Chapter 2 - Theory, Research, and Evidence-Based Practice

The nursing student studying research exhibits an understanding when informing the instructor that which of the following is the bridge between theory and practice? *>Theory development* >Evidence-based research *>Client-focused care* >Case management

Evidence-based research *Explanation:* Evidence-based research is translational research that forms the bridge between theory and practice.

One of the primary focuses of nursing research is to:

generate knowledge to guide practice. *Explanation:* One of the major reasons for conducting research is to expand a profession's knowledge base.

Which method of qualitative research was developed by the discipline of anthropology?

Ethnography *Explanation:* Used to examine issues of culture of interest to nursing

A nurse is formulating a clinical question in PICO format. What does the letter P represent?

Explicit descriptions of the population of interest

After reviewing several research articles, the clinical nurse specialist on a medical surgical unit rewrites the procedure on assessing placement of a nasogastric tube. What source of nursing knowledge did the nurse use in this situation?

Scientific knowledge

Who is considered to be the first nursing theorist who conceptualized nursing in terms of manipulating the environment? *>Florence Nightingale* >Sister Callista Roy *> Dorothea Orem* >Lydia Hall

Florence Nightingale *Explanation:* Florence Nightingale conceptualized the nurse's role as manipulating the environment to facilitate and encourage the reparative process. This would be accomplished by attending to ventilation, warmth, light, diet, cleanliness, and noise.

How are the first stages of the nursing process and nursing research linked?

The nurse assesses problems initially. *Explanation:* The first step for the practicing nurse is to assess a problem; for the researcher, the first step is to recognize the general problem area.

A nurse is using general systems theory to describe the role of nursing to provide health promotion and patient teaching. Which statement reflect key points of this theory? Select all.

>The whole system is always greater that its parts >Boundaries separate systems from each other and their environments >To survive, open systems maintain balance through feedback *Explanation:* According to general systems theory, a system is a set of interacting elements contributing to the overall goal of the system. The whole system is always greater that it parts. Boundaries separate systems from each other and their environments. Systems are hierarchical in nature and are composed of interrelated subsystems that work together in such a way that a change in one element could affect other subsystems, as well as the whole. To survive, open systems maintain balance through feedback. An open system allows energy, matter, and information to move freely between systems and boundaries, whereas a closed system does not allow input from or output to the environment.

A nurse educated at the baccalaureate level is participating in clinical nursing research. Based on the nurse's educational level, which activity would the nurse be expected to perform? Select all that apply.

>evaluate research for its applicability to nursing practice. >participate in the implementation of scientific studies *Explanation:* A baccalaureate-prepared nurse is expected to read, interpret and evaluate research for applicability to nursing practice and participate in the implementation of scientific studies. An associated-degree nurse assists in identifying problem areas in nursing practice; a baccalaureate nurse actually identifies nursing problems that need to be investigated. A master's level prepared nurse analyzes and reformulates nursing practice problems so that scientific knowledge and scientific methods can be used to find solutions; the master's level nurse also assists others in applying scientific knowledge in nursing practice.

A nurse is completing a family assessment on a routine home health visit. The parents have a child with a severe peanut allergy. The mother states that she does not purchase any foods with peanut or peanut oil for her family. The other children are allowed to have foods containing peanuts while they are at school and visiting with friends and family. The nurse would conclude that which of the following theories would most like be the basis for this family's functioning? *>General Systems Theory* >Adaptation Theory *>Developmental Theory* >Maslow's Theory

Adaptation Theory *Explanation:* Adaptation theory is based on an understanding of humans and their interaction with the environment. In this situation the mother is manipulating the physical environment for the child with allergies, as well as the needs and/or desires of the other children. Systems theory is described as studying relationships between a whole and identifying how parts interact and behave. Developmental theory is based on growth and maturation of humans. Maslow's theory is based on a pyramid of human needs related to the most primitive needs moving toward higher level needs, such as self-actualization.

Which of the following theories emphasizes the relationships between the whole and the parts, and describes how parts function and behave?

General systems theory

Evidence-based care emphasizes decision making based on the best available evidence and: *>use of outcome studies to guide decisions.* >evaluation by experts to direct specialty areas. *>care based on pathophysiologic factors.* >cost efficiency of treatment models.

use of outcome studies to guide decisions. *Explanation:* Evidence-based care emphasizes decision making based on the best available evidence and the use of outcome studies to guide decisions.

