EBP

what does pubmed cover?

in addition to medline, provides access to olderreferences and journals before indexed in medicus and medline, very recent entries before getting a MeSH, and full-text books

A group of nurses have successfully implemented a new, evidenced-base protocol around post-operative patient assessment. How should the nurses follow up this success?

tell others about the results of their project

appraisal criteria common to quantitative research?

validity, reliability, applicability

Most common risk factors for falls (highest ratio to least)

muscle weakness, hx of falls, gait deficit, balance deficit, use of assistive device

Level 7 evidence control hierarchy

opinion of authorities and/or reports of expert committees.

validity

our measuring instrument actually measures the property it is supposed to measure. Reliability of an instruments does not warrant it's validity.

Which of the following text words would be helpful in retrieving qualitative studies in MEDLINE, CINAHL, and PsycINFO?

phenomenology

phenomenology

the study of essences (meaning structures) intuited or grasped through descriptions of lived experience

What is the "gold standard"

cochrane database of systematic reviews

Research design common to quantitative research

systematic reviews, RCTs, cohort studies, cross sectional, case-control studies

Level 3 evidence control hierarchy

Controlled trials without randomization

Archie Cochrane

father of EBP based on the publication of his book "effectiveness and efficiency, random reflections on health services", developed cochrane library/center.

Which aspects of the critical appraisal process are the most important parts to learn?

quality and applicability

example of internal evidence

quality improvement project

The number needed to treat (NNT) for an experimental vaccine is 775. This means

775 individuals must be vaccinated to prevent one case of the disease

Four components to asthma care

-assessing and monitoring asthma severity and asthma control -education for the partnership of care -control of environmental factors and comorbid conditions that affect asthma -medications

Which levels on the hierarchy of evidence are quantitative?

1-4

a good quantitative design is one that:

1. appropriately tests the hypotheses or answers the research question 2. lacks bias 3. controls extraneous or confounding variables 4. has sufficient power (the ability to detect statistically significant results)

what does cinahl cover?

13 nursing and allied health disciplines

Which levels on the hierarchy of evidence are qualitative?

5-7

Most efficiacious agents for reducing number of bacteria on personnel

Alcohol based hand rubs antiseptic soaps and detergents non-antimicrobial soaps

Level 2 evidence control hierarchy

RCTs

A nurse has heard from a colleague about a new approach to providing nursing care for confused patients who have been diagnosed with hepatic encephalopathy. In which of the following sources is this information most likely to appear first? A. A newspaper article B. A systematic review C. A conference presentation D. A journal article

D. A journal article

What are the killer B's?

Major factors that prevent practice change - barrier and beliefs that are too high

What does PICOT stand for?

Population Intervention Comparison (of interest) Outcome (expected) Time (for intervention to achieve the outcome

Level 1 evidence control hierarchy

Systematic reviews or meta analyses of RCTs

How are MeSH headings organized in relation to specificity?

They become more specific as you move down the list.

what is the national guideline clearinghouse?

comprehensive database of evidence based clinical practice guidelines. They are developed statements about a plan of care for a set of circumstances involving a particular population

Alcohol-based hand rubs have good or excellent antimicrobial activity against all of the following except

bacterial spores

5 elements of EBP

best evidence patient values patient circumstances resource implications clinical judgment

appraisal criteria common to qualitative research?

creditability, transferability, dependability, confirmability, authenticity

These drugs stabilize mast cells and are particularly useful for prevention of exercise-induced asthma.

cromolyn sodium/nedocromil

clinical grasp

describes clinical inquiry in action.

According to research evidence, which of the following EBP implementation strategies has the least effect?

didactic educational meetings

allocation bias is caused by

differences between treatment and control groups due to methods of selection and assignment to groups.

What questions are posed using PICOT?

foreground questions

4 aspects of clinical grasp

making qualitative distinctions engaging in detective work recognizing and changing clinical relevance developing clinical knowledge about specific pt populations

what does medline cover?

medicine, health, biomedical sciences

The Asthma Guidelines were commissioned by

the National Asthma Education and Prevention Program (NAEPP).

