Evidence-Based Practice Final

grounded theory

An approach to collecting and analyzing qualitative data with the aim of developing theories and theoretical propositions. An inductive method of generating theory from data by creating categories in which to place data and then looking for relationships among categories Grounded theory sets out to discover or construct theory from data, systematically obtained and analyzed using comparative analysis.

What is a clinical guideline?

An evidence-based clinical practice guideline (EBCPG) consists of a set of recommendations from a professional organization, based on research evidence and offered as a generic guideline for care in a variety of settings (Brown, 2018). These guidelines address a variety of medical issues and conditions

The nurse has collected the most relevant evidence. What is the next step of the evidence-based practice process? Evaluate the effect of the practice change Identify a clinical question Integrate evidence into practice Analyze the evidence

Analyze the evidence

All the following are Steps of Reviewers Conducting Systematic Reviews, except ______. A. Search for evidence. B. Conducting your own research. C. Analyze Findings. D. Sort by inclusion/eligibility criteria.

B. Conducting your own research. Rationale: Systematic reviews are a compile of multiple studies on the same topic. The researcher should not conduct their own research for the systematic review research.

Nursing practice can be based on solid evidence only if... a. The first author is a medical professional. b. The research report is critically evaluated. c. The report is based on a systematic review. d. Dr. OZ said it was approved

B. The research report is critically evaluated. Rationale: Nursing practice can be based on solid evidence only if the research has been critically evaluated because thorough critiques of research play a large role in the advancement of nursing practice. Without evaluation, incorrect information could be published and used.

Which statement best describes how evidence-based clinical practice guidelines are mainly and most often used? a. As an educational tool for nurses and other providers b. To inform patients of the care they should expect c. To guide agencies in developing protocols specific to their setting d. As a standard for nurse performance

C. To guide agencies in developing protocols specific to their setting

Which statement is true of clinical practice guidelines? Clinical practice guidelines are evidence-based when the producers conduct a systematic review of the research and formulate recommendations using that evidence. All clinical practice guidelines are evidence-based All clinical practice guidelines produced by specialty associations are dependable Clinical practice guidelines based mainly on the collective opinion of experts in the field are considered evidence-based

Clinical practice guidelines are evidence-based when the producers conduct a systematic review of the research and formulate recommendations using that evidence.

Which is not a building block for EBP? systematic review Cochrane clinical protocols individual research studies clinical practice guidelines

Cochrane

How are cohort studies different from experimental studies? Cohort studies involve indirect comparison rather than direct comparison Cohort studies measure long-term outcomes. Cohort studies use smaller samples. Cohort studies do not employ random assignment to groups.

Cohort studies do not employ random assignment to groups.

individual study

Define and explain: single study on a particular subject "most basic form of research"

experimental research

Define and explain: (week 6 .ppt) Studies involve the researcher collecting data while introducing treatment. • Systematically intervene in a process and measure the outcome • Validity of the research will depend on the experimental design In experimental research, the researcher has complete control over the independent variable and can manipulate it to test the hypothesis. In non-experimental research, the researcher does not have this level of control and must rely on observations and measurements of naturally occurring variables. •More control over confounding variables. •Can establish cause and effect relationships. - randomization - control - manipulation

In which section(s) of a research article will you find the author's opinion about the meaning of the results of the study? Results Discussion Introduction Throughout the article

Discussion

Research variables are: Features, characteristics, or properties of person, situations, experiences, or things that change or vary differences in findings from one study to another different measures of an outcome measures of dispersion in the data of a study

Features, characteristics, or properties of person, situations, experiences, or things that change or vary

Which is not a principle of Beneficence? Freedom of full disclosure Freedom from harm Freedom from work Freedom from exploitation Risk/benefit ratio

Freedom from work

What approach consists of collecting and analyzing qualitative data with the aim of developing theories and theoretical propositions? Phenomenology Descriptive Ethnography Grounded theory

Grounded theory

cohort studies

Groups of persons with different levels of risk are identified and then followed to determine if they develop certain outcomes. know and explain: - Type of longitudinal study - Follows research participants over a period of time (often many years) - Cohort studies recruit and follow participants who share a common characteristic, such as a particular occupation or demographic similarity. A cohort study is a type of epidemiological study in which a group of people with a common characteristic is followed over time to find how many reach a certain health outcome of interest (disease, condition, event, death, or a change in health status or behavior). - Cohort research is considered non- experimental. - The main purpose of the cohort study is to estimate the risk or rate of an outcome among a cohort of individuals. - Two naturally occurring groups are observed and defined based on their exposure (or lack of exposure) to a particular risk factor - Major concern is two groups could differ in some way other than the presence or absence of a particular risk factor

