Evidence-Based Practice & Quality Improvement

What are the types of questions for Step 1?

-diagnosis -therapy -etiology -prognosis

Using EBP can help nurses

-ensure credibility of their profession -provide accountability for nursing care

What are the types of research studies?

-meta-analysis -case study -cohort study -case-control study -randomized controlled trial (RCT)

Criteria that researchers develop for participants includes:

-age, weight, gender, medical history -type, present sate of disease -present medications taken -qualifiers can be categorized as inclusion (acceptable) or exclusion (unacceptable) criteria for participation -vulnerable populations subject to strict legal and ethical considerations

Strategies to Implement EBP

-assess yourself -assess EBP obstacles -practice raising questions

How can the use of EBP in clinical practice improve patient care?

-collaboration with other disciplines -assist patients through system in various roles (care provider, advocate, teacher, researcher) -ensure open, effective communication and continuity among healthcare team members, patients, families

What does PICOT do?

-define, formulate a clinical question for EBP -develops foreground questions that apply EBP to clinical situations, problems

Step 3: Evaluate the evidence

-evidence must be critically appraised: validity, reliability, usefulness -nurses must be able to critique research -categorize: green, yellow, red (PEP system) -rating evidence helps to identify best choices

Who are considered the vulnerable populations in research?

-human fetuses -neonates -children -prisoners -educationally disadvantaged individuals -cognitively impaired individuals

Step 4: Apply the Evidence

-individual nurses can follow this process -EBP similar to nursing process but deals with a specific clinical question -Informatics

Research participants are volunteers for a specific study project who:

-meet all criteria -have been informed of all aspects of study -have signed informed consent

Where does the funding come from for the research?

-professional nursing organizations (small grants from local chapters, larger grants from state or national org.) -corporations -foundations -state agencies -federal organizations

Implications for nursing practice

-providing best evidence for EBP -supporting nursing as a professional discipline -defining current best practice standards of nursing care

What are the 3 main ethical principles that research must adhere to?

-respect for persons (protecting autonomy) -beneficence (protection of participants from injury, harm, exploitation) -justice (fair treatment of all participants)

Step 2: Retrieve the Evidence

-review pertinent literature -nursing databases and resource links can yield list of articles related to question

Informed consent includes

-right to receive full disclosure, information regarding study -right to withdraw from study at any time -given in written form before study begins

What should nurses look for when doing literature review?

-scientific elements -overview of study, including methodology -written conclusion based on study results -relevant references

Criteria for Nursing to be recognized as a professional discipline:

-specialized education requirements -body of well-defined knowledge and expertise -conducting ongoing research -orientation toward service to others -following a code of ethics -having autonomy

Steps of developing EBP

1. Develop a clinical question 2. Retrieve the evidence 3. Evaluate the evidence 4. Apply the evidence

Funding

1. ranges from small to large grants 2. given in all areas of nursing

What are the 3 components of EBP?

1. the best evidence from the most current research available 2. the nurse's clinical experience 3. the patient's preferences- which reflect values, needs, interests and choices

informed consent

A written agreement to participate in a study made by an adult who has been informed of all the risks that participation may entail.

The nurse manager for a​ medical-surgical nursing unit is talking to a group of nursing students. The nurse manager is explaining the types of nursing research studies that are conducted on the unit. Which statement by the students indicates understanding of the nature of nursing​ research? A. "Nursing research impacts nursing by adding knowledge and changing nursing​ practice." ​B. "Nursing research is used to enhance medical​ treatment." ​C. "Nursing research does not include the study of nurses​ themselves." ​D. "Nursing research does not include nursing education or nursing​ leadership."

A. "Nursing research impacts nursing by adding knowledge and changing nursing​ practice."

The head nurse in a​ pediatrician's office is interested in incorporating more aspects of​ evidence-based practice​ (EBP) into the​ facility's regular nursing procedures and protocols. Which of the following resources would be most useful in helping the nurse achieve this​ goal? A. A report from the National Institutes of Health​ (NIH) describing a new sickle cell screening protocol B. An American Nurses Association​ (ANA) report about best practices for reducing the incidence of pressure ulcers C. A journal article discussing the perceived versus actual effectiveness of various approaches to smoking cessation D. Documentation from the Centers for Disease Control and Prevention regarding recommended vaccinations for individuals who plan to travel abroad

