Chapter 5 Flashcards
When engaging in evidence-based health care, the nurse understands that it was originally started as a way to:
a. teach medical students the art and science of medicine.
b. promote technological advances in medicine.
c. integrate individual experience with clinical research.
d. incorporate collaboration within all health care disciplines.
C: D. L. Sackett, well known in the EBM movement, encouraged evidenced-based medicine as a way to integrate individual clinical medical experience with external clinical evidence using a systematic research approach. HISTORY OF EBP
A nurse manager is preparing to develop a research proposal. The manager reviews the Iowa Model of Evidence-based Practice to Promote Quality Care and decides to base the research question around one of the “problem-focused triggers” identified in the model. The nurse manager will most likely choose which of the following triggers?
a. Philosophies of Care
b. New Research or Other Literature
c. Identification of Clinical Problem
d. National Agencies or Organizational Standards and Guidelines
C: The nurse manager will most likely choose “Identification of Clinical Problem” as the problem-focused trigger. The Iowa Model identifies several problem-focused triggers, including risk management data, process improvement data, internal/external benchmarking data, financial data, and identification of clinical problem. According to the Iowa Model, philosophies of care, standards and guidelines, national agency or organizational standards and guidelines would be considered “knowledge-focused triggers.” HISTORY OF EBP
A nurse researcher is planning a study using a procedure for quantitatively combining the results of many research studies that measure the same outcome. The data will be combined into a single pool or summary estimate of results. The nurse’s research will most likely involve which of the following designs?
a. Correlation c. Follow-up study
b. Meta-analysis d. Longitudinal research
B: The nurse researcher will most likely conduct a meta-analysis. Correlation research explores the interrelationship among variables of interest. A follow-up study is the subsequent or long-term study of people who have received a specific treatment. A longitudinal study is designed to collect data at more than one point in time, in contrast to a cross-sectional study. TABLE 5-5 RESEARCH TERMINOLOGY
A nurse researcher is conducting a study that has as its main objective the accurate portrayal of the characteristics of people, situations, or groups, and the frequency with which certain phenomena occur. The research is implementing which type of study?
a. Comparative research c. Correlation research
b. Descriptive research d. Research utilization
B: Descriptive research studies have as their main objective the accurate portrayal of the characteristics of people, situations, or groups, and the frequency with which certain phenomena occur. Comparative research specifies the type of comparisons. Correlation research explores the interrelationships among variables of interest without any active intervention on the part of the researcher. Research utilization is the use of some aspect of a research or scientific investigation in an application unrelated to the original research. TABLE 5-5 RESEARCH TERMINOLOGY
As part of your research, you wish to combine study results and thus integrate the results of multiple studies on a given topic. This action is referred to as:
a. qualitative analysis. c. meta-analysis.
b. quantitative analysis. d. matched case-control study.
C: Meta-analysis is a technique for combining study results and thus integrating the results of multiple studies on a given topic. Qualitative analysis is the non-numeric organization and interpretation of observations for the purpose of discovering important underlying dimensions and patterns of relationships. Quantitative analysis is the manipulation of numerical data through statistical procedures for the purpose of describing phenomena or assessing the magnitude and reliability of relationships among them. A matched case-control study is a research technique that uses select sample characteristics to match experimental subjects with a control group. TABLE 5-5 RESEARCH TERMINOLOGY
You decide to conduct a study that begins with cigarette smoking and then looks at lung cancer. Which type of study will you conduct?
a. Outcome study c. Retrospective study
b. Prospective study d. Time series study
B: A prospective study begins with an examination of presumed causes (cigarette smoking) and then goes forward in time to observe presumed effects (lung cancer). An outcome study is an observation of a defined population at a single point in time or at intervals. A retrospective study begins with the manifestation of the dependent variable in the present (lung cancer) and then links this effect to some presumed cause occurring in the past (cigarette smoking). A time series study is a quasi-experimental design that involves the collection of information over an extended period of time, with multiple data collection points both prior to and after the introduction of a treatment. TABLE 5-5 RESEARCH TERMINOLOGY
In developing research, a possible variable the nurse may be considering would be which of the following?
a. Study intervention c. Body temperature
b. Placebo d. Control group
C: A variable is a characteristic or attribute of a person that varies within the population under study such as body temperature. In a randomized controlled trial, an experimental group receives a study intervention and the control group may receive a placebo. A control group consists of subjects in an experiment who do not receive the experimental treatment and whose performance provides a baseline against which the effects of the treatment can be measured. TABLE 5-5 RESEARCH TERMINOLOGY
When using available evidence, the nurse must be aware of what two major challenges?
a. Balancing the benefits and harm to justify a recommendation of the evidence
b. Reviewing the body of knowledge and evaluating for clinical decision making
c. Recommending or not recommending the research evidence for clinical practice
d. Reviewing the clinical trials and grading the research according to the AHRQ scale
B: The two major challenges are (1) reviewing the rapidly growing body of scientific literature and (2) evaluating and transforming the literature in order to be useful for clinical decision making. Balancing the benefits and harm is a criterion for evaluating research. Recommending or not recommending the research is also a criterion for the evaluation process. Reviewing and grading research according to the AHRQ scale is a criterion for the evaluation process. LEVELS OF EVIDENCE
The nurse is engaged in a process approach of reviewing, interpreting, critiquing, and evaluating research and other relevant literature for direct application to patient care. When asked by a coworker, the nurse explains that this process is called:
a. evidence-based medicine. c. evidence-based care.
b. evidence-based practice. d. critical thinking.
