Chapter 21 Flashcards
A nursing instructor is evaluating whether a student nurse knows the difference between evidence-based nursing practice (EBNP) and evidence-based practice (EBP). Which comment by the student would indicate that further teaching is needed? EBNP:
a. concerns nursing actions, not medical ones.
b. considers the patient’s needs and preferences based upon nursing theory and research.
c. utilizes nursing theory to determine process in nursing care.
d. targets medical decision making for the bulk of evidence-based care strategies.
D: Evidence-based practice (EBP) differs from evidence-based nursing practice (EBNP) in that EBP has a medical focus and EBNP is practice performed by nurses that considers the individual patient’s needs and preferences based upon nursing theory and research.
EVOLUTION OF EBP
The nurse educator explains to the nursing student that an evidence-based practice (EBP) guideline is:
a. a guideline for assessing practice.
b. a descriptive tool for identifying specified care in unique situations.
c. a standardized specification for care of a typical patient in the typical situation.
d. used in medical credentialing.
C: In evidence-based practice, guidelines are standardized tools or specifications of how care should be delivered, and they are used to guide practice treatment and intervention. EVOLUTION OF EBP
A nurse researcher understands that outcomes research:
a. is used in EBP.
b. studies mortality and end-of-life issues.
c. is a way of evaluating the goal or outcome of an educational program.
d. provides evidence concerning the continuum of disease processes.
A: Evidence-based practice (EBP) uses outcomes research to guide the development of specific strategies to deliver quality, cost-effective care. EVIDENCE-BASED PRACTICE
When giving a lecture regarding outcomes, the nurse educator explains that an important report issued by the ANA concerning outcomes is which of the following?
a. Crossing the Quality Chasm
b. To Err Is Human
c. Nursing Report Card for Acute Care Settings
d. Keeping Patients Safe
C: The American Nurses Association’s 1995 report entitled a “Nursing Report Card for Acute Care Settings” listed indicators for patient-centered outcomes, structures of care, and care processes. “Crossing the Quality Chasm,” “To Err Is Human,” and “Keeping Patients Safe” are all reports concerning patient safety and quality care from the Institute of Medicine (IOM). ROLE OF ANA
A nurse is exhibiting the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. The nurse’s actions are an example of which of the following?
a. Evidence-based models c. Evidence-based practice
b. Evidence-based practice guidelines d. Evidence-based nursing practice
C: Evidence-based practice (EBP) is a total process that makes a conscientious, judicious effort to utilize the most current and best evidence for clinical decision making regarding patient care. It uses evidence-based models and guidelines, and when it is applied to nursing practice, it is called evidence-based nursing practice. EVOLUTION OF EBP
The nursing instructor has just completed a lecture on evidence-based practice that included a discussion of the different phases. Which response by a nursing student who is identifying the phases would indicate to the nursing instructor that further clarification is needed?
a. Making the correct diagnosis
b. Locating the best practice
c. Clinical application of the best practice findings
d. Evaluation of the effectiveness of the care given
A: The steps involved in the total process of evidence-based practice are step 1, asking the correct clinical question(s), finding the best practice, and validating the findings to the particular care situation; step 2, clinical application of the best practice; and step 3, evaluation of the effectiveness of the care given and continual process improvement. The nursing instructor would need to clarify that making the correct diagnosis is always important, but it is not one of the steps in the process EVIDENCE-BASED PRACTICE
A student nurse has learned that traditionally, medicine has relied primarily upon biomedical parameters and measures such as laboratory and diagnostic tests to determine if a clinical intervention has been successful. The student nurse asks the nurse educator if this practice reflects current patient needs. Which of the following responses by the nurse educator would be correct?
a. Yes, because it has always been done this way, and it is a sound practice for patient care.
b. Yes, because these tests provide the clinical indicators necessary for accurate diagnosis.
c. No, because they may be false and thus not give enough information to make a sound diagnosis or intervention.
d. No, because these measures do not always address the multifaceted outcomes that patients care about most (quality of life).
D: Traditionally, health care providers have relied solely upon biochemical parameters and diagnostic tests to determine if an intervention is needed or if a treatment was effective. However, in today’s society, there are other outcomes of care that matter most to patients such as quality of life, family, work, and overall level of functioning, which are not reflected in these types of tests or procedures. EVIDENCE-BASED PRACTICE
A student nurse has heard of something called the IHI 100,000 Lives campaign. When the student nurse asks a nurse educator about it, the nurse educator explains that the primary goal of the campaign is:
a. saving lives through improvements in safety and effectiveness of care.
b. delivering reliable evidence-based care for acute myocardial infarctions.
c. the evaluation of the effects of actions in relation to phenomena.
d. preventing adverse drug-related events by medication reconciliation.
