Evidence-Based Practice

5. __________________ are the gold standard for research.

ANS: Randomized controlled trials Individual randomized controlled trials (RCTs) are the gold standard for research (Titler and others, 2001). An RCT establishes cause and effect and is excellent for testing therapies.

7. A nurse writes the following PICOT question: How do patients with breast cancer rate their quality of life? How should the nurse evaluate this question? a. A true PICOT question regardless of the number of elements b. A true PICOT question because the intervention comes before the control c. Not a true PICOT question because the comparison comes after the intervention d. Not a true PICOT question because the time is not designated

ANS: A A meaningful PICOT question can contain only a P and O: How do patients with breast cancer (P) rate their quality of life (O)? Note that a well-designed PICOT question does not have to follow the sequence of P, I, C, O, and T. The aim is to ask a question that contains as many of the PICOT elements as possible.

7. The nurse has done a literature search and found 25 possible articles on the topic that she is studying. To determine which of those 25 best fit her inquiry, the nurse first should look at: a. the abstracts. b. literature reviews. c. the Methods sections. d. the narrative sections.

ANS: A An abstract is a brief summary of an article that quickly tells you whether the article is research based or clinically based. An abstract summarizes the purpose of the study or clinical query, the major themes or findings, and the implications for nursing practice. The literature review usually gives you a good idea of how past research led to the researchers question. The Methods or Design section explains how a research study is organized and conducted to answer the research question or to test the hypothesis. The narrative of a manuscript differs according to the type of evidence-based articleclinical or research.

1. To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is a. A guide for nurses in making clinical decisions. b. Based on the latest textbook information. c. Easily attained at the bedside. d. Always right for all situations.

ANS: A Evidence-based practice (EBP) is a guide for nurses to structure how to make accurate, timely, and appropriate clinical decisions. A textbook relies on the scientific literature, which is often outdated by the time the book is published and is not the most reliable source for EBP. Unfortunately, most of the best information in evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. It is not appropriate for all settings.

8. In reviewing literature for an evidence-based practice study, the nurse realizes that the most reliable level of evidence is the a. Systematic review and meta-analysis. b. Randomized control trial (RCT). c. Case control study. d. Control trial without randomization.

ANS: A In a systematic review or meta-analysis, an independent researcher reviews all of the RCTs conducted on the same clinical question and reports whether the evidence is conclusive, or if further study is needed. A single RCT is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted. Case control studies also have room for bias.

4. In collecting the best evidence, the gold standard for research is a. The randomized controlled trial (RCT). b. The peer-reviewed article. c. Qualitative research. d. The opinion of expert committees.

ANS: A Individual RCTs are the gold standard for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.

4. A nurse has collected several research findings for evidence-based practice. Which article will be the best for the nurse to use? a. An article that uses randomized controlled trials (RCT) b. An article that is an opinion of expert committees c. An article that uses qualitative research d. An article that is peer-reviewed

ANS: A Individual RCTs are the highest level of evidence or "gold standard" for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.

18. The hospital quality improvement committee has noted that the incidence of needlestick injuries on a particular unit has increased. When faced with issues, the committee applies the PDSA model, a formal model for exploring and resolving quality concerns. Because the committee is multidisciplinary in nature, and few members are nurses, it is imperative that the committee first a. Plan. b. Do. c. Study. d. Act.

ANS: A Plan is the first step of the process; it involves a review of available data to understand existing practice conditions or problems to identify the need for change. Do involves selecting an intervention on the basis of the data reviewed and implementing the change. Study means to evaluate the results of the change. Act involves incorporating the change if it is successful.

16. The hospitals quality improvement committee has identified a problem on one of the units. In using the PDSA method to help determine ways to deal with the issue, the committee decides to do a literature review. This is an example of quality improvement a. Combined with evidence-based practice. b. With inability to make the right decision. c. With delay in the action needed. d. With no designated method for dealing with issues.

ANS: A Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a committee defines a problem, it applies a formal model for exploring and resolving quality concerns. One part of the PDSA cycle is the Do section, which requires the selection of an intervention on the basis of data reviewed. Therefore the committee is taking the right action and is not unduly delaying action; data must be obtained that are needed to make the right decision as part of the PDSA method, which is in place.

