Research Ch. 2, Research - Chapter 2

What are the steps in individual EBP efforts?

-Ask questions that are answerable with research evidence -Search for and assemble evidence -Appraise and synthesize evidence -Integrate evidence with other sources -Assess effectiveness of decision or advice

Appraisal of Guidelines Research and Evaluation (AGREE) Instrument consists of ratings of quality on what type of scale? 4-point scale 5-point scale 6-point scale 7-point scale

4-point scale

Several models of evidence-based practice have been developed. Which model focuses on the use of research from the perspective of individual clinicians? A) ARCC Model B) Clinical Nurse Scholar Model C) Iowa Model D) Stetler Model

D) Stetler Model

Fineout-Overholt and Johnston recommended a 5-component scheme for formulating evidence-based practice questions, using the acronym PICOT as a guide. Which two components are not always needed in this model? A) P and C B) I and O C) C and T D) P and O

C) C and T

Which level of evidence is systematic review of RCTs or systematic review of non-randomized trials?

Level 1

What is the highest level of evidence to be sought when making decisions?

Level 1 (Systematic review of RCTs, systematic review of non-randomized trials)

Which level of evidence is single RCT, single non-randomized trial?

Level 2

Whenever level 1 evidence is not available, what is the next level of evidence to be sought?

Level 2 (Single RCT, single non-randomized trial)

Which level of evidence is systematic review or correlational/ observational studies?

Level 3

Which level of evidence is single correlational/ observational study?

Level 4

Which level of evidence is systematic review of descriptive/ qualitative/ physiologic study?

Level 5

Which level of evidence is single descriptive/qualitative/physiologic study?

Level 6

Which level of evidence is opinions of authorities, expert committees?

Level 7

When you ask a research question, then review the literature, if there is sufficient evidence, what do you do next?

perform a pilot study

Research utilization begins with empirical findings for consideration in practice settings. Where does evidence-based practice begin? Integration of clinical judgments with research evidence A desire to abandon decisions based on custom and authority opinion A search for the best possible information for addressing a clinical problem A critique of existing practices

A search for the best possible information for addressing a clinical problem

The student nurse is constructing a presentation on evidence-based practice. Which statement should be included in the introduction about evidence-based practice? A) Conscientious integration of current best evidence with clinical expertise B) Utilization of nursing preferences in making clinical decisions C) Theoretical problem-solving strategy D) Emphasis on decision making based on custom

A) Conscientious integration of current best evidence with clinical expertise

A nurse is putting research into practice. What is the first step that should be considered in the process? A) Framing an answerable clinical question B) Searching for relevant research evidence C) Appraising and synthesizing the evidence D) Integrating evidence with other factors

A) Framing an answerable clinical question

Which occurs with individual evidence-based practice efforts? A) Tend to be less formalized approach than organizational evidence-based practice. B) Must take organizational factors into account. C) Must take interpersonal factors into account. D) Triggers for an individual project include pressing clinical problems.

A) Tend to be less formalized approach than organizational evidence-based practice.

Clinical practice guidelines distill a large body of evidence into a manageable form. Which describes clinical practice guidelines? Give general recommendations for evidence-based decision making. Address all of the issues relevant to a clinical decision. Guide clinical practice when there are a number of published articles. Completed by researchers.

Address all of the issues relevant to a clinical decision.

In which of the following clinical questions is fatigue the "I" component? A) Does fatigue affect agitation in cognitively impaired elders? B) Does a physical activity intervention affect fatigue in patients undergoing cardiac rehabilitation? C) What is the meaning of fatigue among patients with sleep apnea? D) Does the level of depression of patients suffering from chronic fatigue improve by participating in an exercise intervention?

Ans: A Fatigue is the "I" component (intervention, influence, or exposure) in the question, "Does fatigue affect agitation in cognitively impaired elders?" In the other answers, fatigue is one of the other components.

In the following clinical question, what is the Outcome (O component): What is the effect of relaxation therapy versus biofeedback on the functional ability of patients with rheumatoid arthritis? A) Functional ability B) Rheumatoid arthritis C) Biofeedback D) Relaxation therapy

Ans: A In the PIO acronym, P stands for the population or patients (rheumatoid arthritis); I stands for the intervention, influence, or exposure (biofeedback or relaxation therapy); and O stands for the outcomes (functional ability).

