Ch 5

Question 1

Evidence-based practice (EBP)

Answer 1

An evidence-based, patient-centered clinical practice approach integrating best evidence, clinician expertise, patient preferences, and resource considerations for effective problem-solving.

Question 2

Steps of Evidence-Based Practice
There are seven steps, numbered from 0 to 6

Answer 2

0. Cultivate a spirit of inquiry within an EBP culture and environment.
1. Ask a clinical question in PICOT format.
2. Search for the most relevant and best evidence.
3. Critically appraise the evidence you gather.
4. Integrate the best evidence with your clinical expertise and patient preferences and values to make the best clinical decision.
5. Evaluate the outcomes of practice changes based on evidence.
6. Communicate the outcomes of EBP decision or changes.

Question 3

Developing a PICOT Question

Answer 3

P - Patient population of interest
Identify patients by age, gender, ethnicity, and disease or health problem.
I - Intervention or area of interest
Which intervention is worthwhile to use in practice (e.g., a treatment, diagnostic test, prognostic factor)? What area of interest influences a desired
outcome (e.g., complementary therapy, motivational interviewing)? C - Comparison intervention or area of interest
What is the usual standard of care or current intervention used now in practice?
O - Outcome
What result do you wish to achieve or observe as a result of an intervention (e.g., change in patient behavior, physical finding, or patient perception)?
Make an outcome statement nondirectional. For example: “Does use of chlorhexidine affect incidence of CLABSI?” instead of “Does the use of chlorhexidine reduce incidence of CLABSI?” A directional outcome may limit the articles in your search.
T - Time
What amount of time is needed for an intervention to achieve an outcome
(e.g., the amount of time needed to change quality of life or patient behavior)?

Question 4

Peer-reviewed

Answer 4

reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published.

Question 5

Levels of evidence
Figure 5.2

Question 6

hypotheses

Answer 6

predictions made about the relationship or differences among study

Question 7

variables

Answer 7

variables (concepts, characteristics, or traits that vary within or among subjects

Question 8

Scientific method

Answer 8

foundation of all research, an objective methodology for scientific investigation that results in unbiased inter- pretations of the phenomenon under study and refinement of knowl- edge. It is a process that, when done formally and rigorously, yields new knowledge critical to a science, be it nursing, psychology, or medicine. The scientific method is a systematic, step-by-step process.

Question 9

Research using the scientific method includes the following steps:

Answer 9

1. Make an observation. The researcher identifies a problem area or area of interest to study.
2. Ask questions about the observation and gather information. The re- searcher conducts a thorough literature review of the area of interest.
3. Analyzetheliteratureandformaresearchquestionorhypothesis—a proposed explanation for a phenomenon that can be tested, often
   involving a prediction based on that question or hypothesis.
4. Conductastudyusingscientificrigor.Testthequestionorthehypoth- esis and prediction in an experiment (quantitative or qualitative) that can be reproduced. The type of study is driven by the research ques- tion. For example, “Does the use of chlorhexidine reduce incidence of CLABSI?” is a quantitative study involving statistical analysis. “What are nurses’ perceptions of their own grieving when caring for COVID-19 patients?” is a research question best studied qualitatively. Researchers gather empirical data through the use of observations and assessments (e.g., surveys, physiological data, observation) and
   use the data to discover new knowledge.
5. Analyzethedataanddrawconclusions.Acceptorrejectthequestion/
   hypothesis or modify the hypothesis if necessary.

Question 10

TABLE 5.2
Comparison of Steps of the Nursing Process With the Scientific Method Process

Question 11

Quantitative Research

Answer 11

-relies on methods that precisely measure and quantify a study’s variables.
-Quantitative research is the precise, systematic, objective examination of specific concepts. It focuses on numerical data, statistical analysis, and controls to elimi- nate bias in findings
-Two examples of quantitative research are (1) a study dealing with a new pain therapy that quantitatively measures participants’ self-reported pain severity and (2) a study testing different forms of surgical dress- ings to measure the extent of wound healing.
- There are many quantitative methods. Some of the more commonly used quan- titative methods include experimental, nonexperimental, survey, and evaluation research.