7 steps in the EBP process

0 - spirit of inquiry 1 - formulate the burning PICOT question 2 - search for/collect most relevant evidence to answer the clinical question 3 - appraise the evidence that has been collected 4 - integrate evidence with expertise/pt preferences/values to implement a clinical decision 5- evaluate outcomes of the practice decision 6 - disseminate the outcomes of the EBP decision/change

After formulating a clinical question, a nurse has proceeded to search for evidence for ways to foster restful sleep in patients who are receiving care in the intensive care unit (ICU). The nurse has identified a relevant meta-analysis in an electronic database. What will this source of evidence consist of? A. A statistical summary of the results from several different studies B. An examination of the theoretical and conceptual underpinnings of the issue C. An interdisciplinary analysis of the clinical question D. A qualitative study of different interventions related to the clinical question

A. A statistical summary of the results from several different studies

A nurse requires immediate insight into the most effective interventions for maintaining the safety of a patient who is experiencing acute alcohol withdrawal. Which of the following components of the Cochrane Library is most likely to provide the nurse with the most reliable, evidence-based interventions? A. Cochrane Database of Systematic Reviews (CDSR) B. Cochrane Central Register of Controlled Trials (CENTRAL) C. Cochrane Methodology Register D. Health Technology Assessment

A. Cochrane Database of Systematic Reviews (CDSR)

Though rooted in the voices of the 16 men who were interviewed for the study, the findings of a qualitative study into the health practices of male prison inmates is thought to be true for many members of the larger prison population. This fact about the study most clearly demonstrates A. Transferability B. Confirmability C. Dependability D. Credibility

A. Transferability

What is the multistep therapy for asthma care?

Alphabetical order is used when more than one treatment option is listed within either preferred or alternative therapy. ICS, inhaled corticosteroid; LABA, long-acting inhaled beta 2-agonist; LTRA, leukotriene receptor antagonist; SABA, inhaled short-acting beta 2-agonist

A nurse is aware that patients who are confused often have unmet nutritional needs during their care. Which of the following searches related to nutrition promotion among patients with dementia or delirium is most likely to yield the greatest number of relevant results? A. "delirium AND dementia AND nutrition" B. "(delirium OR dementia) AND nutrition" C. "delirium dementia nutrition" D. "delirium AND dementia AND nutrition"

B. "(delirium OR dementia) AND nutrition"

Which of the following clinical questions best exemplifies the PICOT format? A. Among cancer patients, what role does meditation, rather than benzodiazepines, have on anxiety levels during the 7 days following hospital admission? B. Among cancer patients, what role does meditation, rather than benzodiazepines, have on anxiety levels during the 7 days following hospital admission? C. Among undergraduate college students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new gonorrheal and chlamydial infections reported to the campus medical center? D. In patients aged 8 to 12, is the effectiveness of a pain scale using faces superior to a numeric rating scale in the emergency room context?

B. Among cancer patients, what role does meditation, rather than benzodiazepines, have on anxiety levels during the 7 days following hospital admission?

A nurse has recognized a need to understand the ways in which women with fibromyalgia adjust their lifestyles to accommodate the effects of their diagnosis. Which of the following domains of research is most likely to provide evidence for the nurse? A. Randomized controlled trials B. Qualitative studies C. Case control studies D. Cohort studies

B. Qualitative studies

what most accurately conveys the relationship between systematic reviews and clinical practice guidelines?

Clinical practice guidelines normally integrate the results of systematic reviews into their recommendations

dependability

Demonstrated by a research process that is carefully documented to provide evidence of how conclusions were reached and whether, under similar conditions, a researcher might expect to obtain similar findings - parallels reliability

National Guidelines Clearinghouse stores:

Guidelines based on weighted evidence, from systematic reviews to consensus opinion

Who is the father of EBP

archie cochrane

Level 4 evidence control hierarchy

case-control and cohort studies

optimal research design for: accuracy of a diagnostic test

comparison of assessment method with reference standard test

What type of clinical question(s) does quantitative research cover?

effectiveness of interventions, diagnostic, prognostic, harm, causation

David Sackett

epidemiologist, leader of EBP who developed clinical epidemiology. Founded the first department of clinical epidemiology and McMaster University, and the oxford centre for evidence based medicine.

Lewin's model of change: freezing/refreezing

establishing stability once the changes have been made. the changes are accepted and become the new norm. people form new relationships and become comfortable with their routines.

Research design common to qualitative research

ethnography, grounded theory, phenomenology, hermeneutics, conceptualization, evolution, description, interpretation

What tends to lead to fewer barriers in adopting EBP?

higher education

What do you wash your hands with if bacillus anthracis is suspected/proven

non-antimicrobial soap and water.