A: The primary goal of the 100,000 Lives Campaign, launched in 2004 by the Institute of Healthcare Improvement (IHI), is to save 100,000 lives among hospitalized patients through improvements in safety and effectiveness of care. Delivering reliable EB care for acute myocardial infarctions and preventing adverse drug events through medication reconciliation are two of the targeted intervention identified, but they are not the primary goals themselves. The evaluation of the effects of actions in relation to phenomena is one of the defining characteristics of nursing from the 1980 ANA Social Policy Statement. EVIDENCE-BASED PRACTICE
A nurse suggests that deploying rapid response teams and preventing central line infections are important ideas to implement. These ideas were identified in which publication/campaign?
a. Joint Commission Patient Safety Goals c. IHI’s 100,000 Lives Campaign
b. IOM’s “To Err Is Human” d. IOM’s “Crossing the Quality Chasm”
C: Deploying rapid response teams and preventing central line infections are two of six areas for evidence-based interventions identified by the Institute of Healthcare Improvement’s 100,000 Lives Campaign. EVIDENCE-BASED PRACTICE
When comparing the applicability of the University of Colorado Hospital Model and Model for Improvement, the nurse manager realizes that they both have which of the following in common?
a. They have nothing in common.
b. They are the same model, only one is for Colorado and the other is for California.
c. They are used in EBP.
d. They are used in PARETO.
C: The University of Colorado Hospital Model and Model for Improvement are both multidisciplinary practice models used in evidence-based practice. They present frameworks for thinking about the use of specific sources of information to support or change one’s practice. EVIDENCE-BASED MULTIDISCIPLINARY PRACTICE MODELS
A nurse researcher decides to employ the University of Colorado Model, which categorizes information according to several sources of evidence that are linked to a research core. Which source of evidence does not necessarily belong?
a. Patient preference c. Cost-effective analysis
b. Clinical expertise d. Comparison analysis data
D: The nine sources of evidence (information) linked to a central core of valid and current research in the University of Colorado Hospital Model are patient preference; clinical expertise; cost-effective analysis; infection control data (not comparison analysis data); benchmarking data; pathophysiology; retrospective or concurrent chart review; quality improvement and risk data; and international, national, and local standards. THE UNIVERSITY OF COLORADO HOSPITAL MODEL
A student nurse read an article that mentioned PDSA. When the student nurse asks the nurse educator what PDSA is, the nurse educator responds that PDSA is:
a. a national quality improvement campaign.
b. process, demonstrate, supervise, and analyze.
c. an acronym for an EBP model.
d. a type of quality improvement outcome that is part of the 100,000 Lives Campaign.
C: The Model for Improvement, an evidence-based practice (EBP) model, uses the plan-do-study-act (PDSA) format as the basis for its process. THE MODEL FOR IMPROVEMENT
A nurse manager wishes to implement the Model for Improvement with the rest of the team. The nurse manager knows that the Model for Improvement begins with three questions. Which of the following is not necessarily one of the three questions?
a. What are we trying to accomplish?
b. What change is needed for improvement?
c. What change can we make that will result in improvement?
d. How will we know that a change is an improvement?
B: The three primary questions that the Model for Improvement begins with are “What are we trying to accomplish?”, “How will we know that a change is an improvement?” (not “What change is needed for improvement?”), and “What change can we make that will result in improvement?” These three questions begin the PDSA cycle for improvement for this model. THE MODEL FOR IMPROVEMENT
A nurse has been assigned to care for a trauma patient with bilateral femoral spiral fractures and a torn spleen, which was removed 2 days before. The patient confides to the nurse that she agreed to an advance directive when she entered the hospital but now is not so sure that is what she wants. The patient asks if this is normal for her to feel this way. Which element of the University of Colorado Hospital Model should the nurse consider first in this situation?
a. Clinical expertise c. Patient preferences
b. Benchmarking data d. Quality improvement and risk data
C: Of the nine possible elements in the University of Colorado Hospital Model, patient preferences would be the most appropriate in this situation because it includes discussion, documentation, and implementation of the patient’s wishes regarding advanced directives, pain management, etc. Even though consulting the patient’s health practitioner (clinical expertise) is also indicated, the primary need for this patient is to have her questions answered and some discussion of her concern. TABLE 21-2 PRACTICE APPLICATIONS TO ELEMENTS OF THE UNIVERSITY OF COLORADO HOSPITAL MODEL
A patient has been complaining of unrelieved pain. The nurse is aware that unrelieved pain:
a. is unnecessary.
b. can be easily accommodated through drugs and patient positioning.
c. is a major health problem.
d. is one of the interventions in the 100,000 Lives Campaign.
C: Unrelieved pain continues to remain a major health problem. In 2006, pain management standards were added to the Joint Commission’s Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). PAIN AND COMFORT
