Lead and Inspire 2 Exam 1

Questions when searching a database for research

-Is it current? -What search strategies are supported? -When was the database last updated?

Study bias

Anything that distorts study findings in a systematic way arising from the methodology of the study Can compromise the validity of the findings

PICOT etiology format

Are ________________(P) who have _________(I) compared to those without _________________(C) at ______________ risk for/of ___________ (O) over ____________(T)?

The intensive care unit EBP team noticed an increase in ventilator associated pneumonia (VAP) cases in trauma patients on ventilators. Which is a relevant QI question? a. Does oral care with chlorhexidine reduce VAP in patients receiving mechanical ventilation? b. Why are VAP rates so high in our trauma patients? c. In trauma patients that are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect VAP development?

B

In performing a rapid critical appraisal of a research study as evidence, which three factors are the most important to be evaluated? a. Study validity, study veracity, study strength b. Study validity, study reliability, study confidence c. Study validity, study reliability, study applicability d. Study validity, study strength, study reproducibility

C

Which is a relevant intervention clinical question? a. Does oral care with chlorhexidine reduce VAP in patients receiving mechanical ventilation? b. Why are VAP rates so high in our trauma patients? c. In trauma patients that are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect VAP development?

C

An obstetrical nurse wants to implement a body of evidence related to fetal monitoring practices on the unit. What is the first step that this nurse should take? a.Review the literature about fetal monitoring practices b.Consult with the expert nurses on the unit c.Begin to foster an attitude of curiosity in the OB staff d.Evaluate the outcomes of current practices

C Rationale: Cultivating an attitude of inquisitiveness, curiosity, and inquiry is foundational to the EBP process and is considered to be "step 0."

Appraising case studies

Disadvantages ·Ranked lower in the hierarchy of quantitative evidence ·not reliable as a sole source of evidence ·Unable to make generalizations to general population Advantages ·new issues and rare and/or adverse events in practice ·Assists in hypothesis generation

PICOT meaning template

How do ________________(P) with _________(I) perceive _________________(O) during ____________(T)? *note that there is no Comparison

PICOT prognosis template

In ________________(P) how does___________(I) compared to _____(C) influence/predict _______(O) over (T)____________?

PICOT intervention template

In ________________(P) how does___________(I) compared to __________(C) affect ___________(O) within (T)____________?

Narrative vs content analysis

Narrative analysis generates and interprets stories about life experiences in a way that allows understanding of interview data Content analysis commonly refers to breaking down data by coding, comparing, contrasting, and categorizing bits of information, then reconstituting them in some new form, such as description, interpretation, or theory

mixing methods

Only used by experienced researchers who have a deep understanding of the paradigms of both quantitative and qualitative research Useful for focusing on research questions that call for the understanding of real-life contextual, multilevel, and cultural perspectives on intervention success Used when the intent is to combine qualitative and quantitative methods to draw on the strengths of each

Study validity

Study validity refers to whether the study results can be "believed" (internal validity) and whether the results can be generalized to other settings/patient populations (external validity)

AHRQ National Healthcare Quality Report

The National Healthcare Disparities Report tracks the state of national healthcare quality on an annual basis. Measures trends in effectiveness of care, patient safety, timeliness of care, patient centeredness and efficiency, care coordination, timeliness, infrastructure, and access to health care. Data are most useful when combined with external evidence that supports specific actions to improve outcomes

Instrument reliability

The consistency with which a measurement tool gives the same result with repeated use.

Phenomenology/hermeneutics

Used to study the lived experience of a situation Addresses questions about how people perceive their experiences in a specified situation to achieve better understanding of the phenomenon

Limiting in searches

allows you are pare down on the amount of results. Can filter by publication year, full text, type of study, etc. Limiting to RCTs or meta-analysis first can help determine the highest level of evidence that is available

grounded theory

an inductive method of generating theory from data by creating categories in which to place data and then looking for relationships among categories. Theory is then grounded in empirical data.

Foreground questions

asks for specific scientific evidence about diagnosing, treating, or educating patients. Ex. PICOT question

Which of the following sources of evidence would be the best evidence to use to suggest a clinical practice change? a. A well-designed randomized controlled trial (RCT) b. A systematic review that encompasses multiple studies c. Expert opinion of experienced and educated nurses d. A case study that addresses a similar clinical situation

b.A systematic review that encompasses multiple studies Rationale: Systematic reviews are pre-appraised evidence, which are considered to be higher on the hierarchy of evidence than expert opinion, individual RCTs, or case studies.