What is clinical inquiry?

process in which clinicians gather data together using narrowly defined clinical parameters to appraise the available choices of treatment for the purpose of finding the most appropriate choice of action.

what does psycinfo cover

psychology, behavioral sciences and mental health

grounded theory

purpose is to generate theory about how people deal with life situations that is "grounded" in empirical data (moves through time in terms of stages/phases)

Level 6 evidence control hierarchy

single descriptive or qualitative studies

ethnography

study of a social group's culture through combining participant observation, in-depth interviews and the collection of artifacts

What type of clinical question(s) does qualitative research cover?

study of aspects of human response and meaning that surround a health experience, lived experience

What does the cochrane library house?

systematic reviews

Level 5 evidence control hierarchy

systematic reviews of descriptive and qualitative studies

Level of Evidence Hierarchies 1-7

1: systematic reviews/meta analysis 2: RCTs 3: controlled trials w/out random 4: case control/cohort studies 5: systematic reviews of descriptive/qual studies 6: single descriptive or qualitative studies 7: opinions/expert committees

Rosswurm and Larrabee model of change 6 stages

Assess the need for change. Link problem/intervention/outcomes Synthesize the best evidence Design practice change Implement and eval practice change Integrate and maintain change in practice

confirmability

Demonstrated by providing substantiation that findings and interpretations are grounded in the data

A nurse has consulted a clinical practice guideline addressing the prevention of foot complications among patients with diabetes. Which of the following considerations should the nurse prioritize when appraising the guideline?

Validity and reliability of the recommendations

The odds ratio is the odds of an event in the experimental group divided by the odds in the control group. In a study of steroids in treating patients after head injury, the OR was 1. This means that

there was no difference in the odds of dying between the treatment and the control groups

the most significant benefit of clinical practice guidelines, which is their potential to

translate research into clinical practice

true/false One of the key differences between research utilization and EBP is that research utilization focused on applying individual study results while EBP focuses on synthesizing the body of evidence.

true

true/false When Lewin's Theory of Change addresses the status quo, it is concerned about the norm for the environment.

true

3 stages in Lewin's model of change

unfreeze, freeze, refreeze

Nurse R. has observed that reorienting demented patients as frequently as possible tends to minimize the patients' level of agitation in the evening. The nurse has shared this observation with a colleague, who is skeptical, stating that, "It's best to stick to evidence-based practice." How can Nurse R. best respond? A. "EBP can include clinicians' personal expertise." B. "Personal experience is often more sound than formal evidence-based practice." C. "Traditional practice and EBP are usually shown to be the same." D. "My years of experience can be just as valuable as any literature review or randomized trial."

A. "EBP can include clinicians' personal expertise."

A nurse educator has reviewed a study on the coping strategies of freshman nursing students that presents conclusions that differ markedly from other studies that have examined the issue. The study in question may possibly have a flaw in which of the following domains? A. Consistency B. Believability C. Veracity D. Utility

A. Consistency

A nurse has attempted to begin the process of implementing EBP in the area of falls prevention but has become disillusioned by the possibility of having to read a vast number of publications. Which of the following strategies should the nurse implement in response to this problem? A. Narrow the scope of the clinical question B. Restrict the information search to publications from the past 24 months C. Seek recommendations for information sources from trusted colleagues D. Limit the search to articles that relate the findings of randomized control trials (RCTs)

A. Narrow the scope of the clinical question

A nurse is reluctant to recommend a change in practice around teaching deep breathing and coughing to postsurgical patients, citing a lack of randomized controlled trials (RCTs) that directly address the subject. Which of the following statements best captures the role of RCTs in evidence-based practice? A. Only systematic reviews are considered more valuable than RCTs in establishing EBP. B. RCTs provide very high levels of quantitative analysis but are prone to lapses in consistency. C. A qualitative study with a sound and rigorous methodology is considered equal to a well- designed RCT. D. RCTs are the highest level of evidence that can be used to guide practice.

A. Only systematic reviews are considered more valuable than RCTs in establishing EBP.

The primary care provider of a 49-year-old male patient has examined and briefly explained the evidence that supports beginning regular digital-rectal exams. Which of the following factors would justify not performing digital-rectal examinations in this patient's care? A. The patient is vehemently opposed to undergoing a digital-rectal exam. B. Clinical practice guidelines for prostate care have not been published. C. The clinician has been unable to find any large RCTs in a literature review. D. The clinician has previously waited until patients are 55 to begin regular digital-rectal exams.

A. The patient is vehemently opposed to undergoing a digital-rectal exam.

A nurse is reviewing a study comparing a new alcohol screening instrument to an existing instrument in predicting patients' withdrawal symptoms during hospital admissions. The nurse notes that the confidence interval of the study includes a relative risk (RR) of 1. What are the implications of this fact? A. The screening instruments are unable to predict patients' risks for alcohol withdrawal. B. Using the new instrument will result in more unanticipated cases of withdrawal. C. The new instrument is a modest improvement on the existing instrument. D. The new instrument may be no better than the existing one in predicting withdrawal.

