Evidence Based Practice

Three Main Ethical Principles in Research

Respect for persons Beneficence Justice

A pregnant woman presents to the clinic with concerns of natural birth being messy and that she would rather have a cesarean birth. Which response by the nurse is based on a national goal set by Healthy People 2020? "You should be screened for preeclampsia prior to making that decision." "A cesarean birth is a procedure that poses additional risk to you." "A cesarean birth is basically risk free at this point in medicine." "A cesarean birth makes pregnancy and delivery very convenient."

"A cesarean birth is a procedure that poses additional risk to you." Evidence-based resources for the pregnant patient available in Healthy People 2020 include: Preventing excessive alcohol consumption. Educating mothers on breastfeeding. Screening for hepatitis B. Screening for bacterial vaginosis.

Nurses on the institution's research committee are discussing the difference between background questions and foreground questions within clinical research. Which nurse's statement is accurate? "Answers to background questions may be found in drug guides." "Foreground questions are knowledge based." "Background questions address a range of clinical issues." "The answer to a foreground question addresses multiple clinical issues."

"Answers to background questions may be found in drug guides." Background questions are knowledge based and seek more information about a topic, such as medications or diseases. Answers to background questions can be found in textbooks, drug guides, medical dictionaries, and other education resources. Foreground questions are practice based and, compared with background questions, they are narrower in scope. Foreground questions focus on a specific clinical issue and their answers identify useful information about direct patient care that may guide the formulation of nursing interventions that improve patient outcomes.

The nurse is reviewing the legalities that surround a research study the patient is considering. Which patient statement demonstrates understanding of the process of informed consent? "I have to have permission from the healthcare provider to withdraw from the study." "I can withdraw from the study at any time." "Once I begin the study, I must complete it." "I will not know the length of the study prior to participating."

"I can withdraw from the study at any time." Legal practices related to research studies include following criminal, civil, and tort laws. Study volunteers have a legal right to full disclosure of the study's purpose, required procedures, length, expectations, risks, and possible benefits before consenting to participate. Informed consent includes the right to receive this information as well as the right of participants to withdraw from the study at any time. Participants must give informed consent, usually in written form, before the study begins.

The nurse on the research committee agreed to complete a literature review for evidence as part of the team's study. Which statement by the nurse demonstrates understanding of the first step in this process? "I will look for scientific elements in this journal article." "I will write a proposal to management." "I will write a hypothesis." "I will read all articles related to the desired outcome."

"I will look for scientific elements in this journal article." Looking for clinical evidence from research sources usually includes a review of the pertinent literature. When doing a literature review for evidence, nurses look for scientific elements in the journal article, including the abstract, or summary of the article; an overview of the study conducted, including its methodology; a written conclusion based on the results of the study; and relevant references. The researchers will write the hypothesis and desired outcomes after they review the details.

A group of nurses is meeting as a part of a research committee and one of the points of discussion is that they have limited time to read the required articles. Which response by the chairman may be most helpful to this group doing a literature review? "I would suggest reading the introduction." "I would suggest reading the abstract." "I would suggest reading the article's conclusion." "I would suggest skimming the reading for valid points."

"I would suggest reading the abstract." When doing a literature review for evidence, nurses look for scientific elements in the journal article, including the abstract, or summary of the article; an overview of the study conducted, including its methodology; a written conclusion based on the results of the study; and relevant references.

The nurse is developing a research study to explore the emotional experiences of individuals whose children are diagnosed with autism spectrum disorder (ASD). Which statement reflects the nurse's intent to protect the participants' autonomy when describing the research plan to the mentor? "Participants will not be exploited in any way during the course of this study nor at any point afterward." "The primary purpose of this study is to provide the greatest possible benefit to patients." "Protection of the participants' anonymity will be guaranteed." "I'll take steps to ensure that participants are in no way coerced into taking part in this study."

"I'll take steps to ensure that participants are in no way coerced into taking part in this study." Ensuring that participation is not coerced is reflective of the principle of respect for persons. Protecting participants' anonymity is reflective of the principle of justice. Adhering to beneficence includes requiring that the study be conducted for the benefit of others and preventing exploitation of participants during or as a result of the study.

The manager wants to know how a staff nurse supports the use of evidence-based practice (EBP). Which response best reflects the staff nurse's misperception about a barrier to implementing EBP? "I've been picking up a lot of extra shifts—I'm too busy to take on another work-related responsibility." "I think what we're doing now works just fine—why fix what isn't broken?" "I've taken extra patients almost every night this month—I can't handle the thought of adding one more thing to my to-do list." "I'm not certified in research, and I don't have time to take a course right now—EBP is outside my scope of practice."