The Iowa Model identifies several knowledge-focused triggers for implementing an EBP project. Which following statement is considered a knowledge-focused trigger in the Iowa Model? A) A report in the New England Journal of Medicine regarding a potential flu epidemic B) Readmission rate of heart failure patients C) Poor patient survey results D) Increase in pediatric falls

Ans: A Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus ("triggers") for an EBP endeavor—(1) problem-focused triggers—the identification of a clinical practice problem in need of solution, or (2) knowledge-focused triggers—readings in the research literature. A report in a medical journal regarding a potential flu epidemic is an example of a reading in a research literature, and thus would be a knowledge-focused trigger. The other answers are examples of problem-focused triggers.

A narrative integrated review of qualitative studies focuses on interpretation of the studies. Which of the following study types would be considered an systematic integrated review of qualitative studies? A) Meta-synthesis B) Meta-analysis C) Randomized controlled trial D) Quasi-experiment

Ans: A Systematic reviews can take various forms. One form is a narrative (qualitative) integration that merges and synthesizes findings, much like a rigorous literature review. For integrating evidence from quantitative studies, narrative reviews increasingly are being replaced by a type of systematic review known as a meta-analysis. Meta-analysis is a technique for integrating quantitative research findings statistically. For qualitative studies, integration may take the form of a meta-synthesis. A meta-synthesis, however, is distinct from a quantitative meta-analysis: a meta-synthesis is less about reducing information and more about interpreting it. Randomized controlled trials and quasi-experiments are not types of systematic reviews.

Which of the following is an example of a systematic review? A) An RCT study published in the journal Nursing Research B) A meta-analysis from the Cochrane database C) A synopsis published in Evidence-Based Nursing D) A clinical practice guideline from the National Guideline Clearinghouse

Ans: B A meta-analysis is a type of systematic review and a technique for integrating quantitative research findings statistically. In essence, meta-analysis treats the findings from a study as one piece of information. The findings from multiple studies on the same topic are combined and then all of the information is analyzed statistically in a manner similar to that in a usual study. Unlike systematic reviews, clinical practice guidelines (which often are based on systematic reviews) give specific recommendations for evidence-based decision-making. Guideline development typically involves the consensus of a group of researchers, experts, and clinicians. A randomized controlled trial (RCT) is an individual study that focuses on the effectiveness of therapies rather than on broader health-care interventions. Synopses, or summaries, of systematic reviews and of single studies are available in evidence-based abstract journals such as Evidence-Based Nursing.

Most evidence hierarchies put which of the following at the pinnacle? A) Randomized clinical trials (RCTs) B) Systematic reviews of multiple studies C) Quality improvement projects D) It depends on the research question

Ans: B In all evidence hierarchies that include randomized clinical trials, quality improvement projects and research questions, systematic reviews are at the pinnacle.

Which of the following is the best resource to use when beginning the search for evidence necessary for an individual EBP project? A) Hayat, M. (2010). Understanding statistical significance. Nursing Research, 59(3), 219-223. B) Durbin, C. R., Fish, A. F., Bachman, J. A., & Smith, K. V. (2010). Systematic review of education intervention for improving advanced directive completion. Journal of Nursing Scholarship, 42, 234-241. C) Polit, D. R., & Beck, C. T. (2014). Essentials of Nursing Research: Appraising Evidence for Nursing Practice (8th ed.). Philadelphia: Wolters Kluwer| Lippincott Williams & Wilkins. D) Aggarwal, B., Liao, M., & Mosca, L. (2010). Predictors of physical activity at 1 year in a randomized controlled trial of family members of patients with cardiovascular disease. Journal of Cardiovascular Nursing, 29(6), 444-449.

Ans: B For an individual EBP endeavor, the best place to begin is by searching for evidence in a systematic review, clinical practice guideline, or other preprocessed source because this approach leads to a quicker answer—and, if your methodologic skills are limited, potentially a superior answer as well. Of the answers, only Durbin et al is a systematic review. The study by Aggarwal et al is an individual randomized controlled trial, not a systematic review. The article by Hayat provides general information on statistical significance and does not appear to be primary research. Polit and Beck is the textbook you are using, which is a secondary source, not primary research.