Question 12

Experimental Research
Experimental study

Answer 12

-tightly controls conditions to eliminate bias with the goal of generalizing the results of the study to similar groups of subjects.
- Researchers test an intervention (e.g., a new drug, therapy, or educational method) against the usual standard of care.
-They randomly assign similar sub- jects to either a control or a treatment group. When an RCT is completed, the researcher hopes to know whether the intervention leads to better outcomes than the standard of care.

Question 13

Types of Research

Answer 13

• Exploratory research: Initial nonexperimental study designed to develop or refine the dimensions of phenomena (facts or events) or to develop or refine a hypothesis about the relationships among phenomena. Example: Pilot study testing the benefits of a new exercise program for older adults with dementia.
• Evaluation research: A form of quantitative research. Study that tests how well a program, practice, or policy is working. When programs are unsuccessful, evaluation research identifies problems with the program and opportunities for change or barriers to program implementation. Example: Study measuring the outcomes of an informational campaign designed to improve parents’ ability to follow immunization schedules for their children.
• Descriptive research: Study that measures characteristics of people, situations, or groups and the frequency with which certain events or char- acteristics occur. Example: Study to examine RNs’ biases toward caring for obese patients.
• Historical research: Descriptive research designed to establish facts and relationships concerning past events. Example: Study examining the societal factors that led to the acceptance of advanced practice nurses by patients.
• Experimental research: Study in which the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable. Example: RCT comparing chlorhexidine with povidone-iodine in reducing the incidence of IV-site phlebitis.
• Correlational research: Nonexperimental study that explores the interrelationships among variables of interest without any active intervention by the researcher. Example: Study examining the relationship between RNs’ educational levels and their satisfaction in the nursing role.

Question 14

sampling error

Answer 14

sample does not represent entire population under study

Question 15

Qualitative nursing research

Answer 15

-studies phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness or quality of life.
-This research method describes information obtained in a nonnumeric form.
-Data are typically gathered during interviews via recording of each subject.

Question 16

Nursing research

Answer 16

-a way to identify new knowledge that can improve nursing practice, professional education and practice, and the use of nursing and health care resources effectively

Question 17

Translation research

Answer 17

-Translation research focuses on “testing implementation interventions to improve uptake and use of evidence to improve patient outcomes and population health”
-poses a research question or hypothesis.
-Then a variety of research designs and methods are used to answer the research question and test the hypothesis, revealing what is most effective in implementing evidence.
-Doctorally prepared nurses play a key role in conducting translation research to improve health outcomes

Question 18

Care delivery outcomes

Answer 18

-observable or measurable effects of health care interventions
- focuses on the recipients of service (e.g., patient, fam- ily, or community) and not the providers (e.g., nurse or physician).

Question 19

Informed consent

Answer 19

means that research subjects (1) are given full and complete informa- tion about the purpose of a study, procedures, data collection, poten- tial harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity

Question 20

Confidentiality

Answer 20

guarantees that any information a subject provides will not be re- ported in any manner that identifies the subject and will not be acces- sible to people outside the research team.

Question 21

Performance improvement (PI)

Answer 21

-a formal approach for the analysis of health care–related processes at a local level.
-Local means analysis of processes unique to a nursing unit, health care agency, or health care system.
-PI is not a process allowing for generalizability of findings to other settings.
-PI is one approach that organizations use to learn how processes (e.g., discharge process, medication delivery to patient care units, radiological procedure scheduling) can be altered to yield higher-quality care, better patient experience, and lower costs (“triple aim”)

Question 22

TABLE 5.3 Examples of Performance Improvement Models

Question 23

sentinel event

Answer 23

an unexpected occurrence involving death or serious physical or psychological injury of a patient. After a sentinel event, the unit conducts a root cause analysis (RCA).

Question 24

Active errors

Answer 24

-The goal of the RCA is to review all information and identify how the event occurred through identification of active errors (i.e., the acts that personnel perform) and why it occurred through identification and analysis of latent errors

Question 25

latent errors

Answer 25

(i.e., the organization or steps of the process).