"I'm not certified in research, and I don't have time to take a course right now—EBP is outside my scope of practice." The nurse's statement suggesting that development of EBP requires specialty certification best reflects a misperception about EBP. All nurses are encouraged to actively engage in the development of EBP. The remaining three statements reflect the barriers of increased patient workload demands, nursing work schedule demands, and resistance to change from traditional patient-care routines.

The nurse is conducting a class about research methods to colleagues. The nurse asks, "What is the difference between qualitative and quantitative research?" Which participant response is the most appropriate? "Qualitative research does not use the scientific method." "Quantitative research explores individuals' subjective experiences." "Quantitative research uses precise measurement to collect data and analyze it statistically." "Qualitative research is used to test relationships between variables."

"Quantitative research uses precise measurement to collect data and analyze it statistically." Quantitative research uses precise measurement to collect data and to analyze it statistically; this method is used to test relationships between variables. Qualitative research investigates a question through narrative data to explore the subjective experiences of human beings; this method is used to clarify the nurse's understanding of the patient's perspective. The scientific method may be applied to both the qualitative method and the quantitative method of research.

The nurse preceptor is reviewing with a new nurse how to compare the nursing process to the process of evidence-based practice (EBP). Which statement by the preceptor describes the difference in the processes? "The nursing process deals with a specific clinical question, while EBP deals with the patient's holistic needs." "The nursing process only focuses on the patient, while EBP focuses just on a process." "The nursing process is constantly evolving, while EBP is concrete." "The nursing process deals with the patient's holistic needs and EBP deals with a clinical question."

"The nursing process deals with the patient's holistic needs and EBP deals with a clinical question." If this development process sounds familiar, it is probably because the steps are very similar to those of the nursing process of assessment, diagnosis, planning, implementing, and evaluation. Where the nursing process seeks to address the patient's holistic needs, the process of EBP deals with a specific clinical question that may be researched in an attempt to improve patient outcomes related to the clinical question.

The nurse is discussing evidence-based practice (EBP) with a colleague and explains that it is the manager's responsibility to direct them in EBP, but that has not happened. How should the colleague respond? "The healthcare provider is a great resource for that training." "The use of EBP is the responsibility of each individual nurse." "The manager is deficient by not providing this information." "EBP is not widespread at their facility, so it is not that important."

"The use of EBP is the responsibility of each individual nurse." Utilizing EBP in everyday clinical care is the responsibility of each individual nurse. Attitudes of individual nurses (including lack of confidence in using EBP, misperceptions about EBP, lack of motivation in integrating EBP into routines of patient care, and failure to understand the value of EBP) are a barrier to positive outcomes and providing excellence in patient care. The healthcare provider may be able to provide some knowledge, but nursing resources would be most beneficial.

A 72-year-old bedridden patient has extensive contractures of the legs and is a resident of a local nursing home. Which statement by the nurse relates to a national goal for the care of older adults from the Healthy People 2020 report? "This patient will be tube fed." "This patient is at risk for infection." "This patient may quickly develop pressure ulcers."w "This patient is vitamin deficient."

"This patient may quickly develop pressure ulcers." For older adults, Healthy People 2020 objectives address topics including increasing the number of individuals who are up to date on basic preventive care and decreasing the incidence of health alterations such as pressure ulcers and fall-related injuries.

The nurse is providing an in-service on evidence-based practice (EBP). When asked what barriers the nurses experience daily related to EBP, one nurse states that they are so busy and overloaded already. Which resource should the nurse suggest to counteract this barrier? "Learn how to do a critical appraisal of evidence." "Revisit your scope of practice." "Utilize the internet to access practice guidelines." "Join a journal club."

"Utilize the internet to access practice guidelines." Nurses should use the internet when doing searches to cut down the time needed to find good evidence choices. Joining a journal club is recommended to search for evidence and evaluate it collaboratively. Learning how to do a critical appraisal of evidence to determine the best evidence may be a process the nurse would carry out when they have some time to do significant research. A nurse may always revisit their scope of practice, but the fastest way to educate themselves about EBP practices is to visit reputable sites online.

The nurse shares with the research committee that the process they have been researching has been given the yellow light. Which member statement describes a correct understanding of the outcome? We need to continue our research." "We have a strong support for the intervention." "We will need to discard that intervention and start over." "We have found a likely positive outcome."

"We need to continue our research." Yellow light: Not enough evidence is available to determine the effectiveness of the interventions as harmful or helpful. Green light: Strong evidence supports interventions that are likely to be effective and helpful, and they could lead to a positive outcome. Red light: Strong evidence indicates that interventions are likely to be ineffective or possibly harmful.

As part of a research project, the nurse is discussing with a group of peers about the coping process a woman goes through following a mastectomy. Which statement demonstrates that one of the nurses understands methodologies used in nursing research? "We should examine pregnant women who are over 30." "We would set that up as a quantitative study." "That would be an example of a hypothesis." "We would set that up as a qualitative study."

