. b) Conduct skill building practice sessions. c) Introduce a new EBPG each week. d) Allow staff to make changes when they are ready. e) Let the staff know of changes.

Critical Appraisal

The process of evaluating a study for its worth (i.e., validity, reliability, and applicability to clinical practice).

a, c, d, e

The process of searching for reliable guidelines online can be overwhelming. The nurse recognizes that which of the following questions are critical to answer to determine the reliability of any guidelines? Select all that apply. a) Who was on the panel. b) How easily the guideline was located. c) Who funded the guidelines. d) What dates the literature review. covered. e) Who published the guidelines.

validity, reliability

The strength of a guideline is based on the ____________ and ____________ of its recommendations. This consideration supersedes the authors' affiliations and qualifications as well and the nature and reputation of the sponsoring body, though the nurse should also consider these parameters. Clinical applicability is not possible if reliability and validity are lacking. [Answer w/2 words, separated with a comma]

knowledge transfer

The use of best practice champions has been shown to facilitate the ________________ ___________ that is necessary for implementing CPGs. Financial incentives, negative enforcement, or punitive measures and using solely outside experts are not noted to be effective strategies. [2 word answer].

clinical, technical, organizational

There are three (3) 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 ______________, ________________, ____________________.

Quality-Care Improvement Measures

These measures complement established health outcome measures by further quantifying how interventions affect the quality of patients' and families' lives.

Outcome measures

These measures quantify medical outcomes such as health status, death, disability, iatrogenic (undesired/unwanted) effects of treatment, health behaviors, and the economic impact of therapy and illness management

Experience

This 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.

Berwick

Three slogans were developed by ____________ in 2009: (1) the needs of the client come first; (2) nothing about me without me; and (3) every client is the only client. As well as: "the needs of the client come first."

EBP Mentors

Typically, an advanced practice clinician with in-depth knowledge and skills in EBP as well as in individual behavior and organizational change.

Patient-Centered Quality Care Measures

Values patients and families place on the health care received. It requires a philosophy of care that views the patient as an equal partner rather than a passive recipient of care, much like the EBP paradigm, in which patient preferences must be part of the decision making. Commonly described as "soft" indicators/measures that have received limited attention. Policy makers, healthcare organizations, and healthcare professionals now recognize the importance of organizing and managing health systems.

Patient Preferences

Values the patient holds, concerns the patient has regarding the clinical decisions/treatments/situation and choices the patient has/prefers for regarding the clinical decision/treatment/situation.

b

When considering the six areas of EBP evaluation of the clinical environment, which of the following is considered an outcome measure? a. Number of times that heart failure patients are discharged within the case management time parameter b. Incidence of pressure ulcers c. Number of discharged patients who are satisfied with their pain management d. Average turnaround time needed for repair of inoperative intravenous pumps

d

Which of the following factors has the greatest impact on the success of EBPG implementation? a. The strength of the evidence that underlies the guideline b. The validity of the process that was used to develop the guideline c. The education level of the nurses who will implement the guideline d. The commitment of the healthcare team members who will put the guideline into practice

d

Which of the skill sets for evidence-based clinical decision-making includes knowledge, skills, and experience r/t to teamwork, organizational design and development, and leadership? a. Clinical b. Experiential c. Technical d. Organizational

a

Which of the skill sets for evidence-based clinical decision-making includes knowledge, skills, and experience related to direct practice with clients, including diagnosis, assessment, engagement, relationships, communication r/t warmth and genuineness, as well as knowledge of theory and mastery of skills related to specific care models and interventions? a. Clinical b. Experiential c. Technical d. Organizational

c

Which of the skill sets for evidence-based clinical decision-making includes the knowledge, skills, and experience r/t formulating questions, conducting an electronic search, and evaluating validity and reliability of findings in order to engage in evidence-based decision making? a. Clinical b. Experiential c. Technical d. Organizational

d

Which of these statements reflect the three aphorisms about patient-centeredness coined by Dr. Berwick? a. Patients do not always know what is best for them. b. It is better if treatment is planned before discussing it with the patient/family. c. External evidence is the best and only driver of the patient's treatment. d. Clinical decisions need to be discussed with and understood by patients/families.

d

Which of these strategies below is the most effective strategy for engaging care providers in a proposed EBP change? a. Disseminating the evidence that underlies the proposed change b. Reminding staff of their obligation to provide optimal care c. Bringing in EBP experts to speak to staff members d. Creating dissatisfaction with current practice and outcomes (status quo)

Magnet

_________ hospitals must promote quality and disseminate best practices throughout nursing, which are attainable only through the pursuit of an EBP environment by all staff members. While the presence of staff committed to EBP most certainly underlies __________ recognition, this must be combined with meeting outcomes that demonstrate the presence of EBP. Pursuing research and providing only a cohort of staff are the main requirements. [Answer with the same 1 word, used 2x]