EBP Exam One Questions
Guidelines developed by the American College of Chest Physicians would be an example of:
external evidence.
Limiters are aka
filters
To decrease the amount of irrelevant citations when searching with subject headings, the nurse should:
restrict the subject heading to the major concept.
Why is EBP important?
Allows us to discard treatments that are clinically unacceptable even if colleagues and clients endorse the treatments, and it allows us to select treatments that are acceptable
When trying to improve catheter-associated urinary tract infection (CAUTI) rates on a unit, which type of project would the nurse want to utilize? Select all that apply.
An evidence-based practice project, A research project, A quality improvement project
List the 7 steps of EBP.
0 - cultivate a spirit of inquiry 1 - formulate a PICOT question 2 - find evidence 3 - appraise evidence 4 - integrate with clinical expertise and patient preference 5 - evaluate outcomes 6 - disseminate your findings
Please rank the following strength-of-evidence levels from strongest study results to weakest study results.
1)Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) 2)Evidence obtained from well-designed controlled trials without randomization 3)Evidence from systematic reviews of descriptive and qualitative studies 4)Evidence from the opinion of authorities and/or reports of expert committees
Please rank the following study types from highest (Level 1) to lowest (Level 7) in the evidence pyramid.
1)Randomized controlled trial 2)Cohort study 3)Qualitative study 4)Clinical practice guideline
List our current database options (could be a select all that apply):
PubMed TRIP CINAHL ClinicalKey Scopus
How many EBP competencies are there?
24
Preventable medical errors are the ___(#)___ leading cause of death in the US?
3rd
Evidence
A collection of facts which are believed to be true
Which of the following are key considerations when critically appraising a quantitative study (one that uses numbers and statistics to report the data)? Select all that apply.
Applicability, validity, and reliability
What did the Institute of Medicine's Roundtable on EBP predict?
By 2020, 90% of clinical decisions will be supported by evidence.
What is the Best Evidence Design to Answer prediction/prognosis and etiology questions?
Case-control or cohort studies
A client insists on having a wart treated by rubbing a cut potato on the wart rather than the injection that is currently being used in practice. The nurse realizes additional discussion is needed with the client to understand the request. The nurse speaks with the client and realizes the client has a needle phobia. Taking this into account, the nurse mentions that cryotherapy may be another option for wart removal, and that while it doesn't have as high a success rate as the injection being proposed, studies indicate that it is still fairly successful. The client is interested in this approach and wants to know how successful it is compared to the injection. In this scenario, what is being used to drive clinical decision making? Select all that apply.
Clinical expertise, External evidence, Internal evidence, Client preference
Which studies use a control group? Select all that apply.
Controlled trials, Randomized controlled trials
What key word does the OAC use to describe the knowledge nurses must possess?
Current
Identify all sources of internal evidence. Select all that apply.
Data gathered from the EHR, Benchmarking data from other organizations., Data a colleague presented from an EBP project., Your unit's quality improvement data.
What is the difference between QI and EBQI (evidence-based QI)?
Evidence-based QI requires external and internal evidence whereas QI requires only internal evidence.
What does an I grade from the USPSTF signify?
Insufficient evidence to assess benefits and risks
What is the benefit of MeSH?
It covers a "tree structure" of words... i.e. if you search "food poisoning" it will include any relevant medical term to that.
What is the "explode feature" on CINAHL and OVID?
It includes many relevant terms and increases search results greatly using MeSH words.
Describe the rule of thumb used to dictate when a change in practice should occur.
Level of evidence + quality of evidence = strength of evidence
What other terms might a nurse use to express the concept of a subject heading? Select all that apply.
Lexicon, Controlled vocabulary, Descriptors, MeSH
Limiters can help by:
Limiting the results in a search to pre-specified conditions such as language or publication date.
MeSH
Medical Subject Headings
After returning from a conference with an example of best evidence that is not current practice in one's organization, what is the first step toward making a change in that organization?