A type of research mainly expressed in words? Qualitative Quantitative Experimental Descriptive

Qualitative

Studies that are conducted to understand the meaning of human experience are known as Qualitative Clinical guidelines Evidence-based practice Quantitative

Qualitative

The credibility of the findings of a research study is primarily determined by which of the following? The appropriateness and soundness of the study methods The significance of the statistical results The clarity of the study purposes or questions The sample size and appropriateness of the statistics used

The appropriateness and soundness of the study methods

Cohort studies are a good way to study which one of the following phenomena? Outcomes associated with rare diseases The effects of social support on disease outcomes The effectiveness of interventions providing healthcare counseling The effects of risk factors on health outcomes

The effects of risk factors on health outcomes

Which statement is true of the findings of a single, original study? The findings of a single, original study are dependable if quantitative analysis was done. The findings of a single, original study are meaningless The findings of a single, original study are dependable if the sample size was large. The findings of a single, original study should be brought together and integrated with the findings of other studies of the same issue.

The findings of a single, original study should be brought together and integrated with the findings of other studies of the same issue.

What determines whether a researcher uses a qualitative or quantitative research method for a particular study? The ease of collecting and analyzing data The nature of the research question being asked The financial resources available for conducting the study The researcher's knowledge about and preference for one method over the other

The nature of the research question being asked

Dissemination EBP

These are examples of how the evidence is shared: - Posters - Papers - Websites - Presentations - Conferences - Hosting events

Clinical decision support tools are most often designed in the form of a(n) pie chart null hypothesis histogram algorithm

algorithm

Hawthorne effect

define: Participants in behavioral studies that change their behavior or performance in response to being observed.

What is the proper way to write an in-text citation for an article published in 2022 with 3 authors? (Smith et al., 2022) (Smith, Jones, & Adams, 2022) Smith, Jones, & Adams (2022) (Adams et al., 2022)

(Smith et al., 2022)

Define the PICOT research question:

(week 4 ppt.) Population Intervention Comparison Outcome Time PICO(T) The order may vary from question to question P: Population of Patients or Disease I: Intervention or Variable of Interest C: Comparison, what it is being compared to or against? O: Outcome of interest, what is the result? T: Time it takes to demonstrate an outcome. ex. Is oral sucrose pacifier or swaddling more effective (I & C) in controlling pain (O) during and after venipuncture (T) in full-term newborns (P)?

Costs of lack of EBP

- Approx. 99,000 deaths each year - 7.2 - 14.9 billion spent on HAIs. - 5% hospital admissions results in HAIs

Why would a nurse use systematic process or review?

- you need to figure out a simple way of gathering the most important and relevant evidence for your studies. That way, you won't have to waste your time going through all the journals in search of data. This is where systematic reviews come in handy. Since the available journals vary greatly and may not be indexed properly, you will experience great difficulties while trying to appraise them and find quality evidence. - But with a systematic review, you'll have all the relevant evidence synthesized and put in simple and easy-to-navigate journal articles. In fact, a systematic review offers you an organized and reliable overview of the complex and disorganized literature found in research journals. Furthermore, a systematic review offers you evidence gathered from numerous studies, allowing you to make informed decisions in your nursing practice. It also uses methods that minimize bias and produce reliable and accurate conclusions.

In what order does the building of practice knowledge take place? 1. Systematic review guideline protocol individual study 2. Protocol guideline systematic review individual study 3. Individual study systematic review guideline protocol 4. Guideline Protocol systematic review Individual study

3. Individual study systematic review guideline protocol Individual studies are used to make a systematic review. Systematic reviews are used to make clinical guidelines that form clinical protocols to be implemented.

What is CINAHL? A search engine used to search MEDLINE A database of articles, books, and other information sources for nursing and allied health An online encyclopedia of nursing terminology An organization that produces systematic reviews

A database of articles, books, and other information sources for nursing and allied health

Which of the following is considered a primary source of evidence? An integrative review A research study A systematic review A meta-analysis

A research study

Which of the following is an example of a secondary source in a research study? A restrospective study reviewing over 20 years of data A RCT involving multiple locations. A textbook of medical-surgical nursing. A journal article about a study that used large, previously unpublished databases generated by the United States census.