Question 26

BuildingCompetencyinEvidence-BasedPractice The Nursing Practice Council notes that the incidence of falls with injuries has in- creased on all units in the agency over the past year. When checking its fall prevention protocol, the council notes it was last reviewed 4 years ago. The council knows that falls with injuries are a nursing-sensitive outcome (NDNQI) and establishes a goal to reduce the incidence of falls in the upcoming year. How should the Nursing Practice Council proceed?

Question 27

Summary

Answer 27

• EBP guides nurses in addressing clinical problems by looking for the very best scientific and clinical evidence available for treating or managing the problems and implementing changes in practice.
• Use EBP and clinical judgment and consider the patient’s values and preferences to ensure that you provide competent, safe, patient- centered care.
• The steps of EBP include cultivating a spirit of inquiry, asking a clinical question in PICOT format, searching for the most relevant and best evidence, critically appraising the evidence, integrating the best evidence, evaluating the outcomes of the practice change, and communicating results of the change.
• A well-developed PICOT question having the components of population (P), intervention (I), comparison (C), outcome (O), and time (T) will guide your search for evidence in the scientific literature.
• The systematic review or meta-analysis of RCTs and clinical practice guidelines based on systematic reviews provide the highest level of evidence to include when conducting a literature review; opinions are the lowest level of evidence to use in research literature review.
• Nurses apply evidence in practice through direct application or use of the evidence in patient care or by using the evidence to make a larger scale practice change for a health care agency.
• The research process is an orderly series of six steps that allow the researcher to move from problem identification to development of the research question, through study development with data collection and data analysis, to finding an answer to the research question and sharing the findings.
• Quantitative research methods include experimental, nonexperi- mental, survey, and evaluation research. These methods are similar in that these methods are systematic, objective methodologies that use numerical data and statistical analyses to examine a study’s variables and answer the research question.
• Qualitative research methods include phenomenology, ethnography, and grounded theory research. These methods use nonnumerical data gathered through interviews or observation to understand patients’ experiences with health problems and the contexts in which the experiences occur.
• Nursing research is a systematic process that asks and answers questions to generate knowledge and provide a scientific basis for nursing practice.
• Translation research in nursing is conducted to promote the use of evidence-based practice by testing implementation strategies in real-world settings to determine which strategies work best among diverse patient groups.
• Performance improvement (PI) is a formal approach used to study the processes or systems that contribute to the outcomes of an or- ganization. PI also focuses on how to attain and sustain measurable improvements over time.
• EBP, research, and performance improvement (PI) are closely related but separate processes that use best evidence. EBP uses research literature and PI data when available to provide evidence for practice change, and EBP and PI can lead to opportunities for research.

Question 28

• Reflect on the decisions you made during your clinical day. De- scribe you how used EBP to guide your clinical judgment in mak- ing one of the clinical decisions for your patient.
• Think about the nursing care that you provided to your patients on the clinical unit today. What questions came to your mind about the practices that you were doing? Formulate one of the questions in PICOT format.
• After asking a PICOT question, search the literature and find two or three research studies on the topic. What is the current state of the evidence related to your question?

Question 29

Match the components of PICO using the question “Does the use of guided imagery compared with standard care affect the postop- erative pain in hospitalized adolescents?

(P) Patient/population
(I) Intervention
(C) Comparison
(O) Outcome
A. Adolescents receiving standard care
B. Postoperative pain
C. Hospitalized adolescents
D. Guided imagery

Answer 29

P, C
I, D
C, A
O, B

Question 30

Place the steps of the EBP process in the appropriate order.
1. Critically appraise the evidence you gather.
2. Ask the clinical question in PICOT format.
3. Evaluate the outcomes of the practice decision or change. 4. Search for the most relevant and best evidence.
5. Cultivate a spirit of inquiry.
6. Integrate the evidence.
7. Communicate the outcomes of the EBP change.