"We would set that up as a qualitative study." Qualitative research investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of the patient's perspective. Goals of qualitative research include the identification of patterns and themes. An example of a qualitative question is, "What is the nature of coping and adjustment after a radical mastectomy?" Today's nurses have a wealth of nursing research available that uses the scientific method to obtain evidence.

The nurse is teaching a colleague how to utilize the mnemonic PICOT for formulating questions that relate to evidence-based practice (EBP). Which question by the colleague would meet the desired outcome? "What intervention should be utilized?" "What population of patients should we study?" "How long will we collect data?" "What would you like to achieve from that specific intervention?"

"What would you like to achieve from that specific intervention?" The outcome is the desired effect that a study wants to achieve. The population of interest is selected and the type of interventions are matched to see if they match the desired effect. The time frame may be added for the study but is also listed as optional. PICOT develops foreground questions that apply evidence-based practice to clinical situations and problems.

P in PICOT

Population or problem of interest What is the common factor in the group of patients? Alternatively, what is the problem that will be addressed? Factors to Consider Characteristic(s) common to patients in the group Examples A specific age, gender, health problem, or medication taken by all group members

Case study

A case study is specific to one individual, issue, or event.

Meta-analysis

A group of studies on a given topic are examined, and their results are combined and analyzed as if they were from one large study.

Cohort study

A longitudinal study follows two groups and measures the outcomes of an exposure group with those of a nonexposure group.

General elements of the scientific method include the following:

A question is asked about a phenomenon. A literature review is done to identify past research findings on the phenomenon. A hypothesis is proposed. A study, or experiment, is planned and executed. Data are collected, organized, and evaluated. A conclusion about the phenomenon is presented.

The nurse is discussing the research process with colleagues who have an interest in learning more about this process. How should the nurse describe a high-yield source? A source full of opinion A source that can document high volumes of data A source that can only be found via the internet A reputable source with valuable data

A reputable source with valuable data High-yield sources are defined as those that are current, are known for their high quality, and have content applicable to patient care. It is a source with valuable data.

Step 4 of EBP Process

APPLY THE EVIDENCE Integrate best evidence with nurse's own clinical experience, patient preferences Evaluate change in practice for impact on patient outcomes Begins at implementation Monitoring process to make sure change is replicated as intended Evaluation of correct implementation, results, areas for improvement Analysis of data collected Accept, reject, or modify the change for clinical practice If change is beneficial, work with management to modify facility's policies and procedures to reflect the new practice

Which factor would help target health promotion in a patient through a genomic standpoint? Availability of new medications Family history Community resources Common vaccines

Family history New medications and vaccines are treatments, but the family history provides the details necessary to make genomic connections.

clinical practice guidelines (CPGs)

Based on a comprehensive literature review and analysis, CPGs rate the strength of evidence and provide recommendation levels for practice: high, moderate, weak, and not recommended for practice.

Beneficence

Beneficence requires that researchers protect participants from physical injury, psychologic harm, economic insult, and exploitation during or as a result of the study. It also addresses the requirement that the study be conducted for the benefit of others.

C in PICOT

Comparison group or comparing interventions What is the difference (alternative) in the intervention being used when comparing two groups? Factors to Consider Can contrast an experimental group that receives an intervention with a control group that does not receive the intervention Can contrast an experimental group that receives the intervention of interest with a comparison group that receives a different intervention Can help establish a relationship, or the lack of a relationship, between an intervention and a predicted outcome Examples Comparing two ways of doing something to find the best way Identifying the effect of taking medication A by comparing one group receiving medication A with a group receiving a placebo

The nurse is collecting data to determine how much of the unit's nursing practice is evidence based. Which action should the nurse implement as a first step to gather this data? Compare the charting between each member of the staff. Look at each nurse's scope of practice. Compose a list of actions that each nurse completes daily in the clinical setting. Compose a list of the challenges reported by each nurse.

Compose a list of actions that each nurse completes daily in the clinical setting. The nurse needs to assess how much of the current nursing practice is evidence based. The nurse can start this by making a list of actions done in a clinical day. Beside each action, the nurse can then make a note about whether it is evidence based, the routine followed, if a shortcut was used, or whether they perform the action that way because that is how they have learned it.

Step 1 in EBP Process

DEVELOP A CLINICAL QUESTION Mnemonic PICOT used to define, formulate a clinical question for EBP PICOT develops foreground questions that apply EBP to clinical situations, problems

The nurse midwife is researching best practices for pregnant women as presented in Healthy People 2020. Which national health goal for the care of pregnant women does this report include? Evaluating the various types of infant formula available Reducing the occurrence of cesarean births for women at high risk of complications Decreasing mortality rates among pregnant women Documenting the rate of pregnancy-related complications

Decreasing mortality rates among pregnant women Healthy People 2020 addresses practices related to pregnant women. Its goals include reducing mortality rates among pregnant women, reducing the rate of pregnancy-related complications, and reducing the occurrence of cesarean births among women who are at low risk for complications.