A textbook of medical-surgical nursing.

What purpose does a systematic review serve? A. Gives thorough examination to a specific issue B. Focuses research on a specific age group C. Summarizes one study D. All of the above

A. Gives thorough examination to a specific issue Rationale: a systematic review examines multiple studies about a certain issue, then summarizes the findings of those studies and compares outcomes.

Individual research studies are used to create systematic reviews. What follows next in the pyramid of building practice knowledge (use of research results)? a). Guideline; then protocol b). Protocol; then guideline c). Randomized control trial d). Guideline; then opinion

A. Guideline; then protocol

Which words best describe the purpose of informed consent? SATA allows individuals to understand the purpose of the research study individuals willingness to participate in research study individuals understanding allows individuals to understand the benefits & costs of the research study

All of the above

What type of research evidence should an evidence-based protocol work group look for first? A qualitative study An evidence-based clinical practice guideline A study with a large sample that tests an intervention A randomized clinical trial

An evidence-based clinical practice guideline

Why is a study categorized as quasi-experimental (as opposed to being called a randomized clinical trial)? Because it was not possible to recruit participants from the population of interest. Because the intervention was only partially tested. Because the intervention and/or setting was not tightly controlled. Because the researcher does not have a PhD.

Because the intervention and/or setting was not tightly controlled.

Evidence-based practice steps:

Cultivate. 1. Ask PICOT question. 2. Search for and collect evidence. 3. Appraise the evidence. 4. Integrate the best evidence using one's clinical expertise. 5. Evaluate outcomes of the practice decision or change. 6. Disseminate (Share) the outcomes of the EBP decision or change. or for the more in-depth version. 1. Cultivate a spirit of inquiry within an EBP culture and environment. 2. Ask the burning clinical question in PICOT format. 3. Search for and collect the most relevant best evidence. 4. Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, synthesis, and recommendations). 5. Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. 6. Evaluate outcomes of the practice decision or change based on evidence. 7. Disseminate the outcomes of the EBP decision or change.

The "PICOT" format is needed to construct the clinical question. Mary is the new graduating nurse. She has recently found on the Skilled Nursing Unit there is an increased infection rate of central lines in the last 30 days. What would be Mary's first step? Collect data on all patients who had a central line in the past 30 days. Put educational information on the patient's bedside to help the patient and family understand the importance of this matter. Call the CNO of the organization and discuss what the first step should be in educating the staff. Decide which population of interest she wants to identify on the unit.

Decide which population of interest she wants to identify on the unit.

systematic review

Define and explain (.ppt week 5 & 7): a comprehensive and systematic identification, analysis, and summary of research related to a specific issue Type of research method whereby researchers find all of the relevant studies, published and unpublished, on a topic or question and present a state-of-the-science conclusion in the form of an evidence summary. - Systematic reviews collect, appraise and combine evidence. - Translating best available evidence into clinical practice. A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question and is designed to minimize biases and errors inherent to traditional, narrative reviews Systematic reviews are ranked very high in research and are considered the most valid form of medical evidence. They provide a complete summary of the current literature relevant to a research question and can be of immense use to medical professionals.

qualitative study

Define and explain: Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. involves collecting and analyzing non-numerical data to understand concepts, opinions or experiences.

non-experimental research

Define and explain: Studies involve the researcher collecting data without introducing any treatment. - descriptive design, data collected during the study subject without intervening - correlational design In experimental research, the researcher has complete control over the independent variable and can manipulate it to test the hypothesis. In non-experimental research, the researcher does not have this level of control and must rely on observations and measurements of naturally occurring variables.

quasi-experimental research

Define and explain: The independent variable is manipulated with no randomization and/or control group. - Quasi-experimental design attempts to establish a cause-and-effect relationship by using criteria other than randomization. - provides higher internal and external validity due to real-world interventions and better control for confounding variables. - a type of research involving interventions in which one or more of the following features are not possible: random assignment to intervention groups; tight control over the delivery of the intervention; or have a comparison group - The prefix quasi means "resembling". - Research that resembles experimental research but is not true experimental research. - The independent variable is manipulated. - Participants are not randomly assigned to conditions or orders of conditions