Meeting with a manager and continuing to read the literature.
What is the Best Evidence Design to Answer meaning questions?
Meta-analyses or single qualitative studies
What is the Best Evidence Design to Answer intervention/diagnosis questions?
Meta-analysis
What is the highest level of evidence?
Meta-analysis
What term (generalizable, not generalizable or transferrable, transferrable) describes the information from quality improvement (QI)?
Not generalizable or transferrable
Which process produces results that are valid only in the setting in which it took place?
Quality improvement
Levels of evidence are used for which reasons? Select all that apply.
Ranking secondary sources of evidence, Ranking websites, Ranking expert opinion, Ranking primary sources of evidence
List the key initiatives to advance EBP:
USPSTF, Community Services Task Force, PCORI, ANCC, Helene Fuld Health Trust National Institute
When critically appraising a quantitative research study, we are determining the study's validity, reliability, and applicability. In this instance, what does "applicability" refer to?
Whether or not the results of the study can be applied to our population of interest or situation
Can evidence-based theories be included as evidence?
Yes
Evidence-based practice
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Reliability
consistency of measurement (did the intervention work, how large was the effect, and could it reproduce these results in a clinical setting?)
A client's self-report of pain is considered to be:
internal evidence.
Which statements are true about evidence-based practice (EBP)? Select all that apply.
EBP allows clinicians to translate evidence into clinical decision-making., EBP is the integration of best available evidence with clinical expertise and client preferences.
What is the next step a nurse would take to move forward an EBP initiative after attending a professional conference and speaking with key stakeholders?
Formulate a PICOT question.
What term (generalizable, not generalizable, transferrable) describes the information from research?
Generalizable
Subject headings will do which of the following? Select all that apply.
Help decrease the amount of irrelevant citations the nurse finds, Increase the amount of citations that can answer a nurse's PICOT question
A nursing team doesn't have enough funding to properly implement evidence-based practice (EBP). What would be an appropriate way to address this barrier?
Seek out funding sources through local organizations and specialty organizations.
What is the name of nursing's honor society as named in the "Making the Case for EBP" article?
Sigma Theta Tau International
What does a C grade from the USPSTF signify?
Small benefit, should only be applied in specific circumstances
What does an A or B grade from the USPSTF signify?
Substantial or moderate benefit
What is the second highest level of evidence?
Systemic review of randomized controlled trials (RCTs)
A nurse is critically appraising a quantitative study for reliability, and the researchers report a Confidence Interval (CI) of 95%. What does this mean?
The researchers are 95% confident that, if the intervention or treatment is used, clinicians would find their results would fall within the given range of values 95% of the time.
Why are journal clubs especially practical as facilitators of EBP?
They are participatory, actively involving all levels of staff in discussion.
What is the best reason for attending a professional conference in order to advance evidence-based practice (EBP)?
To network and share EBP project findings with other nurses
What term (generalizable, not generalizable, transferrable) describes the information from EBP?
Transferrable
All of the following statements represent nursing activities used in promoting evidence-based practice: participate in interdisciplinary evidence-based projects; join a journal club; and attend professional conferences.
True
What 3 questions are answered in rapid critical appraisal?
Validity, reliability, and applicability
What are common sentence starts for background questions?
What, where, when, why, and how
Applicability
relevance (were the subjects similar to the patients, low potential for harm, is it feasible to implement, does the patient desire the treatment?)
A keyword is (select all that apply):
searchable in several different fields contained in the database., a term that may vary from author to author., used when an appropriate subject heading is not available., a general term that is commonly used within a discipline.
Validity
the extent to which a test measures or predicts what it is supposed to (were participants randomly assigned?)
Which of the following are considered Boolean operators? Select all that apply.
AND and OR
Why are background questions useful before formulating a PICOT question? Select all that apply.
