Chapter 05: EVIDENCE-INFORMED PRACTICE IN COMMUNITY HEALTH NURSING Flashcards
Which of the following actions by the nurse executive would best implement evidence-informed practice at a community nursing centre that serves a large Cuban immigrant population?
a. Having university experts with cultural competency expertise review the centre’s policies
b. Having weekly staff meetings for the purpose of determining which methods seem to work best when helping immigrants
c. Including Cuban immigrants from the community on the centre’s advisory board
d. Sending centre staff to conferences and seminars that focus on providing health care to immigrants from Spanish-speaking countries
C
Although all of the proposed options are good, in order to determine whether the centre’s practice is serving the needs of the population, the nurse executive will need to consult members of the population being served. This means that evidence would be applied to practice with input from the community. For example, decisions related to the services to be offered in a community health nurse (CHN)-managed clinic would be made with input from the clinic’s advisory board, which should include community leaders and consumers of the clinic’s services. The needs of Cuban immigrants may not be the same as those of immigrants from other Spanish-speaking countries, such as Mexico or Spain.
The CHN who best applies evidence-informed practice directly performs which of the following actions to determine the best way to address an outbreak of a new infectious disease?
a. Reviews policies and procedures
b. Reviews outcomes of clinical trials
c. Reviews several nursing textbooks
d. Gets information from the Internet
B
Evidence-informed practice is defined as combining the best evidence derived from research with clinical practice, knowledge, expertise, and unique client expectations, preferences, or choices when making clinical decisions. Getting ideas from the Internet is helpful only if evidence-informed practice sites are accessed; however, most Internet sites do not offer information grounded in evidence-informed practice.
For CHNs who are familiar with evidence-informed practice and want to implement it in their care of clients, which of the following is the biggest challenge?
a. Accessing the evidence and integrating it into practice
b. Convincing others that it is beneficial
c. Distinguishing evidence-informed practice from practice based on old standards
d. Showing clients that evidence-informed practice will improve their health outcomes
A
The challenge for the CHN is accessing the evidence and integrating it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.
A CHN plans to use evidence-informed practice to guide the development of health education programs that are most likely to increase retention of information in elementary school children. Which option represents the best way to use evidence-informed practice in this situation?
a. Asking other CHNs about what they included in their own education programs
b. Comparing and contrasting findings from randomized clinical trials related to learning in elementary school children
c. Developing a series of games to accompany the programs developed to promote health
d. Seeking out and examining information on the Internet on health education programs for elementary school children.
B
Randomized clinical trials are the gold standard for evidence gathering in evidence-informed practice.
A busy CHN who is concerned that obesity is increasing rapidly among children in her community wants to implement evidence-informed practice but faces barriers because of time constraints. A knowledge manager can help this CHN by doing which of the following?
a. Identifying students who are obese in order to closely monitor for weight control success or failure
b. Evaluating best practices to identify those practices that have the highest success rates for weight control in children
c. Organizing files, scheduling appointments, and handling phone calls in order to decrease interruptions
d. Setting up an obesity management program for children whose body mass index exceeds normal
B
The knowledge manager’s role is to assist in the implementation of evidence-informed practice through collection and dissemination of the collective knowledge within an organization, gathering relevant information and applying it to community nursing practice, retrieving and evaluating the best evidence for clinical practice within a community, and staying informed about the community’s politics and policy issues. To increase the likelihood of success, the knowledge manager can equip the CHN with needed information and knowledge to develop interventions that are research based.
A health care provider is concerned about the high number of clients with type 2 diabetes who have poor glucose control. In order to implement evidence-informed practice to manage this problem, which one of the following would be the best reference for the health care provider to use?
a. Published protocols
b. Current research findings
c. Opinions of colleagues
d. Nursing journals
B
Evidence-informed practice in community health nursing challenges CHNs to integrate the best evidence into their clinical practice. Current research findings will explicate the evidence of the most successful interventions. (Randomized clinical trials are the gold standard of research for evidence-informed practice.) Protocols and opinions often reflect tradition rather than the most current scientific evidence. Although many nursing journals are peer reviewed, some are not; and even among those that are peer reviewed, many are not research based or focused on scientific evidence.
A CHN implemented an education program that incorporated computer games to reinforce learning in a community of older adults. Although earlier research had demonstrated evidence of improved retention of information by using this method, the CHN found exactly the opposite effect in this group of clients. Which one of the following is the most likely cause of the poor outcome in the education program?
a. Failure to consider client individuality
b. Inadequate incorporation of evidence into practice
c. Inferior quality of the available research evidence
d. The CHN’s lack of skills in evaluating the evidence
A
Evidence-informed practice cannot be applied as a universal remedy without attention to client differences. When evidence-informed practice is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to that particular community. For example, computer games may be an excellent choice for younger groups but is often not suitable for older adults, who may face challenges with learning new technology.
A nursing administrator who wishes to develop a work environment conducive to the implementation of evidence-informed practice can best achieve it through which of the following actions?
a. Conducting market research to determine customer satisfaction with evidence-informed practice
b. Eliciting opinions from CHNs on how evidence-informed practice will affect workload
c. Increasing access of nursing research holdings, including nursing research journals, in the libraries of health care institutions
d. Sending staff to conferences related to incorporation of evidence-informed practice into practice
C
Inadequacy of nursing research holdings, including nursing research journals, in the libraries of health care institutions can create a barrier to the implementation of evidence-informed practice in community-based nursing agencies. Increased nursing research holdings can help CHNs to quickly access current evidence-informed findings and recommendations.
Which of the following is included in the ways in which a CHN can best facilitate incorporation of evidence-informed practice in the clinical setting?
a. Elimination of all protocols and standards that are not evidence based
b. Group reflection on the ideals and expectations of nursing care
c. Incorporation of more practice-oriented research into decision making
d. Revision of mission statements and organizational philosophies
C
Evidence-informed practice demands changes. It requires the incorporation of more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision making using the various sources of evidence. When CHNs access scientific knowledge of all types, they need to choose the most relevant information for each client’s clinical situation.
Which of the following represents the first step to take when using evidence-informed practice in the clinical setting?
a. Eliminating all protocols and standards that are not evidence based
b. Gathering data on the clinical problem
c. Formulating the clinical question
d. Revising mission statements and organizational philosophies
C
The first step in the evidence-informed practice process is formulating the question, which includes defining and refining the question. To answer the client clinical question that has been formulated, the sources of evidence-informed practice related to community health nursing include the best available evidence.