2. The nurse administrator is doing a study that entails gathering data about new employees over a 10-year period. Which research method would be the best one to use for this type of study? a. Quantitative longitude cohort b. Qualitative longitudinal c. Qualitative interview d. Qualitative case study

ANS: A Quantitative research has been defined as being "focused on the testing of a hypothesis through objective observation and validation." The types of studies that make up this category include randomized controlled studies, cohort studies, longitudinal studies, case-controlled studies, and case reports. The other options are examples of quantitative, not qualitative, studies.

4. A well-developed PICOT question helps the nurse: a. search for evidence. b. include all five elements of the sequence. c. find as many articles as possible in a literature search. d. accept standard clinical routines.

ANS: A The more focused a question that you ask is, the easier it is to search for evidence in the scientific literature. A well-designed PICOT question does not have to include all five elements, nor does it have to follow the PICOT sequence. Do not be satisfied with clinical routines. Always question and use critical thinking to consider better ways to provide patient care.

20. A nurse is using the research process. Place in order the sequence that the nurse will follow. 1. Analyze results. 2. Conduct the study. 3. Identify clinical problem. 4. Develop research question. 5. Determine how study will be conducted. a. 3, 4, 5, 2, 1 b. 4, 3, 5, 2, 1 c. 3, 5, 4, 2, 1 d. 4, 5, 3, 2, 1

ANS: A The steps of the research process are as follows: (1) Identify area of interest or clinical problem (2)develop research question(s)/hypotheses, (3) determine how study will be conducted, (4) conduct the study (5) analyze results of the study.

19. A nurse is implementing an evidence-based practice project regarding infection rates. After reviewing research literature, which other evidence should the nurse review? a. Quality improvement data b. Inductive reasoning data c. Informed consent data d. Biased data

ANS: A When implementing an evidence-based practice project, it is important to first review evidence from appropriate research and quality improvement data. Inductive reasoning is used to develop generalizations or theories from specific observations; this study needs specifics. Informed consent is not data but a process and form that subjects must sign before participating in research projects/studies. Biased data is based on opinions; facts are needed for this study.

1. The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which of the following methods will provide the nurse with the right kind of data? (Select all that apply.) a. Experimental research b. Surveys c. Evaluation research d. Phenomenology e. Grounded theory

ANS: A, B, C Experimental research, surveys, and evaluation research are all forms of quantitative research. Phenomenology and grounded theory are forms of qualitative research.

1. To use evidence-based practice appropriately, you need to collect the most relevant and best evidence and to critically appraise the evidence you gather. This process also includes: (Select all that apply.) a. asking a clinical question. b. applying the evidence. c. evaluating the practice decision. d. communicating your results.

ANS: A, B, C, D EBP comprises six steps (Melnyk and Fineout-Overholt, 2010): 1. Ask a clinical question. 2. Search for the most relevant and best evidence that applies to the question. 3. Critically appraise the evidence you gather. 4. Apply or integrate evidence along with ones clinical expertise and patient preferences and values in making a practice decision or change. 5. Evaluate the practice decision or change. 6. Communicate your results.

2. Before conducting any study with human subjects, the researcher must obtain approval from the agencys human subjects committee or institutional review board (IRB). The IRB ensures that the researcher (Select all that apply.) a. Obtains informed consent. b. Minimizes risk to subjects. c. Ensures confidentiality. d. Identifies risks and benefits of participation. e. Ensures that subjects complete the study.

ANS: A, B, C, D Researchers must protect the confidentiality of those who participate in the study, obtain informed consent, minimize risk to subjects, identify risks and benefits of participation, ensure that participation in the study is voluntary, and allow subjects to withdraw from studies at any time.

2. In a clinical environment, evidence-based practice has the ability to improve: (Select all that apply.) a. the quality of care provided. b. patient outcomes. c. clinician satisfaction. d. patients perceptions.

ANS: A, B, C, D lmaoo what is going on here EBP has the potential to improve the quality of care that nurses provide, patient outcomes, and clinicians satisfaction with their practice. Your patients expect nursing professionals to be informed and to use the safest and most appropriate interventions. Use of evidence enhances nursing, thereby improving patients perceptions of excellent nursing care.

1. How does the Iowa model transcend mere nursing care? (Select all that apply.) a. It includes formalized internal feedback loops. b. Its triggers can have their origins practically anywhere. c. It generates change in practice solely through research. d. It implies a layer of policy development. e. It addresses multiple disciplines' impacts on quality.