Answer 30

5.,2.,4.,1.,6.,3.,7.,

Question 31

A nurse is reading a research article discussing a new practice to de- crease the incidence of catheter-associated urinary tract infections. One section of the article describes who was studied and how the data were collected to answer the research questions and hypotheses. What section of the research article is currently being read?
1. The literature review
2. The data analysis
3. The methods
4. The implications for practice

Answer 31

3

Question 32

A nurse implements an EBP change that teaches patients the impor- tance of taking their diabetes medications correctly and regularly on time using videos streamed on the Internet. The nurse measures the patients’ behavioral outcome from the practice change by using which type of measurement?
1. Measuring the patients’ weight
2. Chart auditing teaching sessions
3. Observing patients viewing the videos
4. Checking patients’ blood sugars

Answer 32

4

Question 33

A patient in the ICU experiences a sentinel event related to central line catheter care that resulted in serious injury. What PI model should the unit use to identify errors that led to the sentinel event?
1. Six Sigma
2. Root cause analysis
3. PDSA
4. Balanced scorecard

Answer 33

2

Question 34

The nurse identifies which of the following as outcomes measure- ments? (Select all that apply.)
1. A nurse teaches a patient how to administer an injection and
then watches the patient do a return demonstration.
2. A nurse implements a new pain-management protocol and checks patients’ charts to confirm whether interventions are being provided.
3. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the
skin to measure incidence of pressure injuries.
4. A nursing unit implements a new fall prevention protocol and
checks the monthly performance data for incidence of falls on
the unit.
5. A nursing unit implements a patient rounding program, and
the charge nurse watches the assistive personnel to see whether
hourly rounding is being done on patients.

Answer 34

1.,3.,4.,

Question 35

The nurses on a medical unit have seen an increase in the number
of pressure injuries developing in their patients. The nurses decide to initiate a PI project using the PDSA model. Which of the follow- ing is an example of “Plan” from that model?
1. Orienting patients to the unit’s practice of hourly rounding on
patients
2. Reviewing the incidence of pressure injuries on patients cared
for using the protocol
3. Based on findings from patients who developed injuries, imple- menting an evidence-based skin care protocol on all units
4. Meeting with all disciplines to develop a multidisciplinary ap- proach for reducing pressure injuries

Answer 35

4

Question 36

The nurse is using the QSEN competency of EBP when working with the unit council to initiate a change related to pain management. Which behaviors demonstrate that the nurse is practicing behaviors associated with EBP? (Select all that apply.)
1. Initiating plan for self-development as a team member
2. Reading original research related to pain management
3. Demonstrating effective use of strategies to reduce risk of harm
to self or others
4. Valuing EBP as critical to the development of pain management
guidelines for the unit
5. Describing to the unit council reliable sources for locating
clinical guidelines
6. Applying technology and information management tools to
support safe processes of care

Answer 36

2.,4.,5.,

Question 37

Nurses in a community clinic are conducting an EBP project focused
on improving the outcomes of children with asthma. The PICO question asked by the nurses is “In school-age children, does the use of an electronic gaming education module versus educational book affect the usage of inhalers?” In the question, what is the “O”?
1. School-age children
2. Educational book
3. Use of inhalers
4. Electronic gaming education

Answer 37

3

Question 38

A nurse research investigator is explaining a research study to a patient. The patient is interested in participating in the research study. The nurse investigator reviews the informed consent with the patient. The patient asks the nurse why he must sign the con- sent to participate in the study. What is the nurse’s best response(s) to the patient’s question? (Select all that apply.)
1. “The informed consent (IC) provides you with complete information on the research study.”
2. “By reviewing the consent with you, I can make sure that you understand the study and what it means for you to par- ticipate.”
3. “The informed consent provides details on the limitations of the study.”
4. “The informed consent provides your voluntary agreement to participate in the research study.”
5. “The informed consent explains how the data collected from you will be kept confidential during and after the study.”

Answer 38

1.,2.,4.,5.,

Question 39

TABLE 5.4 Similarities and Differences Among Evidence-Based Practice, Research, and Performance Improvement