A. A report from the National Institutes of Health​ (NIH) describing a new sickle cell screening protocol

A nurse educator is interacting with a group of nurses who are working toward their graduate degrees. The members of the group are interested in replication studies. Which of the following replication studies would be most appropriate given the changing demographics in the United​ States? A. A study examining the ability of an aging population to care for itself B. A study examining the ability of families to adapt to acute health problems C. A study examining how new technology affects client care D. A study examining how effective use of supplies affects the cost of care

A. A study examining the ability of an aging population to care for itself

The nurse working in a community hospital is caring for a client who does not seem to be responding well to the current plan of care that has been implemented by the nursing team. Given this​ information, which actions by the nurse are​ appropriate? Select all that apply. A. Accessing research journals for evidence that would support a change in the plan of care B. Proposing a nursing research project to the unit manager C. Asking the doctor for a new nursing approach to care D. Trying a different approach to care even though it breaches hospital policy E. Networking online with other nurses who are giving similar care

A. Accessing research journals for evidence that would support a change in the plan of care B. Proposing a nursing research project to the unit manager E. Networking online with other nurses who are giving similar care

Prior to conducting​ research, nurse researchers must have their research protocols approved by which of the following​ bodies? A. An institutional review board B. The U.S. Department of Health and Human Services C. The journal in which the researchers plan to publish their results D. The American Nurses Association

A. An institutional review board

A nurse working in a home health agency is asked to participate on a committee that is looking to incorporate​ evidence-based nursing care. What should be the​ committee's first step in implementing​ evidence-based practice​ (EBP)? A. Compile a list of questions. B. Evaluate the results of different research projects. C. Research​ evidence-based practices that can be implemented. D. Suggest that individual staff members try new means of delivering care.

A. Compile a list of questions.

A nurse preceptor is working with a graduate nurse and explains that the hospital uses EBP as its approach to nursing because of what reason? A. EBP provides credibility of the profession. B. Care cannot be given unless it is backed by research C. EBP assists in the evaluation of nurses' performance D. EBP helps determine the client's preferences for care

A. EBP provides credibility of the profession. Rationale: Evidence-based care provides credibility to the profession because the profession can demonstrate through research that client outcomes are positive. EBP's aren't designed to evaluate performances and will not determine a client's preferences- a nursing assessment will.

A nurse is planning a research project comparing the use of fingerstick blood glucose testing with the use of alternative sites for adult male clients. Which elements of the PICOT formulation of the clinical question still need to be​ defined? Select all that apply. A. Outcome B. Time C. Comparison D. Issue E. People

A. Outcome B. Time

During an interview, a nursing student asks the manager if the unit participates in any EBP practice projects. Which example stated by the nurse manager is an example of randomized controlled trial evidence-based practice project? A. The unit has implemented a new peri-care cleaning product on one hall of the unit and we will compare the UTI rate of the hall with the other hall of the unit, not using the product B. All nursing staff on the unit recently completed an online module on proper indwelling catheter care and the unit will look at the UTI rate for the unit C. The unit has implemented a new peri-care cleaning product and projecting a decrease in our UTI rate with clients with indwelling catheters D. A literature review was completed on not inflating the balloon on the indwelling catheter before insertion, and our policy will be changed to reflect this

A. The unit has implemented a new peri-care cleaning product on one hall of the unit and we will compare the UTI rate of the hall with the other hall of the unit, not using the product Rationale: Randomized controlled trials (RCTs) are designed to illustrate a cause-and-effect relationship by using a control group (clients on one hall not using the product) and an experimental group (clients on the other hall who do use a product). The other examples are examples of evidence-based practice, but are not designed as RCTs.

Concepts Related to EBP

A. accountability B. clinical decision making C. health, wellness, illness and injury D. legal issues E. professional behaviors F. quality improvement

Which of the following would be considered a foreground question when included in a nursing research​ project? A. ​"How does use of behavioral interventions compare to use of pharmacological therapies in treating​ hypertension?" ​B. "What organisms most commonly cause bacterial​ pneumonia?" ​C. "Who is at greatest risk for the development of gestational​ diabetes?" ​D. "What are the side effects of this class of antipsychotic​ medications?"