Background questions are broad and help lead to a PICOT question., Background questions serve as the foundation for asking a PICOT question.
Before making a practice change, what should be considered?
Both internal and external evidence, Clinician expertise, Patient preferences and values
What does a D grade from the USPSTF signify?
No benefit or causes harm
Quality improvement
Used by a facility to improve practice within that facility once a problem is identified.
Which healthcare role is best trained to have the most expertise in the steps of EBP?
Clinical nurse specialist
A culture of evidence-based practice (EBP) is deliberate. Clinicians embrace change and innovation to improve their practice. Administration is supportive and leads by example to promote EBP. What should be present to ensure that a culture of EBP thrives? (Select all that apply.)
Clinicians who are expected to meet EBP competencies., Staff nurses who question how care is provided.
What is the Best Evidence Design to Answer background questions?
Descriptive studies
Which of the statements below describe an EBP project? Select all that apply.
Determining the best standard of care for asthmatic pediatric clients, Determining which dressing is most likely to decrease the occurrence of pressure ulcers
What types of clinical issues might guide a prognosis question? Select all that apply.
Patient choice concerning therapy, Future outcomes regarding therapy
What is the quadruple aim in healthcare?
enhance healthcare quality, improve patient outcomes, reduce costs, and empower clinicians (all of which are achieved through evidence-based practice)
Quality improvement:
generates and uses internal evidence to improve systems or processes within an organization.
What is a facilitator to the implementation of EBP?
Adequate access to resources
What are the 3 entry points to MEDLINE?
PubMed, OVID, EBSCO
What are the 3 areas of emphasis focused on by the Roundtable?
1. Accelerating the progress toward a learning healthcare system, in which evidence is applied and developed as a product of patient care; 2.Generating evidence to support which healthcare strategies are most effective and produce the greatest value; 3.Improving public awareness and understanding about the nature of evidence, and its importance for their healthcare
An adult presenting with a high fever, dizziness and aching joints who has been on an Appalachian trek for a month asks whether Lyme disease is a possible cause of the symptoms they are now experiencing. The provider wonders if running an enzyme immunoassay would get the patient back on the trail sooner than running an immunofluorescence assay. Which question template would the provider use?
Diagnosis/diagnostic test PICOT template
Who is credited with founding the EBP movement?
Doctor Archie Cochrane
Consider the following clinical scenario: Are fair-skinned children who have prolonged unprotected UV exposure compared to darker-skinned children without prolonged unprotected UV exposure at increased risk of melanoma? Which question template would you use?
Etiology
What is the Best Evidence Design to Answer multiple intervention questions in one?
Evidence-based clinical guidelines
Health care organizations can best show support for evidence-based practice by hiring external consultants to perform research and informing nurses within the organization about changes that will be made based on evidence.
False
How many types of templates are there to handle clinical questions?
Five
Which historical figure was an avid supporter of EBP?
Florence Nightengale
What is "step 0"?
Foster an atmosphere of inquiry
A charge nurse and team of nurses lack the motivation required to implement EBP. Which solution may help address this barrier?
Gain authorization to offer continuing education credits for attending training workshops and include staff use of EBP in the annual evaluation.
To facilitate EBP in a hospital setting, which activity would provide recognition for staff who recently completed EBP projects as part of a nurse residency program?
Hold a poster presentation session in the lobby featuring staff's EBP projects.
List some factors the reader might want to consider when reviewing published research data...
How big was the data base in the study? What was the population in the study? Who funded the study? Who conducted the study? What were the outcomes of the study?
In critically appraising quantitative research, we review the statistics used to report results numerically. Some of the statistics reported in quantitative research studies include number needed to treat (NNT), number needed to harm (NNH), relative risk (RR), and odds ratio (OR). These statistics help us to answer which question when critically appraising quantitative research studies?
How large the intervention or treatment effect is
When critically appraising a quantitative study, reliability is one of the three key considerations you are appraising. When appraising for reliability, what are you looking to determine?