Which of the following is a question that would be asked as part of the process of appraising research evidence? A) What are the P, I, and O components? B) How rigorous and reliable is the evidence? C) What type of trigger should I use? D) Is a relevant systematic review available?

Ans: B Individual nurses have opportunities to put research into practice. The five basic steps for individual EBP are: (1) asking an answerable clinical question as evidenced by, "What are the P, I, and O components?" (2) searching for relevant research-based evidence as evidenced by, "Is a relevant systematic review available?" (3) appraising and synthesizing the evidence as evidenced by, "How rigorous and reliable is the evidence?" Triggers for an organizational project include both pressing clinical problems (problem-focused) and existing knowledge (knowledge-focused) such as asked by the question, "What type of trigger would I use?"

Which of following study types is a systematic review used for integration of statistical quantitative research findings? A) Meta-synthesis B) Meta-analysis C) Randomized controlled trial D) Quasi-experiment

Ans: B Systematic reviews can take various forms. One form is a narrative (qualitative) integration that merges and synthesizes findings, much like a rigorous literature review. For integrating evidence from quantitative studies, narrative reviews increasingly are being replaced by a type of systematic review known as a meta-analysis. Meta-analysis is a technique for integrating quantitative research findings statistically. For qualitative studies, integration may take the form of a meta-synthesis. A meta-synthesis, however, is distinct from a quantitative meta-analysis: a meta-synthesis is less about reducing information and more about interpreting it. Randomized controlled trials and quasi-experiments are not types of systematic reviews.

Research utilization is a process that begins with which of the following? A) A clinical problem that needs to be solved B) A problem-focused trigger C) A knowledge-focused trigger or research finding D) A well-worded clinical question

Ans: C Research utilization (RU) is the use of findings from disciplined research in a practical application that is unrelated to the original research. Evidence-based practice is broader than RU because it integrates research findings with other factors. Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus ("triggers") for an EBP endeavor—(1) problem-focused triggers—the identification of a clinical practice problem in need of solution, or (2) knowledge-focused triggers—readings in the research literature. A second catalyst for an EBP project is the research literature—knowledge-focused triggers, which is the origin akin to research utilization.

Asking a clinical question is the first step in evidence-based practice. What are the four components of a PICO clinical question? A) Population, implication, comparison, outcome B) Population, intervention, clinical, outcome C) Population, intervention, comparison, outcome D) Population, implication, clinical, outcome

Ans: C A crucial first step in evidence-based practice (EBP) involves asking relevant clinical questions that reflect uncertainties in clinical practice. Most guidelines for EBP use the acronyms PIO or PICO to help practitioners develop well-worded questions that facilitate a search for evidence. In the acronym PIO, the P stands for population or patients; the I stands for intervention; and the O stands for outcome. The acronym PICO includes these same three components plus a fourth, C, which stands for comparison.

Which of the following activities is part of an organizational—but not an individual—EBP endeavor? A) Asking a good question/identifying a problem B) Searching for evidence C) Assessing implementation potential D) Synthesizing and appraising evidence

Ans: C EBP in an organizational context involves many of the same steps as individual EBP efforts, but is more formalized and must take organizational factors into account. Triggers for an organizational project include both pressing clinical problems (problem-focused) and existing knowledge (knowledge-focused), such as assessing implementation potential. Individual nurses have opportunities to put research into practice. The five basic steps for individual EBP are: (1) asking an answerable clinical question; (2) searching for relevant research-based evidence; (3) appraising and synthesizing the evidence; (4) Integrating the evidence with your own clinical expertise, patient preferences, and local context; (5) Assessing the effectiveness of the decision, intervention, or advice.

