Exam 1: Research Articles
What is the theoretical framework?
(may be combined with review of literature) Describes relationships among general concepts and provides linkages to what is being measured in the study. A model or diagram may be used.
What are the barriers of EBP?
- Nurses being unaware of research - nurses not feeling capable of evaluating the quality of research - nurses being isolated from knowledgable colleagues with whom they could discuss research.
What are some clinical practice guidelines?
- agency for healthcare research and quality (AHRQ) - National Guideline clearing house - Oncology Nursing Society (ONS) - Registered Nurses' Association of Ontario - Royal College of Nursing
Recommended sources about EBP
- clinical practice guidelines - systematic reviews and other synthesis of evidence - clinical trials - other EBP sources
Strength or quality of evidence.
- literature consists of Type 1 evidence or consistent findings from multiple studies from Levels II, III, or IV. - multiple studies with evidence type II, III, or IV that are generally consistent - multiple studies with evidence types II, III, or IV are inconsistent - Limited research evidence or one type II study only - Type IV or V evidence only
What are the qualities of best evidence?
- research articles - clinical practice guidelines - systematic reviews.
What are some clinical trials?
-ClinicalTrials -MedlinePlus
What are the six peer review practice principles?
1. A peer is someone of the same rank. 2. Peer review is practice focused. 3. Feedback is timely, routine, and a continuous expectation. 4. Peer review fosters a continuous learning culture of patient safety and best practice. 5. Feedback is not anonymous. 6. Feedback incorporates the nurse's developmental stage.
Identify 2 ways in which patients and their values and preferences are considered in EBP?
1. Extent patients are involved in shared decision making. 2. the right of the patients to choose or reject an intervention.
Describe the third S: Synopses.
A brief description of the evidence. Abstracts obtained through CINAHI and MEDLINE are essentially synopses. Within the last few years, a variety of EB journals have emerged that provide synopses of valid and clinically useful studies. The medication alerts you may receive on your personal digital assistant (PDA) as updates to your drug book are another example of synopses.
What is the nursing process?
ADPIE - the nursing process means that the nurse must use both theory and evidence to critically think in caring for their patients. Assess = observation + interview + physical exam. Diagnosis = determine the client's response or problem related to an illness or situation Plan = SMART goals Implement = perform cares... Evaluate = Have NSG interventions been effective or helpful in meeting desired outcomes? were client goals/outcomes achieved? 3 choices: terminate, continue, or revise the plan of care.
What makes up a research article?
Abstract, introduction, review of literature, theoretical framework, methods section, results section, discussion section, list of references. Article should be published within the last 5 years and at least one of the articles should be a nurse.
What are some systematic reviews and other syntheses evidence?
Agency for healthcare research quality (AHRQ) - British medical journal (BMJ) - PubMed Clinical Queries
What are some other EBP Sources
American Nurses Association Evidence- Based Care Research - Center for evidence based medicine - Evidence-Based Nursing - National Institute of Nursing Research
What is a review of literature?
An unbiased, comprehensive, synthesized description of relevant, previously published studies should be present. The purpose, sample, design, and significant findings are discussed. Should focus on the most frequent work in the field, but may include older citations if they are considered to be landmark studies. Complete citation is provided for each article so readers can retrieve them if desired Concludes with a summary of what is known about the problem and identifies gaps in the knowledge base to show readers how the study will add to the existing knowledge.
What is the ANOVA?
Analysis of Variance is used to analyze mean score differences between three or more groups. Using the previous example of skills to demonstrate inhaler use, an ANOVA could be done to see whether nurses from ER, PEDS, or general medicine have higher scores.
What are the 5A's to the EBP process?
Ask: pose a clear question that will lead to the right evidence for the problem State the question in the PICO format Acquire: one acquires the best info that links the dx of the pt. problem with potential solutions. You need to know where to look, how to access the source, and how to find the best available evidence. Many people do not have access to the internet or data bases. Appraise: critically evaluate the evidence for its quality, clinical expertise Apply: to apply the evidence makes it actionable. Some of the biggest challenges in EBP relates to changing behaviors and application of the evidence, taking into account clinical expertise, available resources and patient preferences. Assess: or evaluate the outcomes. The method of assessment must be supported by evidence. That is, the measurement must be valid and reliable. Although evidence is not always strong or well developed, audit and feedback remain common methods to enhance the uptake of evidence in practice.
What is the discussion section?
Author provides an interpretation of the results and how findings extend the body of knowledge. Results should be linked to the review of literature and theoretical framework.
PICOT
Be able to pull apart a PICOT question P - population I - intervention C - comparison O - outcome T - time
What are some literature data bases?
CINAHL - cumulative index to nursing and allied health literature MEDLINE PsycINFO Cochrane Library
Describe the first S: Studies.
Case studies are frequently used to report the story of one patient including details such as diagnosis, nursing care, and influential environmental factors. Studies can be Quantitative, Qualitative, Concept Analyses or Case studies: involve direct observation of the situation and are best used as a research approach when studying events that are currently happening and when the researcher has little or no control over these events. Although the findings from case studies are not regarded as highly as findings from research studies, in some instances case study findings can provide insight and understanding when little evidence is available. Although qualitative findings are considered lower level of evidence, they do provide the pt. perspective for EBP. When a Systematic Review contains only qualitative studies, it is known as a meta-synthesis.
What is the introduction?
Contains a statement of the problem and purpose statement. A good introduction will convince readers that the study was worthy of being conducted.
What is the purpose statement?
Derived from the problem statement and indicates the aim of the study.
What is the abstract?
First section, limited to 100-150 words. Provides an overview of the study, methods used, and a conclusion. BRIEF.