Types of questions

Diagnosis How to select, interpret diagnostic tests Accuracy, safety, cost effectiveness Therapy How to select treatments that do more good than harm to patients, lead to best outcomes Etiology How to identify causes of a condition or disease Prognosis How to predict clinical course, possible complications

Step 3 in EBP Process

EVALUATE THE EVIDENCE Evidence must be critically appraised for Validity Reliability Usefulness Nurses must be able to critique research articles to identify strengths and weaknesses of studies, their resulting evidence Allows nurse to discard materials that do not meet standards for application in patient care Categorize Green, yellow, red light (PEP system)

The nurse is caring for a pregnant patient and is interested in evidence-based practice (EBP) resources for both the mother and the infant after birth. Which source should the nurse consider? Journal of Gerontologic Nursing Journal of Nursing Education Journal of the American Psychiatric Nursing Association Healthy People 2020

Healthy People 2020 Healthy People 2020 provides an excellent source of national health objectives, which serve to highlight areas in which EBP is needed as well as the availability of evidence-based resources across the lifespan. The other resources are specific to either education, the older adult, or mental health.

I in PICOT

Intervention What will be done to the patients? Factors to Consider Activity shows the difference in the patient before and after the intervention Examples A treatment, medication, therapy, test, or new routine of care

Justice

Justice requires the fair treatment of all participants, including the right of participants to expect their personal information to be maintained under strict confidentiality and the protection of participant anonymity.

The research committee is meeting to discuss the next step in their proposed study that was just given the yellow light. In beginning their research, which type of study would elicit the strongest evidence related to the hierarchy of research when considering the gold standard?

Large, randomized, controlled studies

Hierarchy of Research

Least powerful evidence Opinions of reviewers that are based on their experience and knowledge Somewhat stronger evidence Opinions that come from well-known experts and respected authorities More compelling evidence comes from research studies Nonexperimental studies: correlational, descriptive, qualitative Quasi-experimental studies: time series, matched case controls Individual experimental studies Meta-analysis of controlled studies Gold standard Large, randomized, controlled studies and meta-analyses of controlled studies

Yellow light

Not enough evidence is available to determine the effectiveness of the interventions as harmful or helpful.

The middle school teacher is researching topics in Healthy People 2020 to incorporate evidence-based resources in the school's health program. Which topic would be the most appropriate for the nurse to research? International transmission of disease Breast cancer Obesity prevention Sickle cell disease

Obesity prevention An appropriate topic for the adolescent population is obesity prevention due to the increase of obesity in this population. Sickle cell disease would be most important for the care of infants. International transmission of disease would be most appropriate for the care of adults who are more likely to travel outside the United States. Breast cancer would be more appropriate for the care of adults and older adults who have a higher incidence of this disease.

O in PICOT

Outcome or desired effects In response to the intervention, what is the desired effect for the patient? In relationship to a selected problem, what is the desired improvement? Factors to Consider Desired effects of an intervention can be proved or disproved Improved outcomes can result from an intervention Examples The desired effect is to minimize or eliminate a specific symptom An improved outcome is to reduce the time needed to accomplish a task

The nurse describes the three components of evidence-based practice (EBP) that support what they do every day. The first component is the knowledge gained in practice and the second is the research evidence. Which item should the nurse identify as the third component? Nursing school training Preferences of the patient Nurses' beliefs of the system Ability to act quickly

Preferences of the patient Evidence-based practice (EBP) is a combination of the knowledge that is generated from the clinician's experience, the research evidence, and the preferences of the patient. Nurses must commit to expanding the implementation of EBP within the nursing profession.

Evidence-based resources for the pregnant patient available in Healthy People 2020 include:

Preventing excessive alcohol consumption. Educating mothers on breastfeeding. Screening for hepatitis B. Screening for bacterial vaginosis.

Which would be considered a main objective of the research related to Healthy People 2020 as it relates to children? Providing patient-centered care for special needs Curing the flu virus Waiting until the child is 1 year old to vaccinate Using limited vaccinations

Providing patient-centered care for special needs Healthy People 2020 objectives include reducing child mortality rates as well as decreasing the incidence of transmission of preventable diseases among children. Increasing access to a medical home—which is a model of care that promotes healthcare provider-led, patient-centered, coordinated health services—for children with special needs is the most important objective.

Changes to a policy should be discussed with the:

Quality control committee. Policies and procedures committee. Nursing unit chain of command.