Which of the following can be used to critically appraise clinical practice guidelines? A) A systematic review from the Cochrane Collaboration B) The Iowa model C) The AGREE instrument D) An evidence hierarchy

Ans: C Evidence-based clinical practice guidelines distill a body of evidence into a usable form. Unlike systematic reviews, clinical practice guidelines, which often are based on systematic reviews, give specific recommendations for evidence-based decision-making. Several appraisal instruments are available to evaluate clinical practice guidelines, but one with broad support is the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument. The Iowa model is used in selecting a problem for an institutional evidence-based project. An evidence hierarchy is a tool for ranking evidence sources according to the strength of the evidence they provide.

A nurse in the United States is scheduled to care for a child with an ostomy. Which of the following resource would best assist the nurse with specific guidelines for evidence-based decision making for this patient? A) MEDLINE B) TRIP C) www.guidelines.gov D) www.rnao.org/bestpractices

Ans: C Finding clinical practice guidelines can be challenging, because there is no single guideline repository. A standard search in bibliographic databases such as MEDLINE will yield many referencesóbut could yield a mixture of citations to not only the actual guidelines, but also to commentaries, implementation studies, and so on. A recommended approach is to search in guideline databases, or through specialty organizations that have sponsored guideline development. In the United States, nursing and health-care guidelines are maintained by the National Guideline Clearinghouse (www.guideline.gov). In Canada, the Registered Nurses Association of Ontario (RNAO) (www.rnao.org/bestpractices) maintains information about clinical practice guidelines. Two sources in the United Kingdom are the Translating Research into Practice (TRIP) database and the National Institute for Clinical Excellence (NICE).

In the following clinical question, what is the Intervention/influence/exposure (I component): Does taking antidepressants affect the risk of suicide in cognitively impaired adolescents? A) Adolescence B) Suicide C) Antidepressant use D) Cognitive impairment

Ans: C In the PIO acronym, P stands for the population or patients (cognitively impaired individuals); I stands for the intervention, influence, or exposure (antidepressants); and O stands for the outcomes (risk of suicide).

The best-known early research utilization (RU) project sought to bridge the gap between research and practice. Which following is the name of that well-known project? A) Cochrane Collaboration B) Stetler Model of Research Utilization C) Conduct and Utilization of Research in Nursing (CURN) Project D) Promoting Action on Research Implementation in Health Services

Ans: C Recognition of the gap between research and practice led to formal attempts to bridge the gap. The best-known of several early RU projects is the Conduct and Utilization of Research in Nursing (CURN) Project, which was awarded to the Michigan Nurses' Association by the Division of Nursing in the 1970s. The Stetler Model of Research Utilization and Promoting Action on Research Implementation in Health Services are evidence-based practice models, not projects. One keystone of the EBP movement is the Cochrane Collaboration, which was founded in the United Kingdom based on work by British epidemiologist Archie Cochrane. It is not a research utilization project.

The Iowa Model identifies problem-focused triggers for implementing an EBP project. Which of the following is a problem-focused trigger in the Iowa Model? A) A finding published recently in a nursing journal B) A new clinical guideline issued by a federal agency C) An increase in latex allergy among emergency room nurses D) Questions from hospital committee

Ans: C Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus ("triggers") for an EBP endeavor—(1) problem-focused triggers—the identification of a clinical practice problem in need of solution, or (2) knowledge-focused triggers—readings in the research literature. A second catalyst for an EBP project is the research literature—knowledge-focused triggers, which is the origin akin to research utilization. The catalyst might be a new clinical guideline or a research article discussed in a journal club.

Which of the following models was explicitly developed with the idea that individual nurses could engage in RU-type activities? A) Iowa Model B) Johns Hopkins Model C) Cochrane Model D) Stetler Model

Ans: D Some models focus on the use of research from the perspective of individual clinicians such as the Stetler Model, one of the oldest models that originated as an RU model, but most focus on institutional EBP efforts such as the John Hopkins Nursing EBP Model and the Iowa Model. There is no Cochrane Model; the Cochrane Collaboration is an organization that prepares, maintains, and promotes the accessibility of systematic reviews.

