(PrepU) Chapter 2: Theory, Research, and Evidence-Informed Practice

One of the primary reasons for conducting nursing research is to:

generate knowledge to guide practice. One of the major reasons for conducting nursing research is to generate knowledge to guide practice. The other answers pertain to other aspects of nursing practice but not to nursing research.

What nursing activity forms the bridge between theory and practice?

Evidence-based research Evidence-based research is translational research that forms the bridge between theory and practice. Theoretical writing focuses on theory. Client-focused care and case management are focused on practice.

Which activity best helps the nurse apply theory to practice?

Evidence-based research Evidence-based research is translational research that forms the bridge between theory and practice. Theory development is how desirable change in society is best achieved. Client-focused care is care provided to a client that maintains the client as a functional component of healthcare team. Case management is when care is provided to an individual client by a healthcare provider.

A nurse develops the following foreground question using the PICOT format in preparation for a research study: "In overweight clients, how do chromium supplements compared to no supplements help with weight loss?" Which part of the question reflects the intervention?

Chromium supplements In this question, the intervention (I) would be the use of chromium supplements. The population (P) would be overweight clients. The comparison (C) would be no supplements. The outcome (O) would be weight loss. The T is for time, which is not reflected in this scenario.

A nurse researcher develops a foreground question in preparation for conducting a research study. The question is: "In clients with intravenous catheters, how does replacing administration sets every 72 hours (h) compared with other frequent intervals (24h, 48h, or 96h) decrease infection rates?" Applying the PICO framework, which part of the statement reflects the "O"?

Decrease infection rates The "O" of PICO indicates the outcome, which in this instance is "decrease infection rates." The "P" refers to patients, who in this case have intravenous catheters; "I" refers intervention, which in this case is replacing the administration set every 72 hours; "C" refers to comparison or control group, which in this case is those who have the administration set replaced at other frequencies.

The National Institute of Nursing Research (NINR) was established following a study in 1983. The center's purpose is to:

promote research for health promotion. The National Institute of Nursing Research was established under the National Institutes of Health to place nursing securely in the sphere of scientific investigation and to support research and training into client care, health promotion, disease prevention, and the mitigation of the effects of acute and chronic disabilities. It does not exist to advance nursing funding, expand nursing theory, or evaluate research.

The process of considering an idea as a whole and then dividing it into smaller, more specific ideas is which?

Deductive reasoning Deductive reasoning involves looking at an idea as a whole and then considering more specific ideas. Theory is a group of concepts and the relationships among them. Concepts are abstract ideas or objects and their relationships to one another. Inductive reasoning is derived from consideration of specific properties to conclusions about a general idea.

Nurses in an ICU noticed that their clients required fewer interventions for pain when the ICU was quiet. They then asked a researcher to design a study about the effects of noise on the pain levels of hospitalized clients. How does this demonstrate the ultimate goal of expanding the nursing body of knowledge?

Nursing research helps improve ways to promote and maintain health. Nursing research expands knowledge to learn improved ways to promote and maintain health. The other answers are incorrect because they are not the primary purpose of nursing research.

Which is a focus of medical research rather than nursing research?

Drug metabolism Drug metabolism is an example of a focus of medical research. Nursing research is defined as a systematic inquiry into the problems encountered in nursing practice and into the modalities of client care such as health appraisal, prevention of trauma, promotion of recovery, and coordination of health care (Gortner, 1975).

The focus of nursing is always on which of the four common concepts in nursing theory?

Person All of these concepts are important in nursing theory; however, the focus of nursing is on the person (client).

A nurse is developing a foreground question for nursing research using the PICO model. Which component would be represented by the statement, "a 45-year-old male with coronary heart disease and atrial fibrillation"?

P When using PICO, the "P" stands for the patient or problem and its delineation. The "I" signifies the intervention considered; "C" denotes comparison if appropriate, or it may be optional; and "O" represents the outcome of interest or relevant outcomes.

A nurse is discussing dietary issues with a Latino client in the clinic. The client states, "My grandmother always told me that I needed to include beans in my diet so that my muscles would grow." The information that the client is expressing is known as what?

Traditional knowledge Traditional knowledge is known as knowledge that is passed down from one generation to the next. A grandmother passing information is an example of traditional knowledge. Authoritative knowledge is information that is gleaned from an expert based on their perceived experience. Scientific knowledge is derived through the scientific method. Philosophy is the study of wisdom and one perceptions of life.

What type of research study would a hospital conduct to explore clients' and families' perceptions of receiving care?

Qualitative Qualitative research is designed to seek the perceptions that the clients' and families' perceptions of receiving their care that the hospital desires. Quantitative researchers tend to use deductive reasoning, logic, and measurable attributes of human experience, whereas qualitative researchers tend to use dynamic, individual aspects of the human experience in a holistic approach. Ordinal and interval refer to types of variables associated with quantitative research analysis. Qualitative research is considered to be scientific even though it is not experimental.

When looking at a model for evidence-based practice, what is the final step of the process?

Evaluating practice change The fifth and final step in the process of implementing evidence-based practice is to evaluate and critically appraise the change in practice. Formulating a clinical question and searching and appraising the literature precede this step.

Who is considered to be the first nursing theorist who conceptualized nursing in terms of manipulating the environment?

Florence Nightingale Florence Nightingale conceptualized the nurse's role as manipulating the environment to facilitate and encourage the reparative process. This would be accomplished by attending to ventilation, warmth, light, diet, cleanliness, and noise. Sister Callista Roy, CSJ is an American nun, nursing theorist, professor and author. She is known for creating the adaptation model of nursing. Dorothea Orem was a nursing theorist and creator of the self-care deficit nursing theory, also known as the Orem model of nursing. Lydia Hall was a pioneer in nursing autonomy and nurse-driven care.