A. The screening instruments are unable to predict patients' risks for alcohol withdrawal.

Which of the following factors constitutes the strongest rationale for creating a new clinical practice guideline for the nursing management of patients who have suicidal ideation? A. There is emerging evidence that there is a large gap between common practices around suicide risk management and optimal practices. B. The costs to patients, families, healthcare institutions, and third parties associated with depression, psychosis, and suicide are unacceptably high. C. The problems of depression and suicide are frequently stigmatized among both healthcare providers and members of the public. D. There is a huge, and growing, amount of research that addresses the problems of suicide and the nursing management of it.

A. There is emerging evidence that there is a large gap between common practices around suicide risk management and optimal practices.

The historical incidence of deep vein thrombosis in medical patients at a university hospital was 2.5%. This figure dropped to 2% among an experimental group during the implementation of a new prophylaxis regimen. What is the nurse's most accurate interpretation of this finding? A. The relative risk of DVT among medical patients is 2/100. B. The relative risk reduction of DVT among medical patients is 20%. C. The absolute risk of DVT among the control group is 2.5%. D. The results of the intervention are valid and reliable.

B. The relative risk reduction of DVT among medical patients is 20%.

Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question? A. Which of the following considerations should be prioritized when choosing a patient population during the formulation of a clinical question? B. The population in the clinical question should closely match the demographics of the nurse's geographic region. C. A specific and defensible rationale should exist for the choice of patient population. D. The patient population in the clinical question should mirror the populations in prominent studies related to the issue

C. A specific and defensible rationale should exist for the choice of patient population.

Controversy exists on an intensive care unit regarding the best ways to prevent ventilator-associated pneumonia (VAP). What action should the nurse first take in response to this controversy? A. Organize a small-scale clinical trial to test current practices on the unit. B. Elicit the views of the most senior nurses and those nurses who exemplify EBP. C. Formulate a question and conduct a thorough search of the existing evidence. D. Seek input from physicians with expertise in the area of VAP.

C. Formulate a question and conduct a thorough search of the existing evidence.

A nurse has presented a published case study to other nurses on the unit that relates the case of a patient who experienced respiratory arrest and sudden death following the infusion of total parenteral nutrition (TPN). How should the nurses respond to the findings of this case study? A. Modify unit practice around TPN administration B. Avoid administering TPN until more is known about the subject C. Take note of the phenomenon and do further research before implementing practice changes D. Disregard the findings of the case study due to the low level of evidence provided by a case study

C. Take note of the phenomenon and do further research before implementing practice changes

A nurse has approached the unit educator with a recently-published article that calls into question the unit's practices around routine changing of peripheral intravenous sites. How should the findings of this article be best translated into practice? A. Unit practices should be amended to reflect the findings of the study. B. The nurses on the unit should combine the study results with their own expertise to create a new guide for practice. C. The nurses should search for further evidence before changing unit practices. D. The nurses should conduct a trial similar to that in the published study.

C. The nurses should search for further evidence before changing unit practices.

Which of the following factors provides the most important rationale for the consistent implementation of EBP? A. EBP provides for the most cost-effective patient care. B. EBP is accessible to all healthcare clinicians. C. EBP provides consistency in care across healthcare settings. D. EBP improves patient outcomes

D. EBP improves patient outcomes

A pediatric nurse provides care for many children who present to the emergency department (ED) with signs and symptoms of asthma. Which of the following questions is a background question that the nurse can utilize in the process of providing EBP? A. What evidence exists to recommend the use of nebulizers over metered-dose inhalers (MDIs)? B. What patient populations respond best to nebulized bronchodilators? C. How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm? D. How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm?

D. How effective are nebulizers compared to metered-dose inhalers at reducing bronchospasm?

Which of the following activities by the nurse most directly fosters phronesis in the care of geriatric patients in a long-term care setting? A. The nurse consistently seeks out and attends continuing education offerings. B. The nurse stays abreast of current research in geriatric nursing. C. The nurse has organized a pilot study on falls prevention in the care facility D. The nurse makes an effort to get know residents' individual needs, concerns, and goals.

D. The nurse makes an effort to get know residents' individual needs, concerns, and goals.

A nurse who provides care on a geriatric subacute medicine unit is aware that elderly patients often exhibit signs and symptoms of infection that are very different from those of younger patients. This knowledge is an example of A. recognizing changing clinical relevance. B. engaging in detective work C. making qualitative distinctions D. developing clinical knowledge about specific patient populations

D. developing clinical knowledge about specific patient populations

correct steps in order of EBP

Identify problem, collect most relevant evidence, critically appraise evidence, combine study findings, evaluate change in practice

The clinical nurse educator (CNE) on a postsurgical unit has recently completed a patient chart review after the implementation of a pilot program aimed at promoting early ambulation following surgery. Which of the following components of EBP is the nurse putting into practice? A. Patient preferences B. Internal evidence C. Experience D. Internal Evidence

Internal evidence is generated from outcomes management or quality improvement projects, such as a pilot program testing an intervention in a particular care setting. Patient preferences, research utilization, and experience are not paramount in the nurse's activities.