Step 2 in EBP Process

RETRIEVE THE EVIDENCE Review of pertinent literature Nurses look for Scientific elements in journal article Overview of study, including methodology Written conclusion based on study results Relevant references Nursing databases and resource links can yield list of articles related to question Many have tutorial Some offer only abstracts; others offer full text of article All sources and sites should be judged for credibility Primary resource: original published article Secondary resources: one author writing about another author's work

A nurse researcher is designing a study intended to explore how certification exam preparation courses affect nursing​ students' success rates in passing the exam. Which element best reflects the​ nurse's use of a randomized control trial​ (RCT) design? A. Compare the exam performance of a control group of graduate nurses who did not complete any certification exam preparation course with a group of graduate nurses who completed a specific certification exam preparation course prior to taking the exam. B. Interview five graduate nurses who completed a certification exam preparation course and detail their experiences with the course and then identify the number of graduate nurses who successfully completed the certification exam. C. Compare graduate nurses who successfully passed the certification exam with graduate nurses who did not pass the exam in order to determine whether or not completing a certification exam preparation course was a variable that contributed to test performance. D. Examine a group of studies on graduate nurses who completed certification exam preparation courses and then combine and analyze the results as if they were from one large study.

Randomized control trials​ (RCTs) are designed to illustrate a​ cause-and-effect relationship by using a control group and an experimental group. An RCT is best illustrated by comparing the exam performance of a control group of graduate nurses who did not complete any certification exam preparation course with a group of graduate nurses who completed a specific certification exam preparation course prior to taking the exam.

Evidence-based resources available in Healthy People 2020 for the older adult patient include:

Screening for breast cancer. Screening for colorectal cancer.

Criteria for nursing to be recognized as a profession include:

Specialized education requirements. A body of well-defined knowledge and expertise. Conducting ongoing research. An orientation toward service to others. Following a code of ethics. Having autonomy as a profession. Professional organization.

Which regulatory body should the nurse identify as defining the nursing scope of practice? American Medical Association National League for Nursing The Joint Commission State board of nursing

State board of nursing Rights, responsibilities, and scopes of nursing practice are legally defined by state nurse practice acts from each state's board of nursing. EBP supports changes in the responsibilities of nurses, including clinical decision making and clinical judgment, and the level and extent of nurses' accountability. Standards of nursing care are defined by the AMA, the National League for Nursing (NLN), and The Joint Commission. These organizations periodically update these standards to reflect current best evidence.

Red light

Strong evidence indicates that interventions are likely to be ineffective or possibly harmful.

Green light

Strong evidence supports interventions that are likely to be effective and helpful, and they could lead to a positive outcome.

The nurse is designing a presentation about evidence-based practice (EBP). Which example illustrates evidence derived from research? A nurse reads studies about the effects of massage on back pain. The patient may refuse to have back surgery. In certain cultures, male patients accept massage treatment only from male therapists. Studies suggest that medical massage effectively reduces lower back pain.

Studies suggest that medical massage effectively reduces lower back pain. Evidence is clinical knowledge, expert opinion, or information resulting from research; this is best illustrated by the study-based conclusion that medical massage reduces lower back pain. Research is gathering objective facts and information to advance knowledge about a specific topic, as illustrated by a nurse reading studies about the effects of massage on back pain. Male patients who accept massage treatments only from male therapists and consent for surgery illustrate patient preferences.

Professional nursing organizations review clinical practice guidelines to ensure that interventions are recommended for safe practice. Which group is an example of an organization that would be responsible for publishing that information? The Emergency Nurses Association (ENA, n.d.a) The American Nurses Association (ANA) The Institute for Emergency Nursing Research (IENR) Putting Evidence into Practice (PEP)

The Institute for Emergency Nursing Research (IENR)

Respect for persons

This comprises acknowledging and protecting the autonomy of all individuals, including individuals whose capacity to exercise autonomy is diminished because of disability, illness, circumstances that restrict liberty, or immaturity.

T in PICOT

Time frame (optional) How long will the study last? How long will it take to achieve the desired outcome? Factors to Consider Extent of time needed to study the impact of an intervention on a group may be brief or extended Examples A brief time could be the first 12 hours after taking a medication An extended time could be 6 months following a treatment regimen

Translational research

Translation of scientific evidence into practical applications Information flows back and forth between researchers and clinicians Benefits: may speed process from discovery to application Risks: applications and technologies may not have been evaluated enough from ethical and social perspectives

Quantitative research

Uses precise measurement to collect data and to analyze it statistically; this method is used to test relationships between variables.

Evidence-based resources for adolescents available in Healthy People 2020 include:

Vaccination programs. Obesity prevention. Reduction of secondhand smoke exposure.

Evidence must be critically appraised for

Validity Reliability Usefulness

Which statement best describes validity of research​ evidence? A. It is the degree to which the study measured what it intended to measure. B. It is reflective of the​ study's application to clinical practice. C. It is used to determine the strengths and weaknesses of a study and its resulting evidence. D. It is the​ study's ability to produce consistent results with each use.