What is the responsibility of the IRB? Ensuring the PICO question is correct Proofreading the data collected before being published Ensuring the rights of human subjects are protected in a study Ensuring the researchers are protected from participants

Ensuring the rights of human subjects are protected in a study

A nurse researcher aims to produce a rich portrayal of the norms, values, language, roles, and social rules of health among Central American immigrants to the United States. What research methodology would work best for this purpose? Grounded theory Case study Phenomenology Ethnography

Ethnography

internal validity

Examines whether the study findings can be generalized to other contexts. Internal validity is defined as the extent to which the observed results represent the truth in the population we are studying and, thus, are not due to methodological errors. extent to which we can draw cause-and-effect inferences from a study High internal validity: you can confidently draw conclusions about causation

Which type of quantitative research design looks for cause and effect between an intervention variable and an outcome variable? Cohort design Correlational design Retrospective design Experimental design

Experimental design

Which of the following statements is not true of the conducting of systematic reviews? It is best done by one person to control conflicting views. Adhering to widely accepted methods reduces bias. It can lead to conclusions based on findings from studies with diverse designs. Findings represent conclusions arrived at across studies.

It is best done by one person to control conflicting views.

What format are clinical questions for EBP typically written? PICOT COPD OEED PICC

PICOT

Which qualitative design is used to study the meaning of a lived experience? Phenomenology Grounded theory Ethnography Historical research

Phenomenology

What does PICOT stand for? Population, Intervention, Comparison, Outcome, Time Population, Integration, Comfort level, Outcome, Teamwork People, Intervention, Care, Options, Teamwork Population, Intervention, Comparison, Outcomes, Theory

Population, Intervention, Comparison, Outcome, Time

Primary vs. secondary source

Primary sources - original evidence - Public health reports and news - Clinical trials in progress - Expert opinions - Websites, social media postings, personal communications - Unpublished "gray" literature - Statistical data sets - Peer-reviewed research studies - Non-peer reviewed articles or editorials Secondary sources—evidence derived from or are interpretations of primary sources examples: Clinical practice guidelines - Critiqued abstracts > Textbooks Review articles that are narrative reviews, integrative reviews, systematic reviews Pre-appraised studies, critiqued abstracts Evidence summaries and synthesis; point-of-care (POC) tools

Know levels of evidence:

Quality of Evidence Level 1 Systematic reviews or meta-analysis of randomized controlled trials (RCT) (Evidence from more than one RCT) Quantitative Level 2 Individual RCT ("Gold Standard" for evaluating cause & effect) Quantitative Level 3 Cohort (looking forward) or Case-control studies (looking back) Quantitative Level 4 Quasi-experimental studies (not randomized and/or no control group) Quantitative Level 5 Individual non-experimental study (e.g., Descriptive or Correlational); metal-synthesis of qualitative studies Quantitative or Qualitative Level 6 Individual qualitative study Qualitative Level 7 Expert opinion; Bench reports; Clinical expertise; Anecdotal experience Neither Quantitative nor Qualitative

Qualitative vs. Quantitative Research

Quantitative Hard science (objective) Deductive reasoning Cause & effect Numbers/Stats Focus - narrow Tests theory Seeks generalization Qualitative Soft science (subjective) Inductive reasoning Meaning, discovery Words, narrative Focus - broad Develops theory Multiple realities...less generalizable

Random Control Trial

Random selection/sample group, control group and manipulation. Intended to test cause and effect.

There are different levels of research used in Evidence-Based Practice, which is the highest level of evidence? Randomized control trials Qualitative with multiple centers participating Clinical expert opinions via their experiences or studies Evidence from case-control analysis or observational studies

Randomized control trials

Which statement is true about the scope of Systematic Reviews? SRs should be as narrow as possible. All SRs aim for a mid-range scope. SRs can be broad or narrow in scope. SRs should be as broad as possible.