In nursing class the instructor asks the students about the nursing research process. The student identifies the first nurse to collect data on clients as which of the following?

Florence Nightingale *Explanation:* Florence Nightingale was the first nurse to collect data. She monitored and recorded care and responses in victims of the Crimean War.

Who is considered to be the first nursing researcher? *>Florence Nightingale* >Dorothea Dix *>Clara Barton* >Lillian Wald

Florence Nightingale *Explanation:* Nursing research has been an integral part of the profession since Florence Nightingale documented the care of soldiers in the Crimean War.

A student nurse interacting with patient on a cardiac unit recognizes the four concepts in nursing theory that determine nursing practice. Of these four which is the most important?

Person *Explanation:* The focus of nursing, regardless of definition or theory, is the person.

There are four common concepts in nursing theory. While all concepts are important, the focus of nursing is always on which of the following? *>Person* >Environment *>Health* >Nursing

Person *Explanation:* All of these concepts are important in nursing theory; however, the focus of nursing is on the person (client).

The director of nurses (DON) in a long-term care facility has noticed an increased number of urinary tract infections (UTIs) on the east wing of the facility, and would like the infection control nurse to investigate this problem. What is the best problem statement for this study? *>"Is there a relationship between the personnel caring for specific clients and whether or not these clients developed UTIs?"* >"Is there an increase in the number of UTIs on the east wing of the facility?" *>"Does the east wing have a greater number of UTIs than the west wing of the facility?"* >"What is the client census on the east wing as opposed to the other wings of the facility?"

"Is there a relationship between the personnel caring for specific clients and whether or not these clients developed UTIs?" *Explanation:* The problem statement in a research study identifies the direction that a research project will take. The statement should be clear and unambiguous, express a relationship between two or more variables, identify the population to be studied, and encourage empiric testing.

When interpreting the results of a research study, a nurse researcher is responsible for making sure the results: *(Select all)* *>make sense* >are consistent with the data *>are in their raw form* >can be applied to a single concept.

>make sense. >are consistent with the data. *Explanation:* The results must make sense and be consistent with the data; this is part of the responsibility of researchers in interpretation. The implications are examined. The following question is asked: "How do these implications apply in the broader context?" Data are not the final results. They are a raw form of the answer. Reviewers put the data through various types of analysis and interpretation and manage them in an orderly, planned manner.

Which nursing actions reflect the use of philosophy as knowledge base when delivering evidence-based care to patients? Select all.

>A nurse draws from personal experience of being a patient to establish a therapeutic relationship wit a patient >A nurse uses spiritual training to draw strength when counseling a patient who is in hospice for an inoperable brain tumor *Explanation:* Philosophy is the study of wisdom, fundamental knowledge, and the processes used to develop and construct one's perceptions of life. A philosophy is developed from personal experiences (such as the experience of being the patient), through formal and informal educational experiences, through religion and culture (such as using spiritual training as a source of strength), and from the environment.

A nursing student is reading a research article from a nursing journal. The student is aware that the opening paragraph summarizing the article and the research findings is a good place to start. What part of the article is the nursing student reading?

Abstract *Explanation:* The abstract is located at the beginning of the article, and it summarizes the entire article and usually provides the purpose of the study, a description of the subjects, data collection and data analysis, and a summary of important findings. The review of literature discusses relevant studies that have been conducted in the area of this study, and it is included in the introduction. The results are the findings of the study and are often presented both in words and charts, tables, or graphs. The conclusions are the discussions of the results and suggestions for further study.

The nursing instructor asks a group of students to identify a theory that describes how humans adjust to life with other living things and with the environment. One student correctly identifies this as which theory? *>Nursing theory* >Systems theory *>Adaptation theory* >Developmental theory

Adaptation theory *Explanation:* The adaptation theory describes adjustment of living things to other living things and the environment. The systems theory describes how parts interact together. The nursing theory describes, explains, predicts, and controls outcomes in nursing practice. The developmental theory describes the maturation of humans through stages.

