Chapter 13: Practicing Evidence-Based Decision Making

Characteristics of a quantitative study include all of the following except: a. clarifies underlying assumptions. b. asks who, what, why, where, when, or how. c. describes the relationship between variables. d. is highly structured and controlled.

ANS: A A quantitative study asks the question who, what, why, where, when, or how and attempts to describe the relationship between one variable and another. A quantitative study plan is also highly structured and controlled. A qualitative study tries to clarify underlying assumptions that are vague or unclear by asking what the perceptions, beliefs, or tenets are within a particular setting.

The chief purpose of evidence-based practice is to: a. offer a problem-solving approach to systematically research clinical evidence directed toward a specific patient problem. b. prepare the nurse to conduct specific research in patient care practices. c. prepare the nurse for employment in an evidence-based research center. d. research clinical evidence that covers the entire aspect of a specific problem.

ANS: A Evidence-based practice (EBP) is the integration of the best available evidence, combined with clinical expertise, which enables health practitioners of all varieties to address health care questions with an evaluative and qualitative approach. EBP preparing the nurse to conduct specific research in patient care practices reflects too narrow a scope for research. EBP preparing the nurse for employment in an evidence-based research center has no basis for requiring evidence-based research. EBP to research clinical evidence that covers the entire aspect of a specific problem is incorrect.

A nurse manager attempts to explain why the greatest number of medication errors occurs during the evening shift. The nurse manager chooses a quasi-experimental design to study this relationship. Why did the nurse manager choose this type of research design? a. It does not allow for complete control over the variance. b. It allows for randomization. c. It allows for control over the independent variable. d. It requires manipulation of the variable.

ANS: A In quasi-experimental designs, strict control is not possible. Allowing for randomization and for control over the independent variable and requiring the manipulation of the variable are true of experimental studies.

The American Nurses Credentialing Center (ANCC) developed the Magnet Recognition Program for hospitals to address quality patient care. What is the significance of achieving magnet status? a. Excellence in quality patient care and recruitment and retention of nurses b. Excellence in research, patient care, and retention of physicians c. Excellence in recruiting nurses, early discharge, and effective billing d. Excellence in recruitment and retention of ancillary caregivers

ANS: A Magnet recognition is one of the many responses to the call for quality of care of the ANCC's Magnet Recognition Program. The significance of achieving Magnet status indicates a hospital that succeeded in creating an atmosphere that nurtures evidence-based practice in nursing practice. The nurses are free to exercise professional autonomy. The particular hospital becomes known for its excellence in quality effective and efficient nursing care. Physician retention, early patient discharge, effective billing, and ancillary caregivers are not criteria for Magnet status.

Research studies must be scrutinized to be deemed credible and trustworthy. Choose all the strategies that may be used to critically appraise a research study. (Select all that apply.) a. Examine the validity of the research. b. Look at the reference list of the study. c. Look for criteria of inclusion. d. Look for use of PICO format. e. Examine the credentials of the authors. f. Look for a proper sample size.

ANS: A, B, C Examining the validity of the research, looking at the reference list of the study, and looking for criteria on inclusion are all strategies that can be used to appraise research studies critically. PICO is an acronym used to describe one format that includes four elements needed to construct a good clinical question. Looking for the PICO format and looking for a proper sample size are not strategies for critically appraising research studies.

What are the problems with variables? (Select all that apply.) a. Vary from subject to subject b. Determined through statistics c. Difficult to account for them d. Challenging to explain in relation to the study topic e. Testing whether a correlation exists between results

ANS: A, C, D A variable is a concept, idea, or attribute that is captured and defined within a research study. Variables vary from subject to subject, as with height and weight. Researchers attempt to control the variables, statistically account for them, or explain them in relation to what is being studied. Variables are not determined through statistics, nor do they test for correlations.

1. Which of the following are most responsible for the emerging use of evidence-based practice (EBP) in health care? (Select all that apply.) a. Accountability by consumers of governmental and health care agencies b. Introduction of national health care guidelines c. Shorter implementation time of new research d. Variability of care among health care practitioners and facilities e. Similarity with other science disciplines and their amounts of research f. Eligibility to receive government grants for research excellence

ANS: A, D Economic factors, the variability of care, and the rising cost of health care have been the driving force in the call for EBP. Consumers and governmental agencies are insisting on transparency, accountability for effectiveness, and efficiency in health care. EBP began before the introduction of national health care guidelines. Shorter implementation time of new research is irrelevant in the use of EBP. Similarity with other sciences and their amounts of research and eligibility to receive government funding for research excellence are incorrect.

