NUR 302 Chapter 5 Evidence-Based Practice

Confidentiality

guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.

Research

is a systematic process that asks and answers questions that generate knowledge, which provides a scientific basis for nursing practice. ____ allows you to study nursing questions and problems in greater depth within the context of nursing. Before ___ can be conducted, a number of issues must be explored. All subjects must have provided informed consent. Their responses must remain anonymous and confidential.

scientific method

The foundation of research The most reliable and objective means of acquiring and conducting research and gaining knowledge. A step-by-step process to ensure that findings from a study are valid, reliable, and generalizable to a similar group of subjects. The goal is to apply the knowledge gained from a study to a broader group of patients.

evaluate

After applying evidence in your practice, your next step is to ___ the outcome. Events or results that you do not expect may occur. Never implement a practice change without ____ its effects.

research study.

After completing a thorough review and critique of the scientific literature, you might not have enough strong evidence to make a practice change. Instead you may find a gap in knowledge that makes your PICOT question go unanswered. When this happens, the best way to answer your PICOT question is to conduct a_____

reliability, validity, practice

After critiquing all articles for a PICOT question: Do the articles offer evidence to explain or answer my PICOT question? Do the articles show support for the ___ and ___ of the evidence? Can I use the evidence in ___?

EBP:, Research:,QI:

Although EBP, research, and QI are closely related, they are separate processes. The relationship among research, EBP, and QI is overlapping and reinforcing. ____ Use of information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes _____Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; may or may not improve patient care ___Improves local work processes to improve patient outcomes and health system efficiency; results usually not generalizable

professional

As a ____nurse it is critical to contribute to the growing knowledge of nursing practice. Nurses often communicate the outcomes of EBP changes at _____ conferences and meetings. Being involved in ___ organizations allows them to present EBP changes in scientific abstracts, poster presentations, or even podium presentations

meta-analyses

At the top of the pyramid are systematic reviews or ____, which are state-of-the-art summaries from an individual researcher or panel of experts. ____ and systematic reviews are the perfect answers to PICOT questions because they rigorously summarize current evidence. In a _____, the researcher uses statistics to show the effect of an intervention on an outcome. In a systematic review, no statistics are used to draw conclusions about the evidence.

institutional review board

Before conducting any study with human subjects, the researcher obtains approvals from the agency's human subjects committee or ___. An IRB includes scientists and laypersons who review all studies conducted at the institution to ensure that ethical principles, including the rights of human subjects, are followed.

practice change

Clinicians enjoy and appreciate seeing the results of a ___. In addition, the _____ will more likely be sustainable and remain in place when staff are able to see the benefits of an EBP change.

peer-reviewed

Databases contain large collections of published scientific studies, including ____ research. A ____ article is reviewed for accuracy, validity, and rigor, and approved for publication by experts before it is published.

abstract

Element of an evidence based article, An ___ is a brief summary that quickly tells you if the article is research or clinically based. An _____ summarizes the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.

Introduction.

Element of an evidence based article, The ___ contains more information about the purpose of the article. There is usually brief supporting evidence as to why the topic is important. Together the abstract and ___ help you decide if you want to continue to read the entire article.

Literature review(1,4,5), background(2,3)

Element of an evidence based article, ____ or ____. A good author offers a detailed ___ of the level of science or clinical information about the topic. The ____ offers an argument about what led the author to conduct a study or report on a clinical topic. This section of an article is very valuable. Even if the article itself does not address your PICOT question the way you desire, the ____ may lead you to other, more useful articles.

Manuscript narrative

Element of an evidence based article, _____. The "middle section" or narrative of an article differs according to the type of evidence-based article it is. A clinical article describes a clinical topic, which often includes a description of the patient population, the nature of a certain disease or health alteration, how patients are affected, and the appropriate nursing therapies. A research article contains several subsections within the narrative, including:

nursing care.

Evidence from research studies and opinions of nursing experts provide a basis for _____

integrated

Evidence is ____ in a variety of ways through teaching tools, clinical practice guidelines, policies and procedures, and new assessment or documentation tools. teaching, assessment or documentation tools, clinical practice guidelines, policies and procedures

outcome research

Helps patients, health care providers, and those in health care policy make informed decisions on the basis of current evidence. Typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients. Outcomes must be observable or measurable.

descriptive, qualitative

If RCTs are not available, you can use results from other research studies such as ____ or ____ studies, to help answer your PICOT question.

apply

Once you decide that the evidence is strong and applicable to your patients and clinical situation, you begin to identify how to incorporate it into practice. Your first step is simply to ___ the research in your plan of care for a patient

evidence

Once you have a clear and concise PICOT question, you are ready to search for ____. Do not hesitate to ask for help to find appropriate _____.