EBP practice change formula

level of evidence (from step 2) + quality of evidence (step 3) = strength of evidence (confidence)

EBP Step 4

synthesis of external evidence, internal evidence, and patient preferences. Also consider the availability of resources

Types of foreground questions

*Intervention questions (What intervention most effectively leads to an outcome?) *Prognosis/prediction questions (What indicators are most predictive of an outcome?) *Diagnosis questions (What test most accurately diagnoses an outcome?) *Etiology questions (To what extent is a factor associated with an outcome?) *Meaning questions (How does an experience influence an outcome?)

Questions about study reliability

-Do the numbers add up? Does the sum of all n values equal the original N reported? -What is the magnitude of the effect? The magnitude of effect is the degree of the difference in effect (or its lack) between study groups -What is the strength of association? Risk comparisons -What is the clinical significance? -What is the precision of measurement of the effect? How much room for error is there.

Types of study bias

-Selection bias: based on how participants are selected for the study. Can be reduced by randomization -Knowledge of who receives the intervention: can be avoided by using double blind studies -Gatekeepers: occurs with convenience sampling, may choose patients that are easier, more likely to volunteer, or healthier rather than a representative sample of the population. -Measurement Bias: how the data are measured -Recall bias: relying on patient's memory to recall information (such as in case-control studies) can lead to errors and inaccurate reporting -Information bias: when researchers record different information from interviews or patient records, usually when they know which group the patient is in for the study. -Loss to follow-up: loss of participants in longitudinal studies that leads to measurement bias - Contamination: measurement bias where participants in one group of the study get exposed to the alternative group's intervention.

Objectives for an EBP vision

-develop a mental framework: what do you want to accomplish? -establish a motivating image for change: motivate staff -create specific goals -gain administrative support -establish a leadership team -involve experts and EBP mentors in clinical practice

external evidence

-generated through rigorous research (RCTs, cohort studies) -intended to be generalized to and used in other settings -peer review

Common barriers to implementing EBP

-inadequate knowledge and skills -weak beliefs about the value -poor attitudes toward EBP -lack of EBP mentors -lack of support by leaders and clinicians -economic restrictions

7 Steps of the EBP Process

0. cultivate a spirit of inquiry 1. Ask the burning clinical question in PICOT format 2.Search for and collect the most relevant best evidence 3.Critically appraise the evidence (i.e., rapid critical appraisal, evaluation, and synthesis) 4. Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practicterm-16e decision or change 5. Evaluate outcomes of the change 6. Disseminate the outcomes of the evidence-based change

2 questions for critical appraisal

1. Are the results of the study valid? (Validity) 2. What are the results? (Reliability) 3. Will the results help me in caring for my patients? (Applicability)

3 strategies for searching a database

1. Keyword searching 2. Subject heading searches (controlled vocabulary)- good for less irrelevant hits 3. Title searching - use specific words from the PICOT question in search

PDSA cycle

1. Plan: Plan the change and measurement of outcomes 2. Do: Try out the change on a small scale (pilot) 3. Study: Analyze the data and determine what was learned 4. Act: Refine the change based on what was learned and emerging external evidence, and repeat the outcomes measurement

Preliminary questions to Ask Prior to Critical Appraisal of Quantitative Studies

1. Why was the study done? What is the purpose? 2. What is the sample size? 3. Are the measurements of major variables valid and reliable? 4. How were the data analyzed? 5. Were there any untoward events during the conduct of the study? the research should explain all adverse events and withdrawal from the study. 6. How do the results fit with previous research in the area? 7. What does this research mean for clinical practice?

Overview questions for appraising qualitative studies

1. are the results valid/trustworthy and credible? 2. are implications of research stated? 3. What is the effect on the reader? 4. what are the results? 5 How does the researcher identify the study approach? 6. Is the significance/importance of the study explicit? 7. Is the sampling strategy clear and guided by study needs? 8 are data collection procedures clear? 9 are data analysis procedures described? 10. How are specific findings presented 11. How are the overall results presented? 12. Will the results help me in caring for my patients?

Why EBP?

1. enhances healthcare quality 2. improves outcomes 3. reduces cost 4. empowers physicians

Background question components

1. the who, what, where, why, when, or how 2. the outcome of interest What is it that you want to know?