A community health nurse has been visiting a diabetic client whose morning fasting glucose levels are constantly elevated. Upon further assessment, the nurse determines that the client's spouse does not understand how to prepare meals following the prescribed diabetic diet. Using Dorothea Orem Self Care Theory, how can the nurse help meet the needs of this client? *>Arrange an evaluation appointment with a dietitian* >Set up diabetic home meal delivery for the client. *>Assist the spouse with online grocery shopping.* >Authorize an unlicensed nursing personnel to cook for the client.

Arrange an evaluation appointment with a dietician. *Explanation:* According to Dorothea Orem's theory, arranging an evaluation appointment with a dietician the nurse is facilitating self-care to sustain life and health, to recover from disease or injury, or to cope with its effects. The nurse is providing a service that assists the client and spouse to progressively maximize their self-care potential. People learn behaviors that they perform on their own behalf to maintain life, health, and well-being. The other options are providing care for the client, not facilitating self-care.

When conducting quantitative research, the researcher collects information to support a hypothesis. This information would be identified as:

Data

A nurse is completing a family assessment on a routine home health visit. There is a mother, father, and three children ages 2, 4, and 6 years of age. She watches the children individually as they play and interact with one another. She compares each child with the norms established for the age groups and determines and they are all within normal limits for their ages. The nurse would be utilizing which of the following theories as the basis for this part of the family assessment?

Developmental Theory *Explanation:* Developmental theory is based on growth and maturation of humans. In this situation the nurse is assessing what the child is doing with regard to norms for the specific age child. Adaptation theory is based on an understanding of humans and their interaction with the environment. Systems theory is described as studying relationships between a whole and identifying how parts interact and behave. Maslow's theory is based on a pyramid of human needs related to the most primitive needs, moving toward higher level needs, such as self-actualization.

A nurse who works in a pediatric practice assesses the developmental level of children of various ages to determine their psychosocial development. These assessments are based on the work of: *>Erikson* >Maslow *>Watson* >Rogers

Erikson *Explanation:* Erik Erikson based his theory of psychosocial development on the process of socialization, emphasizing how individuals learn to interact with the world. Erikson recognized the role of social, biologic, and environmental factors in development, and defined specific tasks or conflicts that people accomplish or overcome during what he defined as the eight stages of life, based on chronological age. Abraham Maslow developed his theory of human needs in terms of physical and psychosocial needs considered essential to human life, rather than by chronologic age as Erikson did. Maslow defined five levels of need in a hierarchy, with different needs existing simultaneously. Jean Watson is a nursing theorist who is known for her focus on caring. The central theme of her work is that nursing is concerned with promoting and restoring health, preventing illness, and caring for the sick. Caring is universal and is practiced through interpersonal relationships. Martha Rogers is a nursing theorist who is known for her theory focus of the individual client being central to the discipline of nursing. Nursing interventions are directed toward repatterning human environment fields or assisting in mobilizing inner resources.

When looking at a model for evidence-based practice, what is the final step of the process?

Evaluating practice change *Explanation:* The fifth and final step in the process of implementing evidence-based practice is to evaluate and critically appraise the change in practice. Formulating a clinical question and searching and appraising the literature precede this step.

A nursing theorist examines a hospital environment by studying each ward and how it works individually, then relates this information to the hospital as a whole working entity. This is an example of the use of which theory?

General systems theory *Explanation:* General systems theory is an example of an interdisciplinary base for a nursing theory. This theory describes how to break whole things into parts and then to learn how the parts work together in "systems." It emphasizes relationships between the whole and the parts and describes how parts function and behave. Another example of an interdisciplinary base for nursing theory is the adaptation theory. Adaptation theory defines adaptation as the adjustment of living matter to other living things and to environmental conditions. A third interdisciplinary base for nursing theory is the developmental theory. Developmental theory outlines the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death.

A charge nurse meets with staff to outline a plan to provide transcultural nursing care for patients in their health care facility. Which theorist promoted this type of caring as the central theme of nursing care, knowledge, and practice?

Madeline Leininger Madeline Leininger's theory provides the foundations of transcultural nursing care by making caring the central theme of nursing.