ANS: A, B, D, E The triggers addressed within the Iowa model process can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from the institutional standards committee. Because the Iowa model is often implemented at a fairly high level of nursing or hospital administration, it scrutinizes the input of nursing and other disciplines in its process. Its output is applied as widely as possible throughout the organization, and it can affect policy within a multihospital system and even across systems. The success of EBP is determined by all involved, including health care agencies, administrators, nurses, physicians, and other health care professionals.

3. The nurse is conducting a review of the literature for pain management techniques. Which of the following would the nurse consider when conducting research that yields solid EBP? (Select all that apply.) a. Search the literature to uncover evidence to answer the question. b. Evaluate the outcome. c. Use the nursing process to evaluate evidence. d. Evaluate the evidence found. e. Develop an answerable question. f. Develop a question that has not been answered. g. Apply the evidence to the practice situation.

ANS: A, B, D, E, G To facilitate the use of evidence, steps have been developed to systematically approach a question of patient care. The steps are outlined as follows: • Develop an answerable question • Search the literature to uncover evidence to answer the question • Evaluate the evidence found • Apply the evidence to the practice situation • Evaluate the outcome • The nursing process is a method of problem solving and can be used to develop a plan of care. Formulating a question that has not been answered in the research would be considered primary research. Therefore, there is no evidence in which to draw from.

1. The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which methods will provide the nurse with the right kind of data? (Select all that apply.) a. Surveys b. Phenomenology c. Grounded theory d. Evaluation research e. Nonexperimental research

ANS: A, D, E Experimental research, nonexperimental research, surveys, and evaluation research are all forms of quantitative research that allow for precise measurement. Phenomenology and grounded theory are forms of qualitative research.

3. The nurse in the outpatient setting would like to conduct a research study that compares patients who take tramadol (Ultracet) to patients who take oxycodone hydrochloride and acetaminophen (Percocet) for managing back pain. Which quantitative research method should yield the best results? a. Longitude study b. Controlled study c. Systematic reviews/meta-analysis d. Survey study

ANS: B A controlled study is a type of quantitative research that seeks to control and examine the variables to determine effectiveness. In this case, the variables would be those that were administered tramadol (Ultracet) and those that were administered hydrochloride and acetaminophen (Percocet) for managing back pain. Correlational research methods help determine association between or among variables. A longitudinal study examines variables over a designated course of time. A systematic reviews/meta-analysis is a type of literature review and not a research method. A survey study is a type of qualitative research method.

37. The nurse is caring for a patient who has a bloodborne pathogen. The nurse splashes blood above the glove to intact skin while discontinuing an intravenous (IV) infusion. Which step(s) will the nurse take next? a. Obtain an alcohol swab, remove the blood with an alcohol swab, and continue care. b. Immediately wash the site with soap and running water, and seek guidance from the manager. c. Do nothing; accidentally getting splashed with blood happens frequently and is part of the job. d. Delay washing of the site until the nurse is finished providing care to the patient.

ANS: B After getting splashed with blood from a patient who has a known bloodborne pathogen, it is important to cleanse the site immediately and thoroughly with soap and running water and notify the manager for guidance on next steps in the process. Removing the blood with an alcohol swab, delaying washing, and doing nothing because the splash was to intact skin could possibly spread the blood within the room and could spread the infection. Contain contamination immediately to prevent contact spread.

11. The hospital policy states that when starting an intravenous (IV) catheter, the nurse must first prepare the potential IV site with alcohol and dress it using a gauze dressing. The nurse has done a literature review and believes that evidence-based practice dictates the use of a transparent dressing to prevent catheter dislodgment. What should the nurse do? a. Begin to use transparent dressing instead of gauze dressings. b. Bring findings to the policy and procedure committee. c. Use transparent dressings on half of her IV starts and gauze on the other. d. Continue following hospital policy without saying anything.

ANS: B As a result of her finding, the nurse should meet with the policy and procedure committee to recommend routine use of transparent dressings. However, until the policy is changed, or the nurse receives approval to conduct a pilot study, the nurse is obligated to follow hospital procedure. If the nurse has information that can lead to better patient care, he or she has an obligation (moral and professional) to bring it to the attention of policy makers.

13. In conducting a research study, the researcher must guarantee that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. This concept is known as a. Anonymity. b. Confidentiality. c. Informed consent. d. The research process.

