NU 302 Module 3 Exam: Chapter 4 Evidence Based Practice

Disseminating outcomes of evidence

-need for sharing to help improve the body of knowledge in PHN and provide studies for future systematic reviews -often required to report to stakeholders, make a formal report or scorecard -can be shared locally through informal networking blogs, pr pertinent listserv, etc...

Descriptive statistics

-portray the data collected in quantitative or mathematical terms -common methods used include calculating the average number of a particular set of occurrences and calculating standard deviations

Veracity

-refers to telling the truth

Justice

-refers to treating people fairly -can be distributive, egalitarian, restorative, or social

Bioethics

-refers to using ethical principles and methods of decision-making in questions involving: biologic, medical, or health care issues all while keeping the centrality of the patient to practice in the face of contemporary systems in care

Experimental Design

-requires that the investigation institute an intervention and then measure its consequences. -Researchers develop a hypothesis and test it to see if the intervention produced a change -requires a experimental group, and a control group through a process called randomization

Methods of Analyzing Data

-use the two categories of statistical analysis: descriptive and inferential

Validity

-used to evaluate instrument accuracy -instrument measures the variable it is supposed to measure

Reliability

-used to evaluate instrument accuracy -refers to the consistency an instrument measures a given research variable within a particular population

Meta-Analysis

-used to evaluate the results of many similar quantitative research studies in an attempt to integrate the findings and combine the sample sizes of many small studies to obtain a single-effect measure or a summary statistic -can give a more complete general perspective

The Future of Nursing

highlights the need for nursing to work with other health professionals in "redesigning health care" by "conducting research" and improving practices through evidence-based means

Self-determination

is a person's exercise of the capacity to shape and pursue personal plans for life

Cochrane Collaboration

lists systematic reviews on various topics of interest to both physicians and nurses.

Research Utilization

new interventions may be tried based on the results of one or two good studies

The nature of values can be described according to five qualities. What are these qualities?

endurance, hierarchical, arrangement, prescriptive-proscriptive belief, reference, and preference

True Experiments

-characterized by instituting an intervention or change, assigning subjects to groups in a specific manner, and comparing the group of subjects who experience the manipulation to the control group

Inferential Statistics

-involve making assumptions about features of a population based on observations of a sample -also used to test hypotheses in research

Conceptual Model

-is a framework of ideas for explaining and studying a phenomenon of interest -conveys a particular perception of the world; it organizes the researcher's thinking and provides structure and direction for research activities

Community based participatory research (CBPR)

-is defined as research done in communities in which those persons affected by the condition or issue of interest and other key community stakeholders have an opportunity to participate fully in each phase of the research study

Generalizabiity

-is the ability to apply research results to other similar populations -allows researchers to test their hypotheses on smaller groups before instituting widespread changes in methods, programs, and even national health policies

Quasi Experiments

-lack one of these elements, such as the randomization of subjects -CHN conduct these more than true experiments because it is often difficult to use randomization

Nonmaleficence

-means avoiding or preventing harm to others as a consequence of a person's own choices and actions

Beneficence

-means doing good or benefiting others -it is the promotion of good or taking action to ensure positive outcomes on behalf of clients

Fidelity

-means keeping promises

Ethical decision making

-means making a choice that is consistent with a moral code or that can be justified from an ethical perspective - a framework used is the DECIDE model

Autonomy

-means the freedom of choice and the exercise of peoples rights

Sytematic Review

compile all recent studies and summarize what is known about the problem the problem or situation

What is evidence based practice?

"Systematically searching for and critically appraising and synthesizing evidence (or research findings), along with consideration of expert clinical nursing judgement and patient's wishes, in making decisions about how to care for patients or clients."

Values

-Something perceived as desirable or a personally held abstract belief about the truth and worth of thought, objects, or behavior -Motivation to behave in certain ways -Derived from societal norms, family, and/or religious beliefs -Value system resulting from experiences with others -Function as standards that guide actions and behavior in daily situations; code of conduct

Qualitative Research

-Subjective -Asks how or why? -Perceptions are often evaluated

Randomized Control Trials (RCTs)

-are generally considered the gold standard of experimental research -they are commonly used to determine the safety and efficacy of new medication or to test the effectiveness of one intervention over another, and they are the foundation of EBP

Nonexperimental designs

-are used in research to describe and explain phenomena or examine relationships among phenomena

Mixed Methods

-Both quantitative and qualitative data are collected and analyzed -provides a broader picture of the gaps between identified areas of 'key services" and the reality of issues that need to be resolved in order to facilitate better nursing care and client outcomes -helpful in program evaluation and can provide a more holistic vision

Critical Appraisal of the Evidence

-Can do this by asking these questions: +What was the review question? +Were the search strategies explained and are they reasonable? +What were exclusion criteria/ were any important, relevant studies overlooked? +Were the studies in the review properly designed and executed (valid)? +Were there similar results found in all studies? +How reliable are the results?