Outcomes management

4 step process: 1. define a clinical problem 2. establish how the outcome will be measured 3. identify practices supported by evidence that need to be implemented to improve the outcome 4. measure the impact of implementing the best practice on the target outcome

The EBP team is wondering how to reduce VAP rates on the unit. Which is a relevant RESEARCH question? a. Does oral care with chlorhexidine reduce VAP in patients receiving mechanical ventilation? b. Why are VAP rates so high in our trauma patients? c. In trauma patients that are mechanically ventilated, how do chlorhexidine mouthwashes compared with probiotics affect VAP development?

A

A group of nurses have successfully implemented a new evidence-based protocol related to postoperative patient assessment. What is the next step for this project? a.Tell others about the results of their project b.Elicit feedback from patients and other stakeholders c.Evaluate the costs of the change in practice d.Search the literature for research that relates to the practice change

A Rationale: The EBP process culminates with the dissemination of results. Searching the literature, consulting with patients, and evaluating costs are actions that should already have been performed earlier in the EBP process.

National quality indicator monitoring systems include:

AHRQ National Healthcare Quality Report National Quality Forum (NQF) National Database of Nursing Quality Indicators® (NDNQI®) These monitor quality of internal evidence

Boolean operators

AND, OR, and NOT used in search strings to refine the scope of the search AND leads to a more restrictive search and links two concepts together OR expands the search and allows for more options

Outcome risk comparison

Absolute risk reduction (ARR): When risk of an undesirable outcome is less for treatment than for control group Absolute risk increase (ARI): When risk of an undesirable outcome is more for treatment than for control group Relative risk (RR): Likelihood that outcome will occur in one group versus the other Odds ratio (OR): Odds of treatment group having the outcome

Skill sets needed for evidence-based clinical decision making (McCracken and Corrigan, 2004)

Clinical: Includes knowledge, skills, and experience related to direct practice with clients •Technical: Includes knowledge, skills, and experience related to formulating questions, conducting an electronic search, and evaluating validity and reliability of findings in order to engage in evidence-based decision making •Organizational: Includes knowledge, skills, and experience related to teamwork, organizational design and development, and leadership

Trustworthiness criteria (in qualitative research)

Credibility; does it make sense? is it accurate/valid? Transferability; can results be transferred to other contexts? Do conclusions have any larger impact? Dependability; is it consistent and able to be repeated? Is it reliable? Confirmability; what is the degree of neutrality? is it grounded in data?

EBP Step 3

Critically appraise the evidence -validity: are the results valid? -reliability: What are the results? Did it work? -applicability: will the results help me care for my patients?

PubMed

Database produced and maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine • Contains >19 million citations from >5,600 journals of biomedical sciences, nursing, dentistry, and pharmacy • Free and committed to providing access to all evidence • Provides free online access to the MEDLINE® database •Includes automatic term mapping that uses the keywords entered to map them to appropriate MeSH® terms

EBP Step 6

Disseminate outcomes, internally and externally.

Who began the concept of EBP?

Dr Archie Cochrane in a 1972 report

National Quality Forum (NQF)

Endorses 15 consensus-based nursing standards (NQF- 15) for inpatient care representing measures that examine nursing contributions to hospital care. NQF-15 includes measures of patient-centered outcomes (e.g., prevalence of pressure ulcers and inpatient falls), delivery of nursing-centered interventions (e.g., smoking cessation counseling), and system-centered measures (e.g., voluntary turnover and nursing care hours per patient day)

National Database of Nursing Quality Indicators (NDNQI)

Established by the ANA to facilitate continued nursing indicator development and further understanding of factors influencing the quality of nursing care. Provides quarterly and annual reports to members on structure, process, and outcome indicators on a unit level

True/false Evidentialism is the process by which an evidence-based clinical decision is reached solely on external evidence.

False Rationale: Evidentialism is the framework for understanding how research evidence can be combined through the practitioner's expertise with patients' concerns, history, family and cultural context, and disease trajectory to develop an evidence-based plan of care.

True or false A single randomized controlled trial (RCT) constitutes the highest level of evidence and is the most reliable guide to nursing practice.

False Rationale: Meta-analyses and systematic reviews that synthesize the results of multiple RCTs or experiments are considered to be the highest form of evidence. A single RCT is classified as Level II evidence.

True or false Foreground questions can often be answered by consulting an up-to-date nursing or science textbook.