ANS: B Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Anonymity occurs when even the researcher cannot link the subject to the data. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer.

14. The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information? a. Abstract b. Conclusion c. Study design d. Clinical implications

ANS: B During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section.

15. When evaluating quality improvement (QI) programs in relation to evidence-based practice (EBP), it is easy to note that a. Both are designed to improve performance. b. When implementing EBP projects, it is important to review QI data. c. EBP is not at all related to QI. d. Evaluation of processes is the realm of performance improvement (PI), not QI.

ANS: B Evidence-based practice and quality improvement go hand in hand. When implementing an EBP project, it is important to review available QI data. Reliable QI data improve the relevance and scope of an EBP project. Performance improvement (PI) analyzes performance. QI analyzes processes.

7. The nurse is developing a PICO question related to whether her patients blood pressure is more accurate while measuring with the patients legs crossed versus with the patients feet flat on the floor. With P being the population of interest, I the intervention of interest, C the comparison of interest, and O the outcome, the nurse determines that this is a. A true PICO question, because the outcome always comes before the intervention. b. A true PICO question regardless of placement of elements. c. Not a true PICO question, because the comparison comes after the intervention. d. Not a true PICO question, because the outcome comes after the population.

ANS: B Note that a well-designed PICO question does not have to follow the sequence of P, I, C, and O. The aim is to ask a question that contains as many of the PICO elements as possible.

8. The nurse wants to determine the effects of cardiac rehabilitation program attendance on the level of postmyocardial depression for individuals who have had a myocardial infarction. The type of study that would best capture this information would be a: a. randomized controlled trial. b. qualitative study. c. case control study. d. descriptive study.

ANS: B Qualitative studies examine individuals experiences with health problems and the contexts in which these experiences occur. A qualitative study is best in this case of an individual nurse who wants to examine the effectiveness of a local program. Randomized controlled trials involve close monitoring of control groups and treatment groups to test an intervention against the usual standard of care. Case control studies typically compare one group of subjects with a certain condition against another group without the condition, to look for associations between the condition and predictor variables. Descriptive studies focus mainly on describing the concepts under study.

18. A nurse is developing a care delivery outcomes research project. Which population will the nurse study? a. Nurses b. Patients c. Administrators d. Health care providers

ANS: B Similar to the expected outcomes you develop in a plan of care, a care delivery outcome focuses on the recipients of service (e.g., patient, family, or community) and not the providers (e.g., nurse or physician/health care provider). Administrators are not recipients of service.

1. Evidence-based practice is a problem-solving approach to making decisions about patient care that is grounded in: a. the latest information found in textbooks. b. systematically conducted research studies. c. tradition in clinical practice. d. quality improvement and risk management data.

ANS: B The best evidence comes from well-designed, systematically conducted research studies described in scientific journals. Portions of a textbook often become outdated by the time it is published. Many health care settings do not have a process to help staff adopt new evidence in practice, and nurses in practice settings lack easy access to risk management data, relying instead on tradition or convenience. Some sources of evidence do not originate from research. These include quality improvement and risk management data; infection control data; retrospective or concurrent chart reviews; and clinicians expertise. Although nonresearch-based evidence is often very valuable, it is important that you learn to rely more on research-based evidence.

5. The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the a. Abstract. b. Introduction. c. Literature review or background. d. Results.

ANS: B The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The abstract is a brief summary of the article. The literature review or background offers a detailed background of the level of science or clinical information that is available about the topic of the article. The results section is the summary section of the article.

3. The nurse is doing a literature review related to a potential problem that has been identified on the nursing unit. The nurse realizes that nursing research is important in that it is designed to (Select all that apply.) a. Enhance the nurses chance at promotion. b. Identify new knowledge. c. Improve professional practice. d. Enhance effective use of resources. e. Lead to decreases in budget expenditures.

ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Effective use of resources does not always result in lower budget expenditures, but rather more effective use of resources. A promotion is not a direct result of research.

3. The nurse is reviewing nursing research literature related to a potential practice problem on the nursing unit. What is the rationale for the nurse's action? (Select all that apply.) a. Nursing research ensures the nurse's promotion. b. Nursing research identifies new knowledge. c. Nursing research improves professional practice. d. Nursing research enhances effective use of resources. e. Nursing research leads to decreases in budget expenditures.

ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Nursing research itself does not lead to a decrease in budget expenditures; however it does lead to using health care resources effectively. A promotion is not a direct result of nursing research.

2. Which statements are true about the Iowa model of EBP? (Select all that apply.) a. It addresses utilization of research findings at an individual level. b. It prioritizes pressing items of interest related to quality of care. c. Individual nurses enact an Iowa decision tree when they examine risk management data. d. It identifies triggers capable of posing hazard or benefit. e. It reiterates that innovators embrace change far earlier than laggards.

ANS: B, D The Iowa model of EBP provides direction for the development of EBP in a clinical agency. This EBP model was initially developed in 1994 and revised in 2001. In a health care agency, there are triggers that initiate the need for change, and the focus should always be to make changes based on best evidence. These triggers can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from an institutional standards committee.

9. Six months after an early mobility protocol was implemented, the incidence of deep vein thrombosis in patients was decreased. This is an example of what stage in the EBP process? a. Asking a clinical question b. Applying the evidence c. Evaluating the practice decision d. Communicating your results

ANS: C After implementing a practice change, your next step is to evaluate the effect. You do this by analyzing the outcomes data that you collected during the pilot project. Outcomes evaluation tells you whether your practice change improved conditions, created no change, or worsened conditions.

3. When a PICOT question is developed, the letter that corresponds with the usual standard of care is: a. P. b. I. c. C. d. O.

ANS: C C = Comparison of interest. What standard of care or current intervention do you usually use now in practice? P = Patient population of interest. Identify your patient by age, gender, ethnicity, disease, or health problem. I = Intervention of interest. What intervention (e.g., treatment, diagnostic test, prognostic factor) do you think is worthwhile to use in practice? O = Outcome. What result (e.g., change in patients behavior, physical finding, change in patients perception) do you wish to achieve or observe as the result of an intervention? T=Time. What amount of time is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

20. The nurse is caring for a patient in labor and delivery. When near completing an assessment of the patient's cervix, the electronic infusion device being used on the intravenous (IV) infusion alarms. Which sequence of actions is most appropriate for the nurse to take? a. Complete the assessment, remove gloves, and silence the alarm. b. Discontinue the assessment, silence the alarm, and assess the intravenous site. c. Complete the assessment, remove gloves, wash hands, and assess the intravenous infusion. d. Discontinue the assessment, remove gloves, use hand gel, and assess the intravenous infusion.

ANS: C Completing the assessment while wearing gloves, removing gloves, washing hands after contact with body fluids, and then assessing the intravenous infusion will assist in the prevention and transfer of any potential organisms to this intravenous line. Completing the assessment, removing gloves, and silencing the alarm leaves out the crucial step of decontaminating and washing the hands. Discontinuing the assessment and assessing the IV leaves out removing the gloves and decontamination, as well as completing the assessment for the patient. Discontinuing the assessment, removing gloves, using hand gel, and assessing the IV is incorrect because upon exposure to body fluids, washing hands is appropriate.

10. A nurse develops the following PICOT question: Do patients who listen to music achieve better control of their anxiety and pain after surgery when compared with patients who receive standard nursing care following surgery? Which information will the nurse use as the "C"? a. After surgery b. Who listen to music c. Who receive standard nursing care d. Achieve better control of their anxiety and pain

ANS: C Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)?

2. In caring for patients, it is important for the nurse to realize that evidence-based practice is a. The only valid source of knowledge that should be used. b. Secondary to traditional or standard care knowledge. c. Dependent on patient values and expectations. d. Not shown to provide better patient outcomes.

ANS: C Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience, or the standard, It has always been done this way. Although these sources have value, it is important to learn to rely more on research evidence than on non-research evidence. Patients who receive care based on the most recent and best evidence experience 28% better outcomes.

12. The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting? a. Nonexperimental research b. Experimental research c. Qualitative research d. Evaluation research

ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent's decision to smoke cigarettes.

12. The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation for patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. What type of research is the nurse conducting? a. Evaluation research b. Experimental research c. Qualitative research d. Nonexperimental research

ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescents decision to smoke cigarettes.

6. The nurse is getting ready to develop a plan of care for a patient who has a specific need. The best source for developing this plan of care would probably be: a. The Cochrane Library. b. MEDLINE. c. NGC. d. CINAHL.