Research process
Follows a basic problem-solving methodology: -- identify the problem -- develop a research question -- design research methods -- collect and analyze the results -- conclusion/ interpret findings Most single studies do not provide enough evidence to change practice, but you can see that the process of planning and conducting research is systematic, rigorous and logical. Through research, scientists aim to describe, explain and predict phenomena. It does NOT prove that things are true but SUPPORTS a particular approach or view, because the probability of error exists in every research study. This underscores why a planned, systematic approach is necessary and why replication studies are important
What is the problem statement?
Formally identifies what problem is being addressed in the study. It must include the scope to the research problem, the specific population, the dependent and independent variables, and the goal or question the study intends to answer.
What is the results section?
Frequently most difficult to understand. It describes the methods used to analyze data and the characteristics of the sample are reported. Quantitative studies: data tables are frequently used for interpretation and authors indicate which findings were significant and which were not. Qualitative studies: themes are presented and supported by quotes from participants
What is power analysis?
Gold standard to determine sample size done with computer software. Statistical method to determine the sample size that will best detect the true effect or difference in the outcome variable.
Describe the Fifth S: Systems.
If you deliver nursing care in a healthcare organization that has an integrated computerized decision support system, you have the systemic place to implement evidence-based care. The system model uses an electronic medical record that has integrated practice guidelines with patients' specific characteristics. Most healthcare providers do not practice in such an advanced healthcare system. Imagine a future when you would open the electronic medical record and you would receive pop-ups that you could click on to link synopses of evidences that pertain to your patient.
What is the rule of 30?
In order to have a sufficient sample size to represent the target population, we need a minimum of 30 subjects in each group being studied. ex. control group and intervention group - a sample size of 60 would be indicated.
What is the method's section?
Includes discussion about study design, sample and data collection. It describes the target population and explains how the samples will be obtained. Procedures for collecting data, including the types of measures that will be used, should be outlined. Author provides rationale for decisions made and how study was implemented. Get approval from IRB (institutional review board) Give ethical approval to protect rights
Describe the fourth S: Summaries.
Integrative summaries are addressed in the fourth level in the pyramid of evidence. Examples would include AHRQ (Agency For Healthcare Research and Quality), and National Guidelines Clearinghouse. These can be found in several summary services such as BMJ Clinical evidence (www.clinical evidence.com/ceweb/index.jsp), the Agency for Healthcare Research and Quality's National Guideline Clearinghouse (www.guideline.gov), and Physician's Information and Education Resource (pier.acponline.org/index.html?jhp;Haynes).
What is problem solving?
It is a generic (Circular) process that describes part of the thinking and doing of solving a problem. 1. define the problem and cause 2. generate alternative solutions 3. Select one of the solutions 4. Implement the solution 5. Evaluate effects
Rating system for levels of evidence.
Level or Type of Evidence 1. Meta-analysis or comprehensive systematic review of multiple experimental research studies. - Cochrane - National Guidelines - Clearinghouse (AHRQ) - The Joanna Briggs Institute - Other groups 2. Well-designed experimental study 3. Well-designed quasi-experimental study - Non-randomized controlled study - Single group pre-post design - Cohort study - Time-series study (one group of subjects over time) - Matched case-controlled study (two or more groups matched on certain variables) 4. Well-designed non-experimental study - Correlational or comparative descriptive study - Case study - Qualitative study 5. Clinical examples and expert opinion - Text books - Non-research journal articles, including non-systematic literature reviews - Verbal report - Non-research-based professional standards or guidelines look at handout
What are the sources or Pyramid of evidence: 5 S's?
Studies Synthesis Synopses Summaries Systems
Describe the second S: Synthesis.
Synthesis integrates various pieces of evidence to prevent a whole depiction of a phenomenon. An example would be a systematic review. A Systematic Review is a rigorously conducted process of obtaining and reviewing the literature to answer pre-established theoretical or practice questions. It is done methodically and in an organized manner. It includes both a systematic approach to obtaining the literature AND also a systematic approach to conducting the review of the literature after it is obtained.
List of references.
Use APA
Summary of nursing, research, an EBP processes.
Variations of problem solving Share parallel and common structures and functions When deconstructed, they look very similar.
What is a sample?
a select group of subjects that is representative of all eligible subjects.
Nursing proces vs. Research process, vs. EBP process.
all variations of problems solving.
What is chi-square?
it compares the actual number with an expected number. It is used the the data are in categories (i.e. male/female or infection/no infection.) Look for the differences in proportion over time such as before and after initiation of the use of new equipment.
What is a t test?
it is used to analyze the difference between two mean scores. I.e. to compare nurses and respiratory therapists mean score of their skill to demonstrate use of inhalation devices.
What are the significance levels?
p value t test ANOVA chi-square correlation
What is the p value?
probability - statistical calculation that shows a relationship between the variables that is unlikely due to chance only; a p of 0.05 means that there is a probability of 5% or less that the results found by the researcher are due to chance alone. A very small p value means that the majority of the observed study results are likely due to the experimental intervention, not chance.
What is a sample size?
small samples can influence the interpretation of results. If you only have a sample size of 10 and you say 80% of the population, it is still only 8.... Rule of 30.
What is the population?
the entire group of elements/subjects that meet the study criteria
What is correlation?
the relationship between two variables. If two variables are correlated, it does not mean that one caused the other, it means that one variable is related to (associated with) the other variable, either directly or indirectly. I.e. height and weight correlate because they are associated... but one does not affect the other. Correlations can be either positive or negative. Correlation results suggest that a result of 0.3 is low, whereas 0.5 is medium and 0.8 is high.
What are questions to consider when appraising a nursing study?
you must be able to judge the strength and quality of the information you use to make decisions. You want to utilize evidence sources in which someone else has already done the hard work of searching, appraising, and summarizing the evidence. Pre-appriaised, digested sources of evidence are ideal for use at the point of care.