A. ​"How does use of behavioral interventions compare to use of pharmacological therapies in treating​ hypertension?"

Which of the following measures would be most directly aimed at upholding the principle of respect for​ persons? A. A policy requiring that all participants in a research effort receive financial compensation B. A policy requiring that any research involving pediatric subjects undergo an extra level of ethical scrutiny prior to approval C. A policy stating that all data gathered during research must be stripped of information that links it to individual research subjects D. A policy stating that a research project must be immediately suspended should any of the participants experience an unexpected adverse event

B. A policy requiring that any research involving pediatric subjects undergo an extra level of ethical scrutiny prior to approval

Which of the following resources would be of least value to a nurse who hopes to employ​ evidence-based practice​ (EBP) in support of the Healthy People 2020 objectives for pregnant​ women? A. A report from the American Congress of Obstetricians and Gynecologists describing best practices for screening for gestational diabetes B. A report from the American Cancer Society regarding changes in the recommended schedule for mammograms C. A document from the National Institutes of Health describing newly identified benefits of receiving vaccines during pregnancy D. A research study linking regular exercise during pregnancy with a reduced likelihood of cesarean section

B. A report from the American Cancer Society regarding changes in the recommended schedule for mammograms

The nurse is caring for a newly admitted client on the unit. When formulating the plan of care, the nurse recognizes that EBP is most helpful to a nurse in which situation? A. Determining the client's nursing diagnosis B. Evaluating the client's outcomes of care C. Collecting data regarding the client's current medications D. Determining the client's dietary needs

B. Evaluating the client's outcomes of care Rationale: A goal of evidence-based practice is to improve client care, and the best way to justify care is by evaluating the client's response to care by examining outcomes.

The nurse is working with a client who has agreed to participate in a research study. Which actions would constitute a violation of the​ client's right to full​ disclosure? Select all that apply. A. Telling a mutual friend about the​ client's involvement in the study B. Giving the client false information about his or her participation in the study C. Withholding information about the study from the client D. Providing the​ client's name as a participant in the study E. Suggesting that participating in the study would greatly benefit the​ client's financial situation

B. Giving the client false information about his or her participation in the study C. Withholding information about the study from the client

A nurse is preparing to conduct a research study and wants to do a literature search for relevant articles. Which of the following sections should the nurse expect to find in each search​ result? Select all that apply. A. Funding B. References C. Results D. Methods E. Abstract

B. References C. Results D. Methods E. Abstract

The nurse is caring for a client who continues to develop pressure sores despite measures the nurses have taken to protect the client's skin. The nurses have participated in a client conference and outlined various methods for protecting this particular client's skin. What design of evidence-based research study is the nursing staff using? A. cohort study B. case study C. meta-analysis D. case control study

B. case study Rationale: the nursing staff is using the case study model, where the information found is being applied to the one client mentioned.

The nurse is caring for a client who requires extensive wound care. The client has consented to participate in a nursing research study regarding the wound care. Which client statement indicates understanding of the research​ goal? A. ​"This research will not influence my​ care." ​B. "Nursing care is based solely on​ research." ​C. "I will be helping to validate nursing​ care." ​D. "I will be paid to participate in the research​ project."

C. "I will be helping to validate nursing​ care."

A home health nurse who is visiting a client to complete a wound dressing notes that the client has a flat affect and is not as responsive as during previous visits. The nurse calls the​ client's primary healthcare provider for a psychiatric referral. By recognizing the signs and symptoms of possible​ depression, the nurse is exhibiting which concept associated with​ evidence-based practice? A. Advocacy B. Professional behaviors C. Clinical decision making D. Accountability

C. Clinical decision making

A nurse manager is encouraging staff on the unit to go back to school and​ "become professionals, not just​ workers" by​ "increasing" their knowledge through education and networking. Which criteria for nursing to be recognized as a profession is the nurse manager​ highlighting? Select all that apply. A. Following a code of ethics B. Conducting ongoing research C. Having autonomy D. Joining professional organizations E. Having specialized education requirements

C. Having autonomy D. Joining professional organizations E. Having specialized education requirements

Which type of research investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of​ clients' perspectives? A. Clinical research B. Quantitative research C. Qualitative research D. Thematic research

C. Qualitative research

A nursing student who is providing care for an assigned client knows that the information documented in the​ client's nursing care plan could potentially be used in research to optimize client care. Which type of research is used to convert research knowledge into healthcare applications for improved​ outcomes? A. Qualitative research B. Transformational research C. Translational research D. Quantitative research

C. Translational research

A nurse has defined the current research problem. What is the next step in the process? A. formulate a hypothesis B. define variables C. review the literature D. select a design

C. review the literature Rationale: before progressing with the research design, the researcher determines what is known and not known about the problem.