What constitutes a good quantitative design?

adequate sample size, inclusion of a control group, sample characteristics look like those of groups to which you are applying generalizations, biases and conflicts of interest are minimized, double/triple blinded preferred

foreground question

answers specific questions a clinician has regarding a specific patient. uncovers something specific to a patient/condition

how to observe an older person for likelihood of falling due to hx of falls?

assessment that includes: a hx of fall circumstances, medications, medical problems, mobility levels, neuro function, vision, etc.

true or false Randomized controlled trials are appropriate and ethical to answer all types of research questions.

false

true/false A case-control study looks forward to answer a question while a cohort study looks back in time.

false

multifactorial interventions for people with fall hx

gait training, advice on assistive devices, review medications, exercise programs, balance training, treating CV disorders

background question

general clinical question regarding a topic such as "what is the disorder" what causes it, how does it present. Can be solved using "background" resources like textbooks, narrative reviews in journals.

Lewin's model of change: unfreezing

getting ready to change, understanding that change is necessary and needing to move away from the comfort zone. Weighing pros and cons before action is taken.

"The frequency and intensity of symptoms and functional limitations the patient is experiencing or has recently experienced" is the Asthma Guidelines" definition of

impairment

How does the use of limiters relate to specificity in a search strategy?

increases specificity

Lewin's model of change: transition

inner movement or journey we make in reaction to a change. we make the changes that are needed. this is a difficult stage as people are learning about changes and need to be given time to adjust.

Killer B: Clinician barriers

lack of time, lack of value for research in practice, lack of understanding of organization or structure of electronic databases, difficulty accessing research materials, lack of technology skills

The following question also refers to the Pravikoff article: The most frequently selected barrier to the use of research in practice (other than lack of time) was

lack of value for research in practice

Iowa model of EBP

looks for triggers (knowledge and problem focused for change)

goals of qualitative research

meaning of experience, produce insights in the social and natural world, answer questions about human responses

The Guidelines state that providers should teach and reinforce self-monitoring to assess level of asthma control and signs of worsening asthma. They further state that either symptom monitoring or peak flow monitoring shows similar benefits for most patients. Peak flow monitoring may be especially helpful for which group of patients?

moderate or severe asthma

how to observe an older person for likelihood of falling as part of routine care?

observed as they stand up from a chair without using their arms, walk several paces and return (get up and go test)

The number one institutional barrier to use of research in practice was

presence of other goals with a higher priority

Killer B: Institutional barriers

presence of other goals with a higher priority, difficulty recruiting/retaining staff, limited resources, budget and training in resource use, perception EBP is not achievable in "real world"

optimal research design for: effectiveness of therapy

randomized controlled test

reliability

reliability refers to the confidence we can place on the measuring instrument to give us the same numeric value when the measurement is repeated on the same object.

S or * (medline)

representing truncation

what hand washing technique is recommended for visibly soiled hands?

soap and water

Lewin's force field analysis

there are lots of different factors for and against making change that we need to be aware of. If the factors FOR outweigh the AGAINST, we'll make the change.

most frequently selected barrier to utilization of research in practice

time

In a study of chemotherapeutic agents, neither the patients, the researchers, or the clinicans administering the drugs are aware of the group to which the participants are assigned. This is known as

triple blinding

NOT

use when you want to eliminate all records that include a term

OR

used to broaden search, find more records

AND

used to narrow/focus a search

The most important distinction between a systematic review and a traditional narrative review of the literature is that a systematic review

uses explicit and rigorous methods for identifying and assessing the evidence.

definition for EBP in nursing

using clinical judgment, the integration of best evidence with patient values as well as the patient's clinical state, setting and circumstances while taking into consideration resource implications

hermeneutics

viewing human "lived experience" as a text that is to be understood through the interpreter's dialogical engagement

The results of a study indicate the 95% CI (confidence interval) lies between 1.5 and 4.2. This means that

you can be 95% certain the true value lies between 1.5 and 4.2.

credibility

· Demonstrated by accuracy and validity that is assured through documentation · Roughly parallel to internal validity in quantitative appraisal

transferability

· Demonstrated by information that is sufficient for a research consumer to determine whether findings are meaningful to other people in similar situations Parallels external validity