As a nurse, you must understand the difference between research utilization and evidence-based nursing practice. Which of the following best defines evidence-based practice? A) Begins with research itself, clinical expertise, and patient preference B) Uses new evidence and translates research findings into real-world applications C) Uses findings from disciplined research in practical application unrelated to original research D) Integrates best research evidence, with clinical expertise, patient preference, and a particular clinical situation

Ans: D Advocates of EBP do not minimize the importance of clinical expertise. Rather, they argue that evidence-based decision-making should integrate best research evidence with clinical expertise, patient preferences, and local circumstances. Research utilization (RU) is the use of findings from disciplined research in a practical application that is unrelated to the original research. In research utilization, the emphasis is on translating research findings into real-world applications. The starting point in RU is new evidence or a research-based innovation. EBP is broader than RU because it integrates research findings with other factors. Whereas RU begins with the research itself (how can I put this innovation to good use in my clinical setting?), EBP starts with a clinical question (what does the evidence say is the best approach to solving this problem?).

In the following clinical question, what is the Comparison (C component): Does chronic stress affect inflammatory responses in older men with atherosclerotic disease? A) Chronic stress B) Inflammatory response C) Atherosclerotic disease D) There is no "C" component

Ans: D In the PICO acronym, P stands for the population or patients (older men with atherosclerotic disease); I stands for the intervention, influence, or exposure (chronic stress); C stands for the component that is needed (there is no intervention or influence of interest contrasted with a specific alternative); and O stands for the outcomes (inflammatory response).

In the following clinical question, what is the Population (P component): Do stress and depression affect dyspnea in patients with chronic obstructive pulmonary disease (COPD)? A) Patients who are stressed B) Patients who are depressed C) Patients who experience dyspnea D) Patients with COPD

Ans: D In the PIO acronym, P stands for the population or patients (patients with chronic obstructive pulmonary disease); I stands for the intervention, influence, or exposure (stress and depression); and O stands for the outcomes (dyspnea).

A nurse is observing how the time of feeding impacts an inpatient's gastric reflux. In which of the following steps of the EBP process would the nurse determine whether a specific feeding time alleviated the patient's gastric reflux symptoms? A) Searching for and collecting evidence that addresses the question B) Appraising and synthesizing the evidence C) Integrating the evidence with own clinical expertise, patient preferences, and local context D) Assessing the effectiveness of the decision, intervention, or advice

Ans: D It would be during step 5 of the EBP process, assessing the effectiveness of the decision, intervention, or advice, that the nurse would determine whether a specific feeding time (an intervention) is effective in alleviating the patient's gastric reflux symptoms.

Some EBP models recommend a formal assessment of organizational ìfit,î known as implementation potential, when an organization is considering undertaking an EBP project. Which following issue is of particular importance to address to determine the implementation potential of the EBP project for the organization? A) Effectiveness of the innovation B) Nurses' attitude toward the innovation C) Patient benefit of the innovation D) Transferability of the innovation

Ans: D Some EBP models recommend a formal assessment of organizational ìfit,î often called implementation potential (or, environmental readiness). In determining the implementation potential of an innovation in a particular setting, several issues should be considered, particularly the transferability of the innovation (i.e., the extent to which the innovation might be appropriate in new settings), the feasibility of implementing it, and its cost-benefit ratio.

Which following level of evidence includes systematic reviews of multiple studies? A) Level IV B) Level III C) Level II D) Level I

Ans: D Systematic reviews are at the pinnacle of the hierarchy (Level I), because the strongest evidence comes from careful syntheses of multiple studies. The next highest level (Level II) includes individual randomized controlled trials (RCTs). Going down the "rungs" of the evidence hierarchy for Therapy questions results in less reliable evidence—for example, Level III evidence comes from a type of study called quasi-experiment. In-depth qualitative studies are near the bottom, in terms of evidence regarding intervention effectiveness.

After an institutional project has been developed, the next step is to conduct a pilot study (a trial study). Based on the Iowa Model, which step would identify the success or failure of a pilot study? A) Developing an evaluation plan B) Measuring client outcomes prior to implementation C) Training relevant staff in the use of the new guideline D) Evaluating the project in terms of both the process and the outcomes

Ans: D The success or failure of the pilot study would be assessed in the evaluation of the study, which is the last step. The other answers refer to earlier steps in the implementation of the study.