How likely it is the intervention would produce the same results if used in other places
If there isn't a systematic review in the literature I've identified,
I'll try and locate a guideline that answers my clinical question., I'll need to read the studies from other levels of evidence I've found.
How can a nurse manager best support staff nurses in their enthusiasm for evidence-based change?
Listen to the nurse, inquire about their EBP knowledge, and connect them with a resource on the unit.
How can the nurse determine a subject heading? Select all that apply.
Look them up in the database being searched., Ask the librarian., Look at the subject headings that were assigned to a study that will answer the PICOT question.
Which keywords could be used for the concept of a rapid response team? Select all that apply.
MRT, MEWS, ENIT, PEWS, RRT
Which statements are potential barriers for evidence-based practice? Select all that apply.
Nurses do not understand research., Nurses do not have the skills to access research evidence., Nurses do not value research.
Which of the following would be considered as external evidence?
Outcome data from a published research study
What review model is often used when performing QI?
PDSA (plan, do, say, act)
Why is it important to generate a good PICOT question? Select all that apply.
PICOT questions avoid directing the search for evidence in one direction., Well-formulated PICOT questions ensure the clinical issue is well defined., Good PICOT questions will ensure the search is likely to be successful.
What are the essential components of PICOT?
PIO
Statistics help us determine how large the intervention or treatment effect is when critically appraising a quantitative research study for reliability. Which statistics help us determine how large the treatment effect is? Select all that apply.
Relative risk Number needed to harm Number needed to treat Odds ratios
A pediatric nurse is participating in a journal club where her colleagues are reading research studies that address the best way to treat acute episodes of asthma in pediatric clients: nebulizer treatments of metered-dose-inhalers with a spacer. The nurse's article is reporting the number needed to treat (NNT), number needed to harm (NNH), relative risk (RR) and odds ratios (OR). Which key consideration of critically appraising a quantitative research study is the nurse exploring?
Reliability
There are several key factors to evaluate when we critically appraise quantitative studies. What key factor of critical appraisal of quantitative studies are you looking at when you are asking the following questions: How large is the intervention or treatment effect? How precise is the intervention or treatment effect?
Reliability
Which statements are true about research? Select all that apply.
Research is a systematic investigation that uses scientific methods to answer clinical questions., Research creates new knowledge or validates existing knowledge., Research can be considered to be external evidence.
Why would it be important to save the search history? Select all that apply.
So that the steps of the search may be shared with anyone who needs to know. To ensure that others will be able to re-create what you have done at a later point in time. To ensure that you replicate as closely as possible the same techniques across all databases you search. To replicate as close as possible the techniques used that resulted in a successful search for evidence.
Levels of evidence are important for which reasons? Select all that apply.
They offer a way for clinicians to recognize the soundness of an individual study's design., They help to rank the potential amount of bias of individual studies., They act as a hierarchy to prioritize which studies to read first when looking at a body of evidence.
What elements will ensure a successful search? Select all that apply.
Use subject headings in the search strategy., Consult the Help pages of the databases primarily being searched., Consult a librarian whenever necessary., Use a PICOT worksheet., Use keywords in the search strategy.
Research
Uses a scientific process to generate new knowledge/external evidence
How can the "explode feature" be controlled?
With the use of limiters (filters)
A nurse is working 12-hour shifts in a large, urban, academic medical center on the east coast of the United States. The nurse's organization is doing an evidence-based practice project exploring the effects of 8 vs. 12-hour shifts on nurses' health and client safety. The shared governance council the nurse sits on is leading the work. The study the nurse has been given to critically appraise measured the effects of 8 vs. 12-hour shifts on health care clinicians across professions in five small, community hospitals in the southern part of the United States. Could the results of this study be applied to the nurse's situation (do the results have applicability)?
Yes; the subjects in the study are adults working 8 vs. 12-hour shifts in health care settings.