SRs can be broad or narrow in scope

What is the main goal of clinical protocols? Protect against lawsuits Set standards of care Orient new nurses Increase hospital revenue

Set standards of care

external validity

Study design, conduct, and analysis. Answers the research question without bias. External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can be generalized to and across other situations, people, stimuli, and times. the extent to which the results of a study can be generalized to other situations and to other people High external validity: you can confidently generalize your conclusions to other populations or setting

Which research purpose is not a purpose of qualitative research? To understand how patients decide whether to have a particular surgical procedure To determine the effectiveness of forced-air warming blankets in preventing shivering in women who are actively giving birth To develop a theory of how spouses and partners of persons who are attempting to stop smoking support the "quitter" To describe the culture of a rural home care agency

To determine the effectiveness of forced-air warming blankets in preventing shivering with women who are actively giving birth

Extraneous variables can contribute to the validity of the study measurements. True or False

True or False

In quantitative research the variables should never be compared to each other? True or False

True or False

It is important for student nurses to learn the value of evidence-based practice as it assists in providing high quality care to patients. True or False

True or False

Nursing care activities that are supported by valid and reliable research is known as evidence-based practice. True or False

True or False

Qualitative methods include interviews with open-ended questions, observations described in words, and literature reviews that explore concepts and theories. True or False

True or False

Research evidence alone is sufficient to justify a change in practice. True or False

True or False

Use qualitative research if you want to understand the concepts, thoughts, or experiences. True or False

True or False

For which of the following research questions would qualitative methods be most appropriate? How does frequency of medication administration impact the degree of pain experienced following knee replacement surgery? What is the meaning of health for migrant farm-worker women? Which pain medications decrease the need for sleep medication in elderly patients? Under what conditions does a decubitus ulcer heal most quickly?

What is the meaning of health for migrant farm-worker women?

In which instance should a researcher use a qualitative research design instead of a quantitative research design? When the research questions are clinical in nature When the goal is to view the experience in the same way that those who are having the experience view it When the researcher is a novice and has minimal experience or skill in scientific problem solving When time for data collection is limited

When the goal is to view the experience in the same way that those who are having the experience view it

How does the researcher know when data saturation has been reached? a. When the participants all agree on the themes derived from the study b. When the ideas or information coming from new participants have been expressed previously by other participants c. When the emerging themes are congruent with those developed as a result of previous studies of the same phenomenon d. When the participants are no longer interested or willing to discuss their experiences or feelings

b. When the ideas or information coming from new participants have been expressed previously by other participants

extraneous variable

define: - Variable that is not being investigated that can potentially affect the outcomes of the research study. - If left uncontrolled, extraneous variables can lead to inaccurate conclusions about the relationship between independent and dependent variables. ex. age, intelligence, motivation, gender

phenomenology

define: A qualitative research method that explores the meaning of human experiences through the "lived experience" of the individual. The study of individuals' own unique, first-person, conscious experience. Phenomenological research is a qualitative research approach that seeks to understand and describe the universal essence of a phenomenon. The approach investigates the everyday experiences of human beings while suspending the researchers' preconceived assumptions about the phenomenon

ethnography

define: A qualitative study that explores the cultural aspects of a particular group of informants. the method by which researchers attempt to understand a group or culture by observing it from the inside, without imposing any preconceived notions they might have Ethnography, simply stated, is the study of people in their own environment through the use of methods such as participant observation and face-to-face interviewing.

dependent variable

define: Variable that is affected. is the effect. Its value depends on changes in the independent variable (the presumed effect) the variable that depends on the other factors that are measured... changes as a result of the independent variable changing (the presumed effect) ex. blood pressure (dependent) is lowered due to the independent variable of medication.

independent variable

define: Variable that is the cause. is the cause. Its value is independent of other variables in the study. the variable that is stable and unaffected by other variables (the presumed cause) ex. low dose of new medicationterm-22

descriptive research

define: this is non-experimental - Data collected during the study subject without intervening. - Validity of the research will depend on the sampling method +surveys +observations +case studies Pros •Allows you to describe your research subject without influencing it .•Accessible - you can gather more data on a larger scale. Cons • No control over confounding variables • Can't establish cause-and-effect relationships.

In qualitative research, data saturation occurs when: no new information is forthcoming, and all major issues are understood. the target sample size has been reached. the researcher's notes fall in a puddle. participants contradict their own statements.

no new information is forthcoming, and all major issues are understood.

All of the following are categorized as systematic reviews, except: systematic review with random selection synthesis. systematic review with narrative synthesis. systematic review with statistical synthesis. systematic review with qualitative synthesis.

systematic review with random selection synthesis.

Which of the following statements is not true about extraneous variables? they can lead to wrong conclusions about the study results they can contribute to the validity of the study measurements they can often be controlled in advance of doing the study they can often be eliminated in advance of doing the study

they can contribute to the validity of the study measurements