Patient population, Intervention, Comparison, Outcome, Time

P = _____ of interest. Identify patients by age, gender, ethnicity, and disease or health problem I = ___ of interest. Which ____ is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)? C = _____ of interest. What is the usual standard of care or the intervention used now in practice? O = _____. What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, patient perception)? T = ____. How much ____ is needed for an intervention to achieve an outcome (e.g., the amount of time needed to change quality of life or patient behavior)?

Methods or design:

Part of the manuscript narrative portion of elements of evidence based article, ____ Explains how a research study was organized and conducted to answer the research question or test the hypothesis. This section explains the type of study that was conducted (e.g., RCT, case control study, or qualitative study) and the number of people who participated in the study.

Purpose statement:

Part of the manuscript narrative portion of elements of evidence based article, ____ Explains the focus or intent of a study. It includes research questions or hypotheses—predictions made about the relationship or difference among study variables. An example of a research question is: Does music therapy reduce a patient's pain and anxiety?

Results or conclusions:

Part of the manuscript narrative portion of elements of evidence based article, ____Both clinical and research articles have a summary section. In a clinical article, the author explains the clinical implications for the topic presented. In a research article, the author details the results of the study and explains whether a hypothesis is supported or how a research question is answered. This section includes a statistical analysis if it is a quantitative research study. A qualitative study summarizes the descriptive themes and ideas that arise from the researcher's analysis of data.

Clinical implications:

Part of the manuscript narrative portion of elements of evidence based article, _____ A research article includes a section that explains if the findings from the study have clinical implications. The researcher explains how to apply findings in a practice setting for the type of subjects studied.

nonexperimental

Quantitative method, Because learning to understand how patients experience health problems cannot always be addressed through an RCT, ____ descriptive studies are often used in nursing research. ____ descriptive studies describe, explain, or predict phenomena. Examples of ____ descriptive studies include case control studies and correlational studies. A case control study is one in which researchers study one group of subjects with a certain condition (such as asthma) at the same time as another group of subjects who do not have the condition. A case control study determines if there is an association between one or more predictor variables and the condition. Correlational studies describe the relationship between two variables (such as the age of the adolescents and if the adolescents smoke). The researcher determines if the two variables are correlated or associated with one another and to what extent.

Experimental research:

Quantitative method, One example of _____ is the randomized controlled trial. An RCT is a true experimental study that tightly controls conditions to eliminate bias with the goal of generalizing the results of the study to similar groups of subjects.

Surveys

Quantitative method, ___ obtain information regarding the frequency, distribution, and interrelation of variables among subjects in the study.

Evaluation

Quantitative method, ____ research is a form of quantitative research that determines how well a program, practice, procedure, or policy is working.

health care setting

Sometimes you use data gathered from a ____ to examine clinical trends when developing clinical questions. For example, most hospitals keep monthly records on key quality of care or performance indicators such as medication errors or infection rates.

hierarchy

The ___ of available evidence offers a guide to the types of literature or information that offer the best scientific evidence. This diagram of the ____ of evidence shows that stronger evidence is farther up the triangle. For instance, a well-designed randomized controlled trial (RCT) carries more weight than even the opinions of experts.

National Guidelines Clearinghouse (NGC)

The ____ is a database supported by the AHRQ. It contains clinical guidelines, which are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a specific patient population.

scientific journals

The best information is evidence that comes from well-designed, systematically conducted research studies, mostly found in _____. It is important to rely more on research evidence rather than solely on evidence that is not research based.