False Foreground questions are clinical questions that can only be answered by specific scientific evidence that is usually found in original studies or systematic reviews of original studies (e.g., RCTs). This type of evidence is not available in textbooks, which are more appropriate for answering background questions.

True/False Implementation of EBP is the responsibility of graduate prepared nurses and members of nursing leadership

False Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines

True or false Internal evidence is characterized by findings that are applicable and generalizable to multiple practice settings.

False Rationale: Unlike external evidence, the generation of internal evidence is intended to improve clinical practice and patient outcomes within the local setting in which it is conducted.

PICOT diagnosis template

In ________________(P) is ___________(I) compared to _____(C) more accurate in diagnosing (O) ____________? *note that there is no Time frame

When considering the six areas of EBP evaluation of the clinical environment, which of the following is considered an outcome measure? a. Number of times that heart failure patients are discharged within the case management time parameter b. Incidence of pressure ulcers c. Number of discharged patients who are satisfied with their pain management d. Average turnaround time needed for repair of inoperative intravenous pumps

Incidence of pressure ulcers Rationale: Incidence of pressure ulcers is an iatrogenic effect of hospitalization. The number of times that heart failure patients are discharged within the case management time parameter is an example of the efficiency of processes. The number of discharged patients who are satisfied with their pain management is an example of patient-centered quality. The average turnaround time needed for repair of inoperative intravenous pumps is a measure of the availability of resources

Instrument validity

Instrument validity refers to whether the study measurements are measuring what they are supposed to be measuring

Licensed databases vs Web search engines

Licensed databases such as PubMed® list the journals indexed, which allows users to know which journals they are searching Internet search engines such as Google and Google Scholar search the Internet, but there is no transparency as to what information is included in the search. There is no peer review and the information must be appraised to ensure reliability.

3 Domains to grading strength of body of evidence

Quality- the extent that the study avoided any biases (internal validity) Quantity- The number of studies that have evaluated the clinical issue, overall sample size across all studies, magnitude of the treatment effect, and strength from causality assessment for interventions, such as relative risk or odds ratio Consistency- among studies with similar designs and findings

EBP Step 2 / Hierarchy of evidence

Search and collect evidence. Hierarchy of evidence: 1. Systematic review or meta analysis of randomized controlled trials (RCTs) 2. One well designed RCT 3. Quasi-experimental study without randomization 4. Well designed case-control and cohort studies 5. Systematic reviews of descriptive and/or qualitative studies 6. Single descriptive and/or qualitative studies 7. Expert opinion/expert committee reports.

Appraising Cohort Studies

Studies in which a sample exposed to an intervention is followed overtime to observe the outcome. - Validity: If a comparison group was used, how similar were they to the exposed group? Follow-up? -Reliability: What was the magnitude of the relationship between treatment and targeted outcome? How likely were the study estimates? -Applicability: Could the results be used to counsel my patients?

ethnography

Study of a social group's culture through combining participant observation, in-depth interviews, and the collection of artifacts

Study reliability

Study reliability refers to the "repeatability" of the study—that is, if the study were repeated under the same circumstances, would the results be the same?

Confounding variables

Study results may be confounded when a relationship between two variables is actually due to a third unknown or unconsidered variable Most often encountered in studies about lifestyle and health

True/false Grounded theory is the most appropriate tradition for a study that explores women's coping as they move through different stages of fertility treatment.

True Rationale: Grounded theory often focuses on changes in the human experience as they move through time.

true/false A well-formulated PICOT question should specify the measurable patient outcomes that need to addressed.

True Rationale: A PICOT question should always specify the outcome that is expected from the clinical question. It is important that the outcome be measurable in some way so that the effectiveness of the change can be evaluated.

True or false Subject headings searching (also known as controlled vocabulary searches) may yield fewer hits than a keyword search, but these hits are more likely to be relevant to the clinical question.