Validity is the degree to which the study measured what it intended to measure. Reliability is the​ study's ability to produce consistent results with each use. Usefulness is reflective of the​ study's application to clinical practice. Critical appraisal is used to identify strengths and weaknesses of a study and its resulting evidence.

The nurse is developing a clinical question that explores the etiology of adult respiratory distress syndrome (ARDS). Which clinical question is the most appropriate What are some potential complications of ARDS? What are the causes of ARDS? Which medications lead to best outcomes for patients with ARDS? How does ARDS affect arterial blood gas values?

What are the causes of ARDS? Etiology-related clinical questions investigate the causes of a condition or disease. Diagnosis-related clinical questions explore selection and interpretation of diagnostic tests, and evaluate a test's accuracy, safety, and cost effectiveness. Therapy-related clinical questions involve identifying treatments that lead to best outcomes and for which the benefits outweigh the risks. Prognosis-related clinical questions examine the prediction of the clinical course and possible complications of a condition or disease.

The nurse is designing a quantitative research study about the relationship between yoga and wellness. Which research question is the most appropriate for this study? How do individuals who engage in yoga perceive the link between exercise and hypertension? What is the nature of the relationship between engaging in yoga and experiencing wellness? What is the relationship between engaging in yoga and the incidence of hypertension? How do health beliefs about hypertension influence an individual's choice to practice yoga?

What is the relationship between engaging in yoga and the incidence of hypertension? A study of the incidence of hypertension among individuals who practice yoga would yield results that can be statistically analyzed to test the relationship between variables (i.e., practicing yoga and the incidence of hypertension).

Barriers to evidence-based practice include:

Work schedule and workload demands. Patient preferences that might conflict with best practice care. Lack of access to technology to find evidence when needed. Limited knowledge in skills for finding and evaluating evidence. Lack of experience and confidence in developing strategies to promote evidence-based care. Lack of support from supervisors or agency personnel. Lack of access to continuing education programs (e.g., due to lack of time, lack of funding, distance from program site). Attitudes of individual nurses (including lack of confidence in using EBP, misperceptions about EBP, lack of motivation in integrating EBP into routines of patient care, and failure to understand the value of EBP). Resistance to change from traditional patient care routines.

Case-control studies

compare individuals with and without a specific condition to identify predictive​ variables; this design is best reflected by comparing graduate nurses who successfully passed the certification exam with graduate nurses who did not pass the exam to determine whether or not completing a certification exam preparation course contributed to the success rates.

meta-analysis

examines a group of studies on a given topic and combines and analyzes the results as if they were from one large​ study; this design is best reflected by examining a group of studies on graduate nurses who completed certification exam preparation courses and then combining and analyzing the results as if they were from one large study.

Background questions:

general questions that seek more information about a topic Answers can be found in textbooks, medical dictionaries, drug handbooks

Putting Evidence into Practice (PEP)

helps identify and qualify evidence-based interventions for patient care and teaching.

Qualitative research

investigates a question through narrative data to explore the subjective experiences of human beings; this method is used to clarify the nurse's understanding of the patient's perspective.

Usefulness

is reflective of the​ study's application to clinical practice.

Case study

is specific to one​ individual, issue, or​ event; this design is best reflected by interviewing five graduate nurses who completed a certification exam preparation course and detailing their experiences with the​ course, as well as identifying the number of graduate nurses who successfully complete the certification exam.​

Validity

is the degree to which the study measured what it intended to measure.

Reliability

is the​ study's ability to produce consistent results with each use.

Critical appraisal

is used to identify strengths and weaknesses of a study and its resulting evidence.

Foreground questions

narrower in focus, about a specific clinical issue Answers can be found in studies conducted to elicit evidence

The Institute for Emergency Nursing Research (IENR)

was launched by the Emergency Nurses Association (ENA, n.d.a), publishes clinical practice guidelines (CPGs).

Which response is an example of a background​ question? (Select all that​ apply.) A. Why​ isn't long-acting insulin administered via the IV​ route? B. What is the pathophysiology of left ventricular heart​ failure? C. How does acupuncture compare with pain medication for treating chronic knee​ pain? D. How does incentive spirometry help prevent collapse of the small airways in the​ lungs? E. What is the link between healthcare​ providers' stethoscopes and​ healthcare-acquired infections?

​Rationale: Background questions are knowledge based and seek more information about a​ topic, such as medications or diseases. Answers to background questions can be found in​ textbooks, drug​ guides, medical​ dictionaries, and other education resources. Foreground questions are practice based​ and, compared with background​ questions, they are narrower in scope. Foreground questions focus on a specific clinical issue and their answers identify useful information about direct client care that may guide the formulation of nursing interventions that improve client outcomes.