PICOT

The questions you ask eventually will lead you to the evidence for an answer. When you go to the scientific literature, you don't want to read 100 articles to find the handful that are most helpful—you want to read the best four to six articles that specifically address your question. Using the ____ format can help. The more focused your question is, the easier it becomes to search for evidence in the scientific literature. Note that a well-designed ____ question does not have to follow the sequence of P, I, C, O, and T. In addition, intervention (I), comparison (C), and time (T) are not appropriate to be used in every question. The aim is to ask a question that contains as many of the PICOT elements as possible.

clinical experts

The use of ____ is at the bottom of the evidence pyramid, but do not consider ___ to be a poor source of evidence. ___ use evidence frequently as they build their own practice, and they are rich sources of information for clinical problems.

textbook, Articles, quality improvement, risk management

There are many sources of evidence. The challenge is to obtain the very best, most relevant, current, and accurate information at the right time, when you need it for patient care. A good ____ incorporates evidence into the information, practice guidelines, and procedures it includes. ___ from nursing and health care literature are available on almost any topic involving nursing practice in either journals or on the Internet. Another source of evidence comes from ____ and ____ data; international, national, and local standards of care; infection control data; benchmarking, retrospective, or concurrent chart reviews; and clinicians' expertise.

Cultivate, clinical question, relevant,appraise, clinical expertise, Evaluate, outcomes

There are seven steps to EBP, which are numbered from zero to six. 0. ____ a spirit of inquiry. 1. Ask a ____ in PICOT format. 2. Search for the most ___ evidence. 3. Critically ____ the evidence you gather. 4. Integrate all evidence with your ____ and patient preferences and values. 5. ___ the outcomes of practice decisions or changes using evidence. 6. Share the ____ with others.

clinical staff

When a practice change occurs on a nursing unit level, the first group to discuss the outcomes of the change is often the ____ on that unit.

inquiry

To be an effective change agent and foster optimal patient care, you need to have a never-ending spirit of _____.

share

To enhance professional development and promote positive patient outcomes beyond the unit level, ____ the results with various groups of nurses or other care providers such as the nursing practice council or the research council.

clinical expertise

Using your ____ and considering patient values and preferences ensures that you apply the evidence available in practice both safely and appropriately.

effective, discontinued

When evaluating an EBP change, determine if the change was ____, if modifications in the change are needed, or if the change needs to be ____.

pilot study

When evidence is not strong enough to apply in practice, your next option is to conduct a ___ to investigate your PICOT question. A ___ is a small-scale research study or one that includes a quality or performance improvement project.

QI data

When implementing an EBP project, it is important to first review evidence from appropriate research and ____data. This information helps you better understand the extent of a problem in practice and within your organization. ___ data inform you about how processes work within an organization and thus offer information about how to make EBP changes. EBP and QI sometimes provide opportunities for research.

medical librarian

When using scientific literature for evidence, seek the assistance of a ____ who knows the various online databases that are available to you.

clinical problem

When you face a _____, always ask yourself where you can find the best evidence to help you find the best solution in caring for patients. Even when you use the best evidence available, application and outcomes will differ on the basis of your patient's values, preferences, concerns, and/or expectations. As a nurse you develop critical thinking skills to determine whether evidence is relevant and appropriate to your patients and to a clinical situation.

RCTs, Single RCT

___ are the most precise forms of experimental study and therefore are the gold standard for research. 2nd from the top of pyramid, A ___ is not as conclusive as a review of several ____ on the same question. However, a ___ that tests the intervention included in your question yields very useful evidence.

Qualitative

___ nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness or quality of life. This research involves inductive reasoning to develop generalizations or theories from specific observations or interviews. There are a number of different ____ research methods, including ethnography, phenomenology, and grounded theory. Each is based on a different philosophical or methodological view of how to collect, summarize, and analyze ____ data.

Quantitative

____ approaches offer precise measurement and quantification. There are many ____ methods, including: experimental, nonexperimental, survey, and evaluation research.

Critiquing

____ evidence involves evaluating it, which includes determining the value, feasibility, and usefulness of evidence for making a practice change. When ____ evidence, first evaluate the scientific merit and clinical applicability of the findings of each study. Then, with a group of studies and expert opinions in hand, determine which findings have a strong enough basis for use in practice.

Evidence-based

_____ care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs. Implementing ____ helps you make effective, timely, and appropriate clinical decisions in response to the broad political, professional, and societal forces present in today's health care environment. ____ is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise and patient preferences and values in making decisions about patient care.

Evidence-based articles

_____ include the following elements: Abstract Introduction Literature review or background Manuscript narrative Purpose statement Methods or design Results or conclusions Clinical implications

Informed consent

_____means Participants receive full and complete information They can understand the information They have free choice to participate They understand how their confidentiality will be kept