A RN is putting research into practice. What step of the process is involved with the validity of study findings? Framing an answerable clinical question Searching for relevant research evidence Appraising the evidence Integrating evidence with other factors

Appraising the evidence

Evidence-based practice writers distinguish between background and foreground questions. What is a background question? A) Based on current best research evidence. B) Specific, detailed questions about a clinical problem. C) General, foundational questions about a clinical issue. D) Questions located on websites.

C) General, foundational questions about a clinical issue.

Which activity will limit researchers to improve the prospect for evidence-based practice and research utilization? A) Conducting high-quality, methodologically sound studies B) Disseminating results to a broad audience C) Providing periodical available supports during regular work hours D) Discussing the clinical implications of their study results in their research reports

C) Providing periodical available supports during regular work hours

Systematic reviews are published in professional journals. Which database contains thousands of systematic reviews related to healthcare interventions? Cochrane Database of Systematic Reviews Campbell Collaboration Agency for Healthcare Research and Quality Joanna Briggs Institute

Cochrane Database of Systematic Reviews

What term means more specific application of targeted research findings to a specific setting and clientele?

Evidence-based practice

A student nurse is trying to find out what a mixed methods synthesis is. What is a mixed methods synthesis? Integrate and synthesize both quantitative and qualitative evidence. Integrate quantitative evidence. Integrate and synthesize qualitative evidence. Integrate qualitative evidence.

Integrate and synthesize both quantitative and qualitative evidence.

What is indirect research utilization? Involves changes in nurses' thinking Involves the direct use of findings in giving patient care Involves use of findings to persuade others Involves changes in patient thinking toward nurses

Involves changes in nurses' thinking

Which reference is a comprehensive reference resource that provides an array of clinical information for nurses, including evidence-based care sheets, best practice guidelines, and point-of-care drug information? Clinical Evidence Evidence-based Nursing Worldviews on Evidence Based Nursing Nursing Reference Center

Nursing Reference Center

What does PICOT stand for?

Population Intervention/ Independent variable/ Issue Comparison factor Outcome Time

There are several resources to support evidence-based practice. What is metasynthesis? Qualitative, narrative approach to integration of a study Quantitative method that integrate findings statistically Synthesis and appraisal of research evidence with specific recommendations Set of interventions to treat or prevent a cluster of symptoms

Qualitative, narrative approach to integration of a study

The "gold standard" of evidence for exploratory (experimental) studies

Randomized control study

Evidence-based practice typically involves weighing various types of evidence in an effort to determine best evidence. Most evidence hierarchies put which systematic review at the pinnacle? Randomized controlled trials Program evaluations Clinical practice guidelines Meta-analyses of multiple clinical trials

Randomized controlled trials

What term means taking research that was done and translating it to real world settings?

Research utilization

There are several resources to support evidence-based practice. What are care bundles? Rigorous integrations of research evidence from multiple studies of a topic Evidence-based clinical practice guidelines that combine a synthesis and appraisal of research evidence Set of interventions to treat or prevent a cluster of symptoms Meta-analysis or quantitative methods that integrate findings statistically

Set of interventions to treat or prevent a cluster of symptoms

A review of multiple studies, the BEST type of evidence

Systematic literature review

Which is not a major barrier to evidence-based practice in nursing? The fact that many clinical nurses are not academically prepared to critically evaluate nursing research studies The support of organizations that reward nurses who engage in research utilization efforts The low number of replication of nursing studies that show promise for utilization The absence of quality, clinically relevant nursing studies

The support of organizations that reward nurses who engage in research utilization efforts

TRUE OR FALSE: A well-written research question should not be able to be answered with a simple "yes" or "no"

True

The terms research utilization and evidence-based practice are sometimes used synonymously. The two concepts are distinct. Where does research utilization start? Uses findings of a study that are related to the previous research of the topic. Emphasis is on translating historical knowledge into real-world applications. Use of a set of studies in a practical application unrelated to the original research. Critique of existing practical applications unrelated to historical research.

Use of a set of studies in a practical application unrelated to the original research.

When you ask a research question, then review the literature, if there is insufficient evidence, what do you do next?

conduct a research study

The goal of nurse's for understanding research is...

to understand the science behind the intervention and to make an informed decision regarding the care that you provide