What is the best explanation for the way evidence-based practice (EBP) has changed the way nursing care is delivered?

Nursing care now uses EBP as a means of ensuring quality care. The facilitation of EBP involves identifying and evaluating current literature and research, as well as incorporating the findings into client care as a means of ensuring quality care. The other answers are incorrect; they were used even before EBP became a major force in the delivery of nursing care.

Of the following client needs, which need takes priority in the nurse's delivery of care?

Oxygenation Oxygen is essential for the body's metabolic processes.

A group of nurses is planning to investigate the effectiveness of turning immobilized stroke clients more frequently in order to prevent skin breakdown. The team has begun by formulating a PICO question. Which element will the "O" in the team's PICO question refer to?

Preventing skin breakdown Within the PICO question framework, the "O" denotes the outcome of interest. In this case, the desired outcome is the prevention of skin breakdown. Stroke clients are the "P," or population of interest, whereas turning clients more frequently is the "I," or intervention. The current turning schedule is the "C," referring to the comparison of interest.

Which statement best explains the importance of theoretic frameworks?

Theoretic frameworks advance nursing knowledge and practice. Theoretic frameworks are important to the advancement of nursing knowledge and professional practice. The other statements describe that theoretic frameworks guide specific types of nursing care, of which these are only two examples. Research is known to take many years to impact clinical practice, so the possibility of advancing the ethical aspects of nursing practice would be a very long term goal without a guarantee.

The following events occurred as part of the growth of nursing research. Place the events in the order that they occurred from earliest to latest.

establishment of the first Canadian nursing research journal ANA recommendation for further research in areas of health promotion and illness prevention Institute of Medicine's urge to increase the level of federal funding for nursing research ANA's identification of 11 priorities for nursing research Establishment of the journal Applied Nursing Research In 1969, the first Canadian nursing research journal was started. This was followed, in 1981, by the ANA Commission on Nursing Research recommendation for further research in areas of health promotion, illness prevention, cost-effective health care, and nursing care for high-risk clients. In a 1983 study, the Institute of Medicine urged for increased federal funding for nursing research. In 1985, The journal Applied Nursing Research was established.

A nurse is preparing to conduct a research study and uses the PICO format to develop the foreground question which is: "In adults, does reducing salt intake, compared to no change in salt intake, lower blood pressure?" The nurse identifies the "P" as:

adults Using the PICO format, "P" refers to the population, which in this case is adults. "I" refers to the intervention, which is reducing salt intake. "C" refers to comparison, which is no change in salt intake. "O" refers to the outcome, which would be lower blood pressure.

The director of nurses (DON) in a long-term care facility has noticed an increased number of urinary tract infections (UTIs) on the east wing of the facility, and would like the infection control nurse to investigate this problem. What is the best problem statement for this study?

"Is there a relationship between the personnel caring for specific clients and whether or not these clients developed UTIs?" Research cannot begin before considerable review, investigation, and forethought have been given to the issue that appears to be the problem to be investigated. The problem statement in a research study identifies the direction that a research project will take. The statement should be clear and unambiguous, express a relationship between two or more variables, identify the population to be studied, and encourage empiric testing.

A nurse is completing a family assessment on a routine home health visit. The parents have a child with a severe peanut allergy. The mother states that she does not purchase any foods with peanut or peanut oil for her family. The other children are allowed to have foods containing peanuts while they are at school and visiting with friends and family. The nurse would conclude that which of the following theories would most like be the basis for this family's functioning?

Adaptation Theory Adaptation theory is based on an understanding of humans and their interaction with the environment. In this situation the mother is manipulating the physical environment for the child with allergies, as well as the needs and/or desires of the other children. Systems theory is described as studying relationships between a whole and identifying how parts interact and behave. Developmental theory is based on growth and maturation of humans. Maslow's theory is based on a pyramid of human needs related to the most primitive needs moving toward higher level needs, such as self-actualization.

A community health nurse has been visiting a diabetic client whose morning fasting glucose levels are constantly elevated. Upon further assessment, the nurse determines that the client's spouse does not understand how to prepare meals following the prescribed diabetic diet. Using Dorothea Orem's Self-Care Theory, how can the nurse help meet the needs of this client?

Arrange an evaluation appointment with a dietitian. According to Dorothea Orem's theory, the role of the nurse is to facilitate self-care to sustain life and health, to recover from disease or injury, or to cope with its effects. Arranging an evaluation appointment with a dietitian facilitates self-care because the nurse is providing a service that assists the client and spouse to progressively maximize their self-care potential. People learn behaviors that they perform on their own behalf to maintain life, health, and well-being. The other options are providing care for the client, not facilitating self-care.

A nurse who works in a pediatric practice assesses the developmental level of children of various ages to determine their psychosocial development. These assessments are based on the work of:

Erikson Erik Erikson based his theory of psychosocial development on the process of socialization, emphasizing how individuals learn to interact with the world. Erikson recognized the role of social, biologic, and environmental factors in development, and defined specific tasks or conflicts that people accomplish or overcome during what he defined as the eight stages of life, based on chronologic age. Abraham Maslow developed his theory of human needs in terms of physical and psychosocial needs considered essential to human life, rather than by chronologic age as Erikson did. Maslow defined five levels of need in a hierarchy, with different needs existing simultaneously. Jean Watson is a nursing theorist who is known for her focus on caring. The central theme of her work is that nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. Caring is universal and is practiced through interpersonal relationships. Martha Rogers is a nursing theorist who is known for her theory of the individual client being central to the discipline of nursing. Nursing interventions are directed toward repatterning human environment fields or assisting in mobilizing inner resources.