Which question is most appropriate for the nurse to consider when evaluating the impact of​ evidence-based practice​ (EBP) on client​ outcomes? (Select all that​ apply.) A. Is the new practice beneficial to the​ nurse? B. Is the new practice being implemented​ correctly? C. Does the change in practice yield the intended​ results? D. Is the practice in accordance with the​ state's nurse practice​ act? E. Does the practice adhere to the American Nurses Association​ (ANA) standards of nursing​ care?

​Rationale: Evaluation seeks to answer questions​ including, "Is the new practice being implemented​ correctly?" and​ "Does the change in practice yield the intended​ results?" Nurses are legally bound to practice in accordance with their​ state's nurse practice act and to provide care that adheres to the ANA standards of nursing​ care; these concerns must be addressed before implementing care. The practice is intended to be beneficial to the client.

Which statement best reflects the​ nurse's correct understanding of principles related to​ evidence-based practice​ (EBP)? (Select all that​ apply.) A. "Client choices do not affect​ evidence-based practice." B. ​"Client-centered care is an outcome of​ evidence-based practice." C. "The nurse's level of expertise influences​ evidence-based practice." D. "Evidence-based practice promotes individualization of client​ care." E. "Evidence-based practice requires application of all research evidence about a given​ topic."

​Rationale: Evidence-based practice​ (EBP) combines the best evidence from the most current research​ available, the​ nurse's clinical​ expertise, and the​ client's preferences, including​ needs, values, and choices. EBP promotes individualization of client care and provides best practice for​ client-centered care.

The nurse researcher is explaining​ evidence-based practice​ (EBP) to a group of nurses. Which statement is appropriate to include in the​ explanation? (Select all that​ apply.) A. "EBP promotes generalization of client​ care." B. "EBP incorporates the​ nurse's clinical​ expertise." C. "EBP considers the​ client's needs,​ values, and​ choices." D. "EBP tests hypotheses about​ health-related conditions." E. "EBP is reflective of the best evidence from current​ research."

​Rationale: Evidence-based practice​ (EBP) combines the best evidence from the most current research​ available, the​ nurse's clinical​ expertise, and the​ client's preferences, including​ needs, values, and choices. EBP promotes individualization of client care. Nursing research tests hypotheses about​ health-related conditions and nursing care.

The nurse is delivering a presentation about​ evidence-based practice​ (EBP). Which statement best reflects the​ nurse's correct understanding of​ EBP? A. "EBP involves combining quality​ research, clinical​ expertise, and client preferences to achieve the best client​ outcomes." B. "EBP incorporates clinical​ knowledge, expert​ opinion, or information resulting from​ research." C. "EBP is the gathering of objective facts and information to advance knowledge about a specific​ topic." D. "EBP uses a systematic and strict scientific process to test hypotheses about​ health-related conditions and nursing​ care."

​Rationale: Evidence-based practice​ (EBP) seeks to achieve optimal client outcomes by combining the best evidence from the most current research​ available, the​ nurse's clinical​ expertise, and the​ client's preferences, including​ needs, values, and choices. Research involves gathering objective facts and information to advance knowledge about a specific topic. Nursing research is a systematic and strict scientific process that tests hypotheses about​ health-related conditions and nursing care. Evidence can be defined as clinical​ knowledge, expert​ opinion, or information resulting from research.

Which​ evidence-based resource would be appropriate for the nurse to integrate into the care of a pregnant​ client? A. Teaching pamphlets on circumcision B. Consequences of illegal drug use from the local police department C. Safety instructions from a car seat manufacturer D. Information on breastfeeding from Healthy People 2020

​Rationale: Evidence-based resources use current best evidence in making decisions about the care of individual patients. Healthy People 2020 provides​ science-based benchmarks to track and monitor progress towards health to motivate individuals. While there are multiple opportunities for educational​ topics, only those based in the science can be considered​ evidence-based. Healthy People 2020 strives to identify nationwide health improvement priorities. As​ such, breastfeeding information from this source would be considered​ evidence-based, while other teaching pamphlets or information from local agencies or manufacturers may not.