True Rationale: Controlled vocabulary systems exist to increase the relevance of search results while limiting the number of less relevant hits

Appraising Case Control Studies

a sample is categorized as having a condition (case) or not (control). A retrospective investigation is performed to find out why. ·Validity questions: How were the cases obtained; were appropriate controls selected; and were data collection methods the same for the cases and controls? ·Reliability questions: What were the results and how were they reported? ·Applicability questions: Is the sample similar to my patient(s)? Is more evidence needed before making a decision?

quality improvement (QI)

a systematic process that often uses the plan, do, study, act, model. Used to improve healthcare systems processes or outcomes for a specific population once a problem is identified. NOT the same as EBP. Is a type of internal evidence

Qualitative evidence is most likely to inform which of the following aspects of the care of patients with cancer? a.Cancer patients' perceptions of hope during chemotherapy treatment b.Treatment options for chemotherapy-induced nausea c.Clinicians' choices of chemotherapeutic agents d.The relationship between anxiety and nausea in patients undergoing chemotherapy

a. Cancer patients' perceptions of hope during chemotherapy treatment Rationale: The concept of hope is an aspect of the human responses and meaning that surround a health experience. Treatment options and the relationships between different concepts are likely better addressed by quantitative evidence.

A team of researchers has received a grant to investigate the potential links between diet and the development of stomach cancer. What research design is most likely to answer the researchers' clinical question? a.Case-control b.Case study c.Randomized controlled trial (RCT) d.Qualitative study

a. Case-control Rationale: A case-control study selects individuals with a particular disease (e.g., stomach cancer) and looks back to identify factors that may underlie that disease (e.g., diet). Neither a case study nor a qualitative study would inform this relationship and an RCT would be unethical and impractical.

The question that best addresses study reliability is: a. How big is the magnitude of the effect? b. Did the investigator(s) applying the intervention know to which groups subjects were assigned? c. Were the instruments calibrated according to manufacturer specifications? d. How many subjects were lost to follow-up and what groups were they in?

a. How big is the magnitude of the effect? Rationale: Magnitude of effect allows for determination of the certitude of results in similar patient populations (generalizability). Answers "b" and "d" are questions related to the validity of the study. Answer "c" is related to instrument reliability, not study reliability.

In which stage of the PDSA cycle is external evidence most likely to be used? a. Plan b. Do c. Study d. Act

a. Plan Rationale: Although newly developing external evidence might be used in the Act stage if the outcomes from the change were not as expected, the Plan stage uses external evidence as a main foundation on which to plan a clinical change.

Which of the skill sets for evidence-based clinical decision-making includes the knowledge, skills, and experience related to formulating questions, conducting an electronic search, and evaluating validity and reliability of findings in order to engage in evidence-based decision making? a. Clinical b. Experiential c. Technical d. Organizational

c. Technical Rationale: Clinical skills include the knowledge, skills, and experience related to direct practice with clients, while organizational skills include knowledge, skills, and experience related to teamwork, organizational design and development, and leadership. Experiential skills could be considered the culmination of all three skill sets, which include, but are not limited to, the technical set of skills.

A nurse is examining whether the participants in a qualitative study focusing on the meaning of dependence among IV drug users are similar to clients with which the nurse works. To determine that, the nurse will need to evaluate what area of the study's trustworthiness? a.Dependability b.Confirmability c.Transferability d.Credibility

c. Transferability Rationale: Transferability addresses the question of whether the findings of a qualitative study are applicable to other people who are in similar situations.

EBP step 0

cultivate a spirit of inquiry

Which of the following sources of knowledge would be the primary basis for clinical decision making when determining the turning schedule for an immobilized patient? a. The traditional practice on the unit b. The nurse's knowledge of skin breakdown from experience c. The preferences of the patient and the patient's family d. An evidence-based clinical practice guideline for preventing skin breakdown

d. An evidence-based clinical practice guideline for preventing skin breakdown Rationale: Although EBP encompasses patient preferences and the clinical expertise of individual practitioners, the primary source of knowledge is research evidence. Evidence-based clinical practice guidelines synthesize this evidence in order to guide practice.

Which of these statements reflect the three aphorisms about patient-centeredness coined by Dr. Berwick? a. Patients do not always know what is best for them. b. It is better if treatment is planned before discussing it with the patient/family. c. External evidence is the best and only driver of the patient's treatment. d. Clinical decisions need to be discussed with and understood by patients/families.

d. Clinical decisions need to be discussed with and understood by patients/families. Rationale: Answers a, b, and c reflect a paradigm in which patients/families cannot understand or are not able to participate in decisions about health care. Berwick's statements contradict these paternalistic assumptions about healthcare consumers.

