Ch 5 - EBP
The nurse educator is helping an evidence-based practice (EBP) team implement some of the results obtained through the process. The educator suggests doing "some small tests of change" with the Plan-Do-Study-Act (PDSA) cycle and questions the team about its understanding of this process. Which team member statement shows a correct understanding? A "During small tests of change, it will be helpful to use the concept of PDSA cycles to guide our activities." B "One benefit of doing small tests of change is that we perfect the practice that we want to implement after we have already disseminated and used it widely." C "'P' stands for 'problem' and is the first step in introducing a practice change." D "'S' represents 'statistics' and refers to review and analysis of data collected during the cycle."
A "During small tests of change, it will be helpful to use the concept of PDSA cycles to guide our activities." During small tests of change, using the concept of PDSA cycles to guide activities allows the team to test on a small scale and make revisions to the process as it deems necessary. A big benefit of small tests of change is that the EBP team has a chance to perfect the process or practice that it wants to implement before disseminating and using it on a wide scale. "P" stands for "plan" and is the first step in introducing a practice change. During this phase, a project team develops a protocol for implementation, which includes not only the protocol or procedure for the practice innovation, but also a total plan for the exact process that will be followed in implementing the project. "S" represents "study" and refers to review and analysis of data collected during the "Do" (D) phase of the cycle.
The evidence-based practice improvement (EBPI) model follows a specific order when approaching the implementation of improvements in nursing practice. (Place the steps of the process in the order in which they are to be implemented.) A Formulating a focused clinical question in Population, Intervention, Comparison, Outcome, and, occasionally, Time (PICO[T]) format B Developing an aim statement or project goal C Appraising and synthesizing relevant evidence D Searching for evidence to answer the question E Describing the practice problem F Developing, implementing, and evaluating the protocol for practice improvement G Disseminating best practices H Using small tests of change or Plan-Do-Study-Act (PDSA) cycles to test methods
A Formulating a focused clinical question in Population, Intervention, Comparison, Outcome, and, occasionally, Time (PICO[T]) format B Developing an aim statement or project goal C Appraising and synthesizing relevant evidence D Searching for evidence to answer the question E Describing the practice problem F Developing, implementing, and evaluating the protocol for practice improvement G Disseminating best practices H Using small tests of change or Plan-Do-Study-Act (PDSA) cycles to test methods The EBPI model combines the best of the EBP and process/quality improvement systems into one approach. This model is prescriptive and easy for guiding health care practitioners from any discipline and setting to achieve positive change. The steps of the model include: 1) the description of the practice problem; 2) the formulation of a focused clinical question (in PICO[T] format); 3) the search for evidence to answer the question; 4) the appraisal and synthesis of relevant evidence; 5) the development of an aim statement or project goal; 6) the development, implementation, and evaluation of the protocol for practice improvement; 7) the use of small tests of change or PDSA cycles to test methods; and 8) the dissemination of best practices.
Newly hired RNs are learning about implementing evidence-based practice (EBP) to answer clinical questions. How does the hospital's nurse educator define the process for them? (Select all that apply.) A Acquisition of practice competencies attained by using client feedback B A strategy for making clinical decisions about nursing practice C Incorporation of current evidence with clinical expertise and client values D Making clinical nursing decisions using research and other evidence E Seeking evidence from the medical industry to make informed nursing decisions F Using "trial and error" strategies to establish nursing protocols
B A strategy for making clinical decisions about nursing practice C Incorporation of current evidence with clinical expertise and client values D Making clinical nursing decisions using research and other evidence EBP is a strategy for making clinical decisions about how we practice nursing and other health care professions using research and other evidence. EBP incorporates the best current evidence with the expertise of the clinician and the client's values and preferences to make a decision about health care. EBP may actually contribute to the nurse's acquisition of competencies, but this is not the main purpose, nor is it the definition. Seeking medical industry data to relate it to nursing decision making is not a definition for EBP. EBP is not a "trial and error" method; it is a scientific approach to looking at problems (questions) that arise in nursing practice.
The nurse is mentoring a team with a clinical question through the process of evidence-based practice. How does the mentor advise the team about performing a literature review? A "Database use in research about clinical practice guidelines (CPGs) is not usually helpful." B "Make sure you organize your pertinent research data into a table of evidence that is easily understood." C "Provide copies of all pertinent literature to each member of the team for review." D "Use at least 10 to 20 sources of data to ensure that that you have a broad range of information."
B: "Make sure you organize your pertinent research data into a table of evidence that is easily understood." When performing a literature search on current evidence to answer a particular clinical question, organize the data into a table of evidence. When CPGs do not provide a sufficient answer to clinical questions and/or they are not based on high-quality evidence, nurses need to search databases; they are helpful. The purpose of having a team is to divide the tasks, including review of the literature. Often hundreds of resources are available; providing all team members with all of these resources would be wasteful. Confining the search to a specific number (10 to 20) of sources is unwise. Fewer high-quality resources may be available, or there may be many more. Part of the team's work is to review and reassign sources of evidence to members so that a comprehensive review can be prepared.