ANS: C The National Guidelines Clearinghouse (NGC) is a database supported by the Agency for Healthcare Research and Quality (AHRQ). It contains clinical guidelinessystematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population. The NGC is a valuable source when you want to develop a plan of care for a patient. The Cochrane Library Database of Systematic Reviews, MEDLINE, and CINAHL are all valuable sources of synthesized evidence (i.e., preappraised evidence).

3. The first step in evidence-based practice is to ask a clinical question. In doing so, the nurse needs to realize that in researching interventions, the question a. Is more important than its format. b. Will lead you to hundreds of articles that must be read. c. May be easier if in PICO format. d. May be more useful the more general it is.

ANS: C The PICO format allows the nurse to ask questions that are intervention focused. Inappropriately formed questions will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. The more focused the question asked, the easier it will become to search for evidence in the scientific literature.

2. When evidence-based practice is used, patient care will be: a. standardized for all. b. unhampered by patient culture. c. variable according to the situation. d. safe from the hazards of critical thinking.

ANS: C Using your clinical expertise and considering patients cultures, values, and preferences ensures that you will apply available evidence in practice ethically and appropriately. Even when you use the best evidence available, application and outcomes will differ; as a nurse, you will develop critical thinking skills to determine whether evidence is relevant and appropriate.

19. The quality improvement committee is examining an increase in medication errors on a particular unit. In conducting its analysis, what should be the committees primary focus? a. Nurses who administer the medications b. Pharmacy that prepares the medications c. Secretaries who enter the orders d. None of the above

ANS: D A well-organized QI program focuses on systems that significantly contribute to outcomes, not on individuals. Therefore, the entire process needs to be evaluated to determine effectiveness.

16. A nurse identifies a clinical problem with pressure ulcers. Which step should the nurse take next in the research process? a. Analyze results. b. Conduct the study. c. Determine method. d. Develop a hypothesis.

ANS: D After identifying an area of interest or clinical problem, the steps of the research process are as follows: Develop research question(s)/hypotheses; determine how the study will be conducted; conduct the study; and analyze results of the study.

14. The researcher is preparing to publish his study findings. In doing so, the researcher is aware of many ways that the study could have been done better, but that he did not have the ability to do. The researcher discloses these limitations in the manuscript, but they are most likely detected during which phase of the research process? a. Problem identification b. Study design c. Formulation of recommendations d. Analysis of data

ANS: D During analysis of data, the researcher interprets the demographics of the study population, as well as results, including limitations. Problem identification involves identifying the area of interest and study variables, reviewing the literature, formulating the theoretical framework, and devising research questions. Study design involves selection of research methods. Formulation of recommendations involves determining the implications of the study for nursing.

4. The nurse in the psychiatric unit is involved in a research study for a depression medication. In the study, patients are randomly assigned to one depression medication and the other group is receiving no medication to treat the depression. What method of research are the patients involved with? a. Descriptive b. Correlational c. Quasi-experimental d. Experimental

ANS: D Experimental tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment. Descriptive defines the magnitude of a concept and its characteristics. Correlational determines association between or among variables. Quasi-experimental tests an intervention and lacks either a control group or random assignment.

1. One of the first nurse researchers to document evidence-based practice for nursing was Florence Nightingale. What did Nightingale incorporate into her practice that made her practice different from her colleagues? a. Nightingale gathered scientific data. b. Nightingale calculated statistics to report her findings. c. Nightingale communicated her findings to powerful others. d. Nightingale based her nursing practice on her findings.

ANS: D Florence Nightingale had tried to develop the role of researcher by using evidence from her practice and implementing these findings. Evidence-based practice (EBP) includes conducting quality studies, synthesizing the study findings into the best research evidence available, and using that research evidence effectively in practice. Although gathering scientific data, calculating statistics to report findings, and communicating findings to powerful others are all important components of conducting research, Nightingale's action that most appropriately reflects the current nursing research priority is that she based her nursing practice on her findings.

9. Qualitative nursing research is valuable in that it a. Excludes all bias. b. Uses randomization in structure. c. Determines associations between variables and conditions. d. Studies phenomena that are difficult to quantify.

ANS: D Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients perceptions of illness. No study can totally exclude bias. However, randomization, such as that used in randomized control studies, helps. Qualitative nursing research does not usually randomize its subjects. Control studies determine whether there is an association between one or more predictor variables and the condition.