A nursing preceptor is working with a novice nurse on a​ medical-surgical unit. During client​ care, the novice nurse shares an​ evidence-based wound care technique that is being used with much success. Which of the following is being encouraged when the novice nurse shares this information with the​ preceptor? A. Use of trial and error to gain knowledge B. Use of medical knowledge to perform care C. Use of existing unit modes of care D. Use of new knowledge gained through research

D. Use of new knowledge gained through research

The nurse is caring for a client with a chronic disease process. The client tells the nurse he recently read an article about funding for the National Institute of Nursing Research​ (NINR). He then asks the nurse why the U.S. Congress would fund such an organization. Which response by the nurse is most​ appropriate? A. ​"The government is interested in preventing chronic​ disease." ​B. "Funding the NINR is one cause of health cost increases in the​ country." ​D. "The government is looking to the NINR for information about promoting​ health." ​E. "Nursing research is focused on prevention and health​ promotion, which will decrease healthcare​ costs."

E. "Nursing research is focused on prevention and health​ promotion, which will decrease healthcare​ costs."

What does the Agency for Healthcare Research and Quality do?

Funds 13 evidence-based practice centers that: -review all relevant scientific literature -synthesize evidence -help to translate evidence-based research findings

Institutional Review Board

Group that reviews research in advance to ensure ethical considerations are met

PICOT

Population Intervention Comparison Outcome Time

Step 1: Develop a Clinical Question

Population (of patients) or Problem of interest Intervention, prognostic factor, or type of exposure Comparison of interventions or main alternatives to interventions (including no interventions) Outcomes (desired effect) Time frame (optional)

Step 1: Develop a Clinical Question

Types of questions: Diagnosis: -how to select, interpret diagnostic tests -accuracy, safety, cost effectiveness Therapy: -how to select treatments that do more good than harm to patients, lead to best outcomes Etiology: -how to identify causes of a condition or disease Prognosis: -how to protect clinical course, possible complications

What is the key to understanding research findings?

ability to weigh scientific merit of a research study ----not all findings have equal validity----

What is evidence?

clinical knowledge, expert opinion, or information resulting from research

What is evidence based nursing?

defined by Sigma Theta Tau. Integration of best evidence, nursing expertise, and values and preferences of individuals, families, and communities

What is background questions?

general questions that seek more information about a topic

By integrating the 3 components of EBP into the clinical-decision making process, nurses can

individualize patient care and provide best practice for patient-centered care

What is qualitative research?

investigates a question through a narrative data exploring subjective experience i.e.- patient's experience (qualitative) vs. hard numbers (quantitative)

Gold Standard

large randomized controlled studies and meta-analyses of controlled studies -----best source of research-----

What is a secondary resource?

one author writing about another author's work

What is a primary resource?

original published article

Three P's of HCAPHS

potty position pain

What is foreground questions?

questions narrower in focus than background questions. Concern a specific clinical issue

three main ethical principles

respect for persons, beneficence, justice

What do Institutional Review Boards do?

review research protocols and ensure that they adhere to ethical standards

Nursing Clinical Research

study that seeks answers to questions about improving nursing care

What is translational research?

systematic approach of converting research knowledge into applications of healthcare for improved patient outcomes --information flows back and forth between researchers and clinicians----

What is research?

the formal, systematic application of the scientific method to the study of problems

What is EBP used for?

to form a bridge between research and nursing practice

What influences the validity of research?

type of methodology (quantitative vs. qualitative)

nursing research

use of a systematic and strict scientific process to analyze phenomena of interest to all areas of nursing

What is quantitative research?

use of precise measurement to collect data, analyze it statistically

What are the goals of EBP?

using the best evidence to: 1. reduce inappropriate variations in healthcare 2. facilitate the standardization of safe, effective healthcare practice

research participants

volunteers for a specific study project that meet all the inclusion criteria, have been informed of all aspects of the study, and have signed informed consent

A client in the clinic is being asked to participate in a research study. The client asks why a nursing research study is necessary given that research on this subject has already been published by the American Medical Association​ (AMA). Which of the following responses should the nurse offer in reply to the​ client's question? ​A. "This study is useful because it supports the medical​ profession." ​B. "This study is useful because it supports products used in nursing​ care." ​C. "This study is useful because it validates nursing​ care, not medical​ care." ​D. "This study is useful because it validates nursing through medical​ research."

​C. "This study is useful because it validates nursing​ care, not medical​ care."