The nurse educator is exploring some of the barriers that prevent nursing staff from engaging in evidence-based practice inquiries. Which barrier do nurses rank as the chief obstacle to conducting the process? A Difficulty understanding research articles and data B Lack of computer skills C Not having enough time D Not understanding the organization
C Not having enough time Lack of time is the major barrier that Pavikoff, Tanner, and Pierce (2005) found prevented nurses from engaging in evidence-based practice activities. Difficulty understanding research articles and data, lack of computer skills, and not understanding the organization are cited as barriers to nurse participation in the process, but they are not the most important.
The nurse works on a maternal-newborn unit at a hospital that encourages family-centered care. Maternal databases on the unit reflect that 82% of the expectant mothers plan to breast-feed their babies. The nurse determines that only 64% of the new mothers are actually breast-feeding their babies when they are discharged from the unit. What type of clinical question does the nurse ask to find out "why?" A Background B Critical C Qualitative D Quantitative
C Qualitative Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people using interviews or observation. The nurse wants to find out why the percentage of women who are actually breast-feeding is less than the percentage of women who formerly planned to breast-feed. These findings will be qualitative, such as "I was afraid the baby wouldn't get enough to eat" or "It was too painful." A background question usually asks for a fact, that is, a statement about which most authorities or experts would agree; such a type of question is not applicable to this scenario. "Critical" questions are not a specific category in evidence-based practice; if a question is considered to be "burning," it might also be considered to be "critical," but in this instance it is an incorrect response. Quantitative questions focus on the relationships among measurable phenomena and include statistical analysis of information.
An evidence-based practice (EBP) team is beginning to work on a clinical problem that has been identified on the unit. The nurse educator discusses using the Population, Intervention, Comparison, Outcome, and, occasionally, Time (PICO[T]) format to frame the question. Which team member statement needs clarification about the format from the educator? A "A comparison component is a current treatment or another intervention used for comparison." B "Outcomes should be desired and measurable and should result from the intervention." C "Populations of clients should be generalized for greater application of the developed interventions." D "The intervention component pertains to the therapeutic effectiveness of a new treatment."
C: "Populations of clients should be generalized for greater application of the developed interventions." Population indicates a specific, not generalized, group of clients to which the question applies; this component is important because evidence that may support an intervention with one group of clients may not apply to another group of clients. The comparison component of the clinical question may be the standard or current treatment, or it may be another intervention against which the innovative practice is compared. The outcome component specifies the measurable and desired outcomes of nursing practice innovation, diagnosis, or prevention intervention. The intervention component pertains to the therapeutic effectiveness of a new treatment.
The evidence-based practice (EBP) team follows a specific order when conducting research into practice issues. (Place the steps of the process in the order in which they are to be implemented.) A Finding the very best evidence to try to answer the question B Evaluating outcomes C Asking a "burning" clinical question D Making recommendations for practice improvement E Critically appraising and synthesizing relevant evidence F Implementing accepted recommendations
CAEDFB The EBP process is systematic and includes several steps in the context of practicing and teaching medicine: 1) identify and pose a "burning" clinical question(s), 2) find the very best evidence to try to answer those questions, 3) critically appraise and synthesize the relevant evidence, 4) make recommendations for practice improvement, 5) implement accepted recommendations, and 6) evaluate the outcomes.
The nurse manager is educating staff members about levels of inquiry used in the initial step of the evidence-based practice process. After the first step (asking "burning clinical questions") is learned, which staff member statement needs clarification? A "A question at the 'group' level needs to be researched through background literature." B "Questions at the 'Individual' client level constitute the first level of inquiry." C "Questions that describe 'organizational'- level problems require internal institutional evidence." D "Questions at the 'Unit' level need to bypass existing policies and procedures if one is to gain perspective."
D "Questions at the 'Unit' level need to bypass existing policies and procedures if one is to gain perspective." Unit-level questions need to look at existing policies and procedures to progress with the process. Protocol references should be noted, as should cited references for the policy or procedure. Group-level questions are researched; background information from the literature and internal evidence from the organization describe the problem more fully. Individual (client)-level questions are at the first level of inquiry. Organizational questions do require evidence from the institutional organization to be adequately posed and then moved through the process.
The nurse works on a maternal-newborn unit at a hospital that encourages family-centered care. Maternal databases on the unit reflect that 82% of the expectant mothers plan to breast-feed their babies. The nurse suspects that the number is less than 82% and wants to determine how many new mothers are actually breast-feeding their babies when they are discharged from the unit. What type of clinical question is the nurse asking? A Background B Critical C Qualitative D Quantitative
D Quantitative Quantitative questions focus on the relationships among measurable phenomena and include statistical analysis of information. A background question usually asks for a fact, that is, a statement about which most authorities or experts would agree. "Critical" questions are not a specific category in evidence-based practice; if the question is considered to be "burning," it might also be considered to be "critical," but in this instance it is an incorrect response. Qualitative questions focus on the meanings and interpretations of human phenomena or experiences of people using interview or observation.