17. The quality improvement committee has been alerted to an increased number of falls in the hospital. Most of these falls have occurred at night and have involved patients who were trying to crawl over bedrails. A literature review brought out that most falls occur because patients are trying to go to the bathroom. The committee created a practice change that bedrails should be left in the down position, and hourly nursing rounds should be conducted. What is the committees next step? a. Evaluate the changes in 1 month. b. Wait a month before implementing the changes. c. Implement the changes as a pilot study. d. Communicate to staff the results of this inquiry.

ANS: D Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a QI committee makes a practice change, it is important to communicate the results to staff. Practice changes will not likely last when QI committees fail to report findings and results of interventions. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either fully or as a pilot study) and as soon as practical; this should be followed by re-evaluation.

9. A nurse is reviewing research studies for evidence-based practice. Which article should the nurse use for qualitative nursing research? a. An article about the number of falls after use of no side rails b. An article about infection rates after use of a new wound dressing c. An article about the percentage of new admissions on a new floor d. An article about emotional needs of dying patients and their families

ANS: D Studying emotional needs is a qualitative study. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness. The number of falls, infection rates, and percentages of new admissions are all examples of quantitative research.

5. The nurse is not sure that the procedure the patient requires is the best possible for the situation. Utilizing which of the following resources would be the quickest way to review research on the topic? a. CINAHL b. PubMed c. MEDLINE d. The Cochrane Library

ANS: D The Cochrane Library Database of Systematic Reviews is a valuable source of synthesized evidence (i.e., preappraised evidence). The Cochrane Database includes the full text of regularly updated systematic reviews and protocols for reviews currently happening. MEDLINE, CINAHL, and PubMed are among the most comprehensive databases and represent the scientific knowledge base of health care.

17. After reviewing the literature, the evidence-based practice committee institutes a practice change that bedrails should be left in the down position and hourly nursing rounds should be conducted. The results indicate over a 40% reduction in falls. What is the committee's next step? a. Evaluate the changes in 1 month. b. Implement the changes as a pilot study. c. Wait a month before implementing the changes. d. Communicate to staff the results of this project.

ANS: D The last step of evidence-based practice (EBP) is to share the outcomes of EBP changes with others. Changes must be evaluated before the outcomes are shared. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either hospital wide or as a pilot study). Waiting should not be an option unless the results are not to the committee's liking.

10. The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurses best option? a. Drop the idea of making the change at this time. b. Insist that management hire the needed staff to facilitate the change. c. Seek employment in another institution that may have the staff needed. d. Conduct a pilot study to develop evidence to support the change.

ANS: D When evidence is not strong enough to apply in practice, or if resources are limited, the next option is to conduct a pilot study to investigate the PICO question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines.

6. The nurse is caring for a patient with chronic low back pain. In providing care for this patient, the nurse wonders whether the guidelines utilized for this type of pain are adequate. The nurse wants to determine the best evidence-based practice regarding these guidelines. What is the best database for the nurse to access? a. MEDLINE b. EMBASE c. PsycINFO d. AHRQ

ANS: D f*ck this question, i dont even remember this in the book. The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines.

1. _________________ is a guide for making accurate, timely, and appropriate clinical decisions.

ANS: Evidence-Based Practice Evidence-based practice is a guide for making accurate, timely, and appropriate clinical decisions.

7. ____________________ is the extent to which a study's findings are valid, reliable, and relevant to your patient population of interest.

ANS: Scientific rigor Scientific rigor is the extent to which a studys findings are valid, reliable, and relevant to your patient population of interest.

A systematic review explains whether the evidence that you are searching for exists and whether there is good cause to change practice. In _____________, all entries include information on systematic reviews. Individual randomized controlled trials (RCTs) are the gold standard for research.

ANS: The Cochrane Library A systematic review explains whether the evidence that you are searching for exists and whether there is good cause to change practice. In The Cochrane Library, all entries include information on systematic reviews. Individual randomized controlled trials (RCTs) are the gold standard for research.

2. Evidence-based practice requires good ______________.

ANS: nursing judgment Evidence-based practice requires good nursing judgment; it does not consist of finding research evidence and blindly applying it.

8. Patient fall rates are an example of a ______________ type of study in the evidence hierarchy.

ANS: quality improvement data Data collected within a health care agency offer important trending information about clinical conditions and problems. Staff in the agency review the data periodically to identify problem areas and to seek solutions.