A nurse is planning to conduct a nursing research study and is seeking federal funding. Which institution would be most helpful for the nurse to contact funding? *>National Institutes of Health* >National Institute of Nursing Research *>Institute of Medicine* >ANA Cabinet on Nursing Research

National Institute of Nursing Research *Explanation:* The nurse would most likely contact the National Institute of Nursing Research, which was established under the National Institutes of Health in response to a 1983 study by the Institute of Medicine. The institute's purpose was to place nursing securely in the sphere of scientific investigation and to support research and training in client care, health promotion, and disease prevention, as well as the mitigation of effects of acute and chronic disabilities. The NINR has continued to fund and support nursing research and is instrumental in the support and dissemination of seminal work in nursing. The ANA Cabinet on Nursing Research was responsible for establishing priorities for nursing research.

What is the best explanation for the way evidence-based practice (EBP) has changed the way nursing care is delivered?

Nursing care now uses EBP as a means of ensuring quality care. *Explanation:* The facilitation of EBP involves identifying and evaluating current literature and research, as well as incorporating the findings into client care as a means of ensuring quality care. The other answers are incorrect; they were used even before EBP became a major force in the delivery of nursing care.

A nurse is developing a foreground question for nursing research using the PICO model. Which component would be represented by the statement, "a 45-year-old male with coronary heart disease and atrial fibrillation"? *>P* >I *>C* >O

P *Explanation:* When using PICO, the "P" stands for the patient or problem and its delineation. The "I" signifies the intervention considered; "C" denotes comparison if appropriate, or it may be optional; and "O" represents the outcome of interest or relevant outcomes.

A nurse manager schedules a clinic for the staff to address common nursing interventions used in the facility and to explore how they can be performed more efficiently and effectively. What is the term for this type of theory affecting change in clinical nursing practice?

Perspective theory *Explanation:* Perspective theories address nursing interventions and are designed to control, promote, and change clinical nursing practice.

Which type of quantitative research is often conducted to examine the effects of nursing interventions on patient outcomes?

Quasi-experimental research *Explanation:* Quasi-experimental research is often conducting in clinical settings to examine the effects of nursing interventions on patient outcomes.

A nurse is discussing dietary issues with a Latino client in the clinic. The client states, "My grandmother always told me that I needed to include beans in my diet so that my muscles would grow." The information that the client is expressing is known as what? *>Traditional knowledge* >Authoritative knowledge *>Scientific knowledge* >Philosophical knowledge

Traditional knowledge *Explanation:* Traditional knowledge is known as knowledge that is passed down from one generation to the next. A grandmother passing information is an example of traditional knowledge. Authoritative knowledge is information that is gleaned from an expert based on their perceived experience. Scientific knowledge is derived through the scientific method. Philosophy is the study of wisdom and one perceptions of life.

When you ask an experienced nurse why it is necessary to change the patient's bed every day, the nurse says, "I guess we have just always done it that way." This answer is an example of what type of knowledge?

Traditional knowledge *Explanation:* Traditional knowledge is the part of nursing practice passed down from generation to generation, often without research data to support it. Scientific knowledge is that knowledge obtained through the scientific method (implying thorough research). Authoritative knowledge come from an expert and is accepted as truth based on the person's perceived expertise. Instinct is not a source of knowledge.

A nurse is preparing to conduct a research study and uses the PICO format to develop the foreground question which is: "In adults, does reducing salt intake, compared to no change in salt intake, lower blood pressure?" The nurse identifies the "P" as: *>adults* >reducing salt intake *>no change in salt intake* >lower blood pressure.

adults. *Explanation:* Using the PICO format, "P" refers to the population, which in this case is adults. "I" refers to the intervention, which is reducing salt intake. "C" refers to comparison, which is no change in salt intake. "O" refers to the outcome, which would be lower blood pressure.

When the nurse researcher informs the participant that his identity will not be linked with the information that is collected, the researcher is ensuring the participant's: *>anonymity* >protection from harm. *>ability to withdraw* >confidentiality.

confidentiality *Explanation:* Confidentiality ensures that the subjects' identities will not be linked with the information they provide and will not be publicly divulged.

A nurse researcher develops a foreground question in preparation for conducting a research study. The question is: "In clients with intravenous catheters, how does replacing administration sets every 72 hours (h) compared to other frequent intervals (24h, 48h, or 96h) decrease infection rates?" Applying the PICO framework, which part of the statement reflects the "O"?

decrease infection *Explanation:* The "O" of PICO indicates the outcome, which in this instance is "decrease infection." The "P" refers to patients with intravenous catheter; "I" refers to replacing administration set every 72 hours; "C" refers to replacing it at other frequencies.