Integrating the evidence

-Can do this by asking: +How can I apply these results to my community health nursing practice? +Will it benefit my clients? +Are my clients similar to the population studied? +Do I have the necessary resources? +Does this go against my client's values or preferences?

NFP program

-Improves prenatal health -Reduces rates of subsequent pregnancies/births -Increases intervals between births -Increases in maternal employment -Improves child school readiness

Cultivate a spirit of inquiry

-In order for effective change to occur, current practices must be continually examined, questioned, and challenged -need for continual curiosity about how we can best conduct our practice and the evidence needed to guide our clinical decision making: Why are we doing this? Is there evidence to support this practice?

Ethics and Values in Research

-Institutional Review Board (IRB)- must have approval anytime human subjects are used for research -Code of Ethics for Nurses- respect and dignity for clients -Values- personal beliefs regarding worth, truth, behaviors

Levels of Evidence

-Level One: experimental. Research studies, meta-analysis of RCTs -Level Two: Quasi-experimental studies with either no control group or no randomization -Level Three: Non-experimental studies, qualitative studies, meta-synthesis of qualitative studies; secondary analysis of existing quantitative studies, descriptive or comparative survey research -Level Four: expert consensus on evidence findings, clinician expertise, and patient preferences, clinical practice guidelines -Level Five: opinions of experts recognized on a national level; includes literature reviews, case studies, experience. Organizational experience, financial reports; cost benefit studies, and quality improvement studies; local data

Definitions of PICOT

-P: age, gender, ethnicity, with certain disorder +the population or problem at interest -I: exposure to disease, risk behavior, education +the intervention or range of interventions of interest -C: no disease, absence of risk factors, placebo or no intervention +what you want to compare the intervention against -O: risk of disease, rate of occurrence of adverse outcomes, accuracy of diagnosis +outcome of interest -T: time it takes for the intervention to achieve the outcome, time interval selected to observe the population of problem/condition +the time involved for the intervention to demonstrate an outcome

Quantitative Research

-Provides information that can be quantified -Objective measurement -May be as simple as providing specific numbers -Helps identify problems or relationships -Tend to examine isolated parts of problems or phenomena and do not generally pay attention to the larger context or overall health of individuals

Ethical Decision Making

-Respect -Autonomy -Beneficence -Nonmaleficence -Justice -Veracity -Fidelity

Key Values Influencing Client Health and Nursing Decision Making

-Self Determination -Right to health and well being -Right to equal access and quality of health care

Methods of Collecting Data

-Self report -observation -physiologic assessment -document analysis

Steps to Evidence-Based Practice (EBP)

1. Cultivate a spirit of inquiry 2. Ask the question (PICOT format) 3. Critically appraise the evidence 4. Integrate evidence with expertise 5. Evaluate outcomes 6. Disseminate outcomes

Steps in the Research Process

1. IDENTIFY an area of interest 2. FORMULATE a research question or statement 3. REVIEW the literature 4. SELECT a conceptual model 5. CHOOSE a research design 6. OBTAIN IRB approval 7. COLLECT and ANALYZE data 8. INTERPRET results 9. COMMUNICATE findings

Evaluating the emotional affects of long-term care on the elderly would be what type of research? A. Qualitative B. Quantitative C. Systematic D. Mixed methods

A. Qualitative Evaluates emotion and perceptions

Whose approval is needed for studies conducted on human subjects?

IRB (Institutional Review Board) and HSC (Human Subjects Committee)

The 5 A's

Ask Advise Assess Assist Arrange

Which ethical principle is applied when the nurse ensures the groups' involvement in decision-making?

B. Autonomy Autonomy is applied when the nurse promotes a group's right to and involvement in decision-making. Beneficence is demonstrated when the nurse makes decisions that actively promote the community's best interest and well-being. Respect is demonstrated by acknowledging the client as participants in shaping their own and the community's health outcomes. Justice is demonstrated when clients are treated fairly and equally.

Research done to evaluate the relationship of the implementation of a VAP bundle on the number of Ventilator Acquired Pneumonia cases is an example of what type of research? A. Qualitative B. Quantitative C. Systematic D. Mixed methods

B. Quantitative This research is able to be quantified and shows the relationship between two factors

When preparing to perform research, which would the nurse do first? A. Choose a research design B. Review the literature C. Formulate a research question D. Select a conceptual model

C. Formulate a research question After identifying an area of interest, the next step would be to formulate a research question or statement. This is followed by a review of literature, selection of a conceptual model, and then selection of a research design

DECIDE Model

D- define the problem E- ethical review C- consider the options I- investigate outcomes D- Decide and action E- Evaluate results

T or F? An instrument consistently measures what it is supposed to measure is generalizability?

False Reliability

PICOT

P- patient population/problem I- intervention C- comparison intervention or issue of interest O- outcome T- time

The 5 R's

Relevance Risks Rewards Roadblocks Repetition

True or False? Evidence-based practice involves clinical reasoning.

True; Clinical reasoning is an important component of evidence-based practice