C: Evidence-based care is the process approach to collecting, reviewing, interpreting, critiquing, and evaluating research and other relevant literature for direct application to patient care. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is about clinical competence in the individual care of patients, decision analysis, human value, use of information technology for best available clinical evidence from systematic research, and stewardship of resources. Evidence-based care should be viewed as the highest standard of care so long as critical thinking and sound clinical judgment support it. IMPORTANCE OF EBP
The nurse is aware of the growing development of evidence-based care. The nurse would recognize that an issue driving this development is:
a. increased variability in implementation of practice and variance analysis.
b. requirement of evidence-based standards of care by PEW.
c. decreased numbers of well-designed RCTs.
d. growth of advanced practice roles.
D: Issues driving the development of evidence-based practice are growth of advanced practice roles; increased numbers of well-designed RCTs; need for decreased variability in implementation of practice and variance analysis; demand of the PEW Health Professions Commission Report for evidence-based, clinically competent care; increased experience in clinical pathways, standards, protocols, and algorithms; increase in integrated systematic reviews of research studies found in the nursing, medical, and health care literature; need for outcome data to guide patient care; explosion in information technology; improved knowledge base facilitating research capable of supporting evidence-based care models; need to collaborate in complex decision making with patients and other members of the health care team; and requirement for evidence-based standards of care by the Joint Commission. TABLE 5-1 CURRENT ISSUES AND TRENDS DRIVING DEVELOPMENT OF EBP IN NURSING
When engaging in evidence-based practice, the nurse would use which of the following criteria to determine the relevance of the study or report?
a. Level of evidence
b. Clearinghouse to purge outdated research
c. Quasi-experimental pre-post study research
d. Scale for grading research for recommendation
A: Level of evidence identifies the strength or quality of evidence generated from a study or report. Level I includes systematic reviews or meta-analyses of randomized controlled trials (RCTs) and evidence-based clinical practice guidelines are considered to be the strongest level of evidence upon which to guide practice decisions. Level II in the evidence hierarchy is that evidence which is generated by at least one well-designed RCT. An RCT is an experimental research study in which subjects are randomly assigned to experimental and control groups.
LEVELS OF EVIDENCE
A group of nurses wishes to create an evidenced-based environment within the institution where they work. Which of the following is an attribute of such an environment?
a. Maintaining the status quo
b. Using the organizational external structure
c. Maintaining the culture
d. Creating a capacity to change
D: Three specific attributes of establishing an evidence-based environment within an institution are (1) create a capacity for change, (2) establish the culture, and (3) use the organizational infrastructure to sustain and reinforce change. ATTRIBUTES OF EBP
The nurse wishes to employ Melnyk & Fineout-Overholt’s five-step process of evidence-based practice. The nurse recognizes that the five-step process includes:
a. asking relevant questions, searching for evidence, appraising the evidence, integrating evidence with clinical practice and patient preferences in order to make practice decisions, and evaluating the practice decision.
b. knowledge discovery, evidence summary, translation into practice, integration into practice, evaluation.
c. grading the research, leveling the evidence, source of evidence, strength of evidence, publishing the evidence.
d. designing the research study, selecting research subjects, controlling variables, collecting data, analyzing.
A: Melnyk & Fineout-Overholt’s five-step process of evidence-based practice includes asking relevant questions, searching for evidence, appraising the evidence, integrating evidence with clinical practice and patient preferences in order to make practice decisions, and evaluating the practice decision. EVIDENCE FROM THE LITERATURE
An instructor wants to determine whether a group of nursing students understands the process for conducting evidence reports in nursing using a PICO-based approach. Which of the following comments by the students would indicate that learning has occurred?
a. Select problem, identify methods for assigning level of evidence, report evidence, report findings, make recommendations, give summary
b. Select problem, report evidence, identify methods for assigning level of evidence, report findings, make recommendations, give summary
c. Select problem, report findings, report the evidence, identify methods for assigning level of evidence, give summary, and make recommendations
d. Formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement
D: The steps in the method for conducting evidence reports in nursing based on a PICO-based method are to formulate a well-built question, identify articles and other evidence-based resources that answer the question, critically appraise the evidence to assess its validity, apply the evidence, reevaluate the application of evidence and areas for improvement. PICO-BASED APPROACH TO GUIDING AN EVIDENCE SEARCH
The nurse follows practice protocols and clinical guidelines primarily because they help to produce better patient care by reducing:
a. variations in care and increasing efficiency.
b. the need for individual patient variations.
c. waste of resources available in the hospital.
d. the number of inpatient care days per year.
A: Using tools such as clinical guidelines may help reduce variations in care and has the potential to increase efficiency. Practice protocols are no substitution for the need to assess each patient’s unique individual needs and variations with the care. Using practice protocols may have an influence on reducing waste; however, reducing waste does not necessarily produce better patient care. Practice protocols are not used primarily to reduce the number of inpatient care days. TABLE 5-5 RESEARCH TERMINOLOGY