A nurse evaluates the results of two different studies examining the relationship between time of day and sundowning in the geriatric setting. After 1 month, the nurse realizes that there is a difference of 1 hour in the instruments used for measurement. What conclusion can be drawn about the type of threat this causes the study? a. Validity b. Reliability c. Causality d. Truthfulness

ANS: B Reliability refers to measuring the instrument by asking how trustworthy it is at gathering the intended data. Validity measures the degree to which an instrument is measuring what it is supposed to measure. Causality and truthfulness are not criteria researchers use to determine whether research instruments give accurate results.

Which step does a researcher first use when starting a new study? a. Data collection b. Refining an abstract idea c. Literature review d. Statistical analysis

ANS: B The first step in the nursing research process is refining an abstract idea by developing an answerable question that is focused on a specific patient-centered concern. Data collection, literature review, and statistical analysis occur later in the research process.

Which goals best justify the need for evidence-based practice (EBP) in nursing? (Select all that apply.) a. Redesign the health care system and recruit more nurses. b. Improve patient outcomes with evaluations that track outcomes. c. Introduce national health care guidelines and standards. d. Restructure health care delivery and improve quality of health care. e. Apply clinical experience to improve patient care.

ANS: B, D The initial intent of EBP was to improve patient outcomes by evaluating and tracking outcomes, including qualitative reports by patients, and to redesign health care delivery and improve the quality of health care. (EBP has nothing to do with nurse recruitment or national health care guidelines and standards. Applying clinical experience to patient care is not a goal of EPB. Clinical expertise is a factor used in research.

Which of the following is an example of direct research utilization? a. Advocating for a change in policy b. Basing practice on current research available c. Implementing new techniques for practice d. Critiquing a research study

ANS: C Direct research utilization describes applying research findings directly to change practice. Advocating a change in policy based on research findings such as when working on a policy and procedure committee is persuasive research utilization. Basing practice on current research available and critiquing a research study are examples of indirect research utilization.

The nurse manager wants to determine the cause of an increase in medication errors over the past 6 months. This is an example of which type of research? a. Experimental b. Trial and error c. Quality assurance d. Scientific

ANS: C Quality assurance research uses data not only to determine whether procedures are being done per protocol, but also to determine whether patient outcomes are being met, and if charting is complete. Experimental research is a type of study design. Trial and error is not proper research methodology. Scientific research is what all evidence-based research demonstrates.

Which question should the nurse ask in order to judge the validity of a research study? a. What reliability information has been provided? b. Are the instrument measures applied consistently? c. Does the instrument measure what it is supposed to measure? d. How much random error exists?

ANS: C Validity measures the degree to which an instrument is measuring what it is supposed to measure. Reliability measures whether the device, technique, or instrument accurately collects the intended data. How consistently the measurements are applied and what amount of random error exists have nothing to do with testing validity.

Several sections are included in a research article. For example, the methods section describes the research study and what assessment quality and criteria were used. What information does the abstract or introduction section include? a. An evidence summary from the results of several other studies b. An outline of the number of studies retrieved and excluded and respective reasons for their inclusions or exclusions c. A discussion about whether the results are heterogeneous with possible reasons d. A clearly stated review question

ANS: D The review question should be clearly stated in the title, the abstract, or final paragraph of the introduction. The summary section provides an evidence summary from the results of several studies. The results section outlines the number of studies retrieved, excluded, and why. The data/analysis section states whether the results are heterogeneous and discusses possible reasons.

ANS: A, B, C EBP is problem-solving in its approach, which takes into account the clinical experience of the nurse. Clinical experience refers to the nurse's ability to use clinical skills and past experience to identify the patient's health state, diagnosis, and the risks and benefits of the prospective interventions. EBP combines researched evidence with knowledge and theory. The use of patient-centered researched evidence allows for accuracy and precision of diagnostic tests and prognosis markers, in addition to the effectiveness and safety of therapeutic treatment. EBP allows for patients' values to be expressed and incorporated into treatment regimens. Patients bring their individual preferences, concerns, and expectations to the clinical setting. The statement that EBP is designed to create a generic plan of patient care in clinical settings is incorrect because a patient's plan of care should always be individualized and never generic. EBP does not authorize autonomy for any nursing professional.

What characteristics support evidence-based practice (EBP)? (Select all that apply.) a. The nurse's clinical experience is fundamental to the evidence-based practice process. b. Evidence-based practice provides a theoretical framework for accuracy and safety in patient care. c. Evidence-based practice involves the use of a holistic approach to patient care in health care. d. Evidence-based practice is designed to create a generic plan of patient care in clinical settings. e. Evidence-based practice allows the nurse autonomy in patient care because research proves success.