The charge nurse is providing an educational seminar for a group of nurses. Which factor should the nurse expect to be discussed as an​ evidence-based practice topic for older adults that correlates with Healthy People 2020​? A. Fall-related injuries B. Screening protocols for sickle cell C. Obesity prevention D. Transmission of infectious disease during travel

​Rationale: For older​ adults, Healthy People 2020 objectives address topics including increasing the number of individuals who are up to date on basic preventive care and decreasing the incidence of health alterations such as pressure ulcers and fall related injuries. For the general care of​ adults, goals associated with the promotion of global health include protecting the health of the national population as well as limiting the international transmission of infectious diseases during travel.​ Evidence-based resources related to newborns and infants address topics such as screening protocols for phenylketonuria and sickle cell disease. Next Question

​Evidence-based practice​ (EBP) is very prescriptive across the lifespan. Which client would be the focus for decreasing the incidence of pressure ulcers as presented in Healthy People 2020​? A. A​ 65-year-old client who is bedridden in a nursing home B. A​ 12-year-old who sleeps​ 10?12 hours a day C. A​ 16-year-old who is hospitalized after knee surgery D. A​ 35-year-old who is in a rehab facility following neck fusion surgery

​Rationale: For older​ adults, Healthy People 2020 objectives address topics including increasing the number of individuals who are up to date on basic preventive care and decreasing the incidence of health alterations such as pressure ulcers and fall related injuries. The older adult who is bedridden would be the focus of pressure ulcer prevention due to thinner skin and no mobility. Lying in the bed put pressure on the bony prominences.

A​ 2-year-old child with cerebral palsy may benefit from the model known as a medical home.Which goal from Healthy People 2020 does the nurse identify for the​ client? A. Limiting who lives in the home B. Coordinating their healthcare services C. Paying for their medication D. Paying the mortgage for the home

​Rationale: Healthy People 2020 objectives include reducing child mortality rates as well as decreasing the incidence of transmission of preventable diseases among children. Increasing access to a medical home—which is a model of care that promotes​ physician-led, client-centered, coordinated health services —for children with special needs is also an objective. The services do not provide financial backing nor do they limit who lives in the home.

The nurse is designing a nursing clinical research study. Which research question is most appropriate for this type of​ study?(Select all that​ apply.) A. What factors influence an​ individual's choice to enroll in online nursing​ education? B. How do communication styles influence the​ nurse's perception of nurse​ educators? C. How do environmental noise levels affect the​ client's pain perception​ postanesthesia? D. Is there a relationship between acupressure and incidence of nausea in clients who are receiving chemotherapy​ medications? E. What is the relationship between the duration of​ nurse-client interaction and the​ client's level of satisfaction with nursing​ care?

​Rationale: Nursing research is a systematic and strict scientific process that tests hypotheses about​ health-related conditions and nursing​ care; as an extension of nursing​ research, nursing clinical research seeks answers that will ultimately improve client care.

In a professional development​ seminar, the educator shares barriers that they may encounter as they try to implement​ evidence-based practice​ (EBP) into their care. Which statement most accurately describes these potential​ barriers? (Select all that​ apply.) A. Client workload demands B. Nursing misperceptions about EBP C. Providing accountability for nursing care D. Ensuring credibility of the nursing profession E. Lack of access to continuing education programs

​Rationale: Potential barriers to implementation of​ evidence-based practice​ (EBP) include lack of access to continuing education​ programs, nursing misperceptions about​ EBP, and client workload demands. Benefits of EBP include providing accountability for nursing care and ensuring credibility of the nursing profession.

The nurse is critically appraising a research study. Which statement is reflective of an appraisal of the​ study's reliability? A. ​"Although the study was supposed to measure the​ client's wound​ healing, it really measured the​ client's satisfaction with​ care." B. "The study's results are applicable to clinical​ practice." C. ​"The original study was repeated three​ times, but it did not produce consistent​ results." D. ​"The study's results are not applicable to clinical​ practice."

​Rationale: Reliability is the​ study's ability to produce consistent results with each use. Validity is the degree to which the study measured what it intended to measure. Usefulness is reflective of the​ study's application to clinical practice.

The nurse conducting a research study needs to determine if an individual qualifies to be a participant. Which criteria must be met for​ inclusion? (Select all that​ apply.) A. he individual meets all the inclusion criteria. B. The individual has been given informed consent. C. The individual receives payment for participation. D. The individual must waive the right to anonymity. E. The individual is informed of all aspects of the study.

​Rationale: Research participants are defined as volunteers for a specific study project who meet all the inclusion​ criteria, have been informed of all aspects of the​ study, and have given informed consent. Adherence to the ethical principle of justice requires protection of the research​ participant's anonymity. Payment is not a mandatory condition of participation in research.

The nurse is doing a case study on a client with​ long-term cardiovascular disease.Which would be the best way to target health promotion for treatment as it relates to​ evidence-based practice? A. Genomic standpoint B. Looking at the hospital data C. Examining cultural views D. Following federal regulation

​Rationale: Targeting health promotion from a genomic standpoint allows for more accurate risk​ prediction, diagnosis, and treatment of a variety of health​ alterations, such as heart​ disease, stroke,​ cancer, diabetes, and Alzheimer disease​ (HHS, 2016e). Goals associated with the promotion of global health include protecting the health of the national population as well as limiting the international transmission of infectious diseases during travel.​ Evidence-based resources related to global health and genomics are emerging.