Which of these strategies below is the most effective strategy for engaging care providers in a proposed EBP change? a. Disseminating the evidence that underlies the proposed change b. Reminding staff of their obligation to provide optimal care c. Bringing in EBP experts to speak to staff members d. Creating dissatisfaction with current practice and outcomes

d. Creating dissatisfaction with current practice and outcomes Rationale: If care providers are not satisfied with the status quo, then they will be open to evidence-based change. Other strategies, such as bringing in outsiders to teach, disseminating research findings, and telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change.

Which of the following components of a PICOT question is absent from the following clinical question? "Among patients with dementia, how does the use of reorientation therapy compared with regular, supervised mobility affect patient agitation?" a.P (Population) b.I (Intervention) c.O (Outcome) d.T (Time)

d. T (Time) Rationale: This question specifies the patient population (patients with dementia), the intervention (reorientation therapy), the comparison (regular, supervised mobility), and the relevant outcome (patient agitation), but does not provide the time frame for an expected outcome.

Which of the following online evidence sources is most likely to provide pre-appraised evidence? a. CINAHL b. MEDLINE c. PubMed d. The Cochrane Library

d.The Cochrane Library Rationale: The Cochrane Databases include the Cochrane Database of Systematic Reviews (CDSR), which is a collection of systematic reviews that synthesize RCTs from multiple peer-reviewed sources. CINAHL, MEDLINE, and PubMed may contain evidence at a synthesis level, but most of the sources are individual research articles that must be appraised by the user.

EBP Step 1

develop PICOT question Patient population Intervention/Issue/Interest Comparison/intervention Outcome Time frame

internal evidence

evidence typically produced through practice initiatives such as outcomes management or quality improvement projects that are not intended to be generalized to other clinical settings

3 components of EBP

external evidence (best research evidence) + CLinical expertise (including internal evidence) + patient values and preferences

focus groups

group interviews that generate data on designated topics through discussion and interaction

Qualitative research is important in regard to clinical questions that address _________

human responses and meaning

Evidence based QI

includes both internal and external evidence in decision making about a practice change to be implemented to improve an important clinical outcome

translational research

research that uses knowledge derived from basic research to develop and test solutions to real-world problems. Studies how interventions are translated into the real world clinical setting

Meta-synthesis

synthesis of qualitative research involving the critical analysis of primary qualitative studies and synthesis of findings into a new theory or framework for the topic of interest A holistic translation, based on comparative analysis of individual qualitative interpretations, which seeks to retain the essence of their unique contributions

Clinical inquiry

the ongoing process in which clinicians gather data using narrowly defined clinical parameters to appraise the available choices of treatment to find the most appropriate choice of action.

True or false Finding a quasi-experimental study in a peer-reviewed nursing journal article that tests a protocol for the frequency of turning for immobile patients is an example of external evidence.

true External evidence includes peer-reviewed publications that present the findings of research and are intended to be generalized to other clinical settings.

central themes of evidentialism

·Clinicians must find and know the information upon which decisions are made ·Decisions are based on current evidence, which means that they are based on what is presently known. That this might change in the future is acknowledged. ·Experiences that a clinician and a patient have had can be counted as evidence

Barriers to EBP

·Lack of administrative/management support and mentors ·Resistance to change ·Misconceptions or negative attitudes about EBP ·Lack of EBP knowledge and skills Lack of autonomy over practice and lack of incentives

Common qualitative research techniques

·Observation and fieldnotes ·Interviews and focus groups ·Narrative and content analysis ·Sampling strategies ·Data management and analysis ·Mixing methods

5 assumptions in evidentialism

·Only decisions that result from thoughtfully responsible behavior are justified ·External evidence that supports a conclusion about patient care may not be sufficient to make that conclusion clinically meaningful ·As available external evidence changes, the decision maker's responses should change too ·Decisions made from a set of external evidence depend on the validity, reliability, and applicability of that evidence and on the clinician's grasp of the evidence, which is clinical wisdom ·Having a "belief" without supportive external evidence is unwise, and therefore, that belief is unjustified. Not only will such a belief have an impact on decisions that are based on that belief, it will affect all decisions connected to that unjustified belief.

EBP Step 5

·Outcomes measurement determines whether the evidence-based change resulted in the expected outcome in the clinical practice setting

PICOT question format

·P: Population of interest ·I: Intervention or issue of interest ·C: Comparison of interest ·O: Outcome expected T: Time needed for the intervention

evidentialism

·a framework for understanding how research evidence and patients' concerns, history, family and cultural context, and disease trajectory are used in a decision-making process by clinicians to determine an evidence-based plan of care