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NURS 305 > Chapter 5: Evidence-Based Practice > Flashcards

Chapter 5: Evidence-Based Practice Flashcards

1
Q

Evidenced Based Practice

A

a systematic, problem solving approach that:

  • integrates best evidence
  • uses clinical expertise & experience
  • includes patient preferences and values
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2
Q

What are the steps of Evidenced-Based Practice (EBP)

A
  1. ask a clinical question in PICOT format
  2. collect the most relevant & best evidence
  3. critically appraise the evidence you gather
  4. integrate all evidence utilizing clinical expertise, patient preferences and values in making a decision of change.
  5. evaluate the outcomes of the practice decision or change
  6. share the outcomes of EBP changes with others
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3
Q

Step 1: Ask a Clinical Question

A

P: What is the patient population are you interested in?
I: What is the intervention of interest?
C: What are you trying to compare
O: What outcome are you trying to measure?
T: What is the time frame?

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4
Q

Step 2: Collect the most relevant and best evidence

A
  • use your PICOT question to expeditiously access info/peer reviewed articles.
  • search data base
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5
Q

Hierarchy of Evidence

A

….

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6
Q

Step 3: Critically appraise the evidence you gather

A

Evaluate: scientific merit, clinical applicability, and study limitations.

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7
Q

What are the elements of EBP articles?

A
  1. abstract
  2. introduction
  3. literature review
  4. manuscript narrative
  5. methods or designs
  6. results and conclusions
  7. clinical implications
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8
Q

manuscript narrative

A

the body of the article.

a. purpose statement
b. hypotheses
c. variables

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9
Q

Step 4: Integrate all evidence utilizing clinical expertise, patient preferences and values

A
  • apply the research to your plan of care

- integrate evidence

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10
Q

Apply the research to your plan of care by asking yourself

A
  • Does the practice change fit with scope of practice?
  • Are the necessary resources available?
  • Is a pilot study necessary?
  • Who are the major stakeholders?
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11
Q

Integrate evidence through:

A
  • teaching tools
  • clinical practice guidelines
  • policies and procedures
  • assessment or documentation of tools
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12
Q

Step 5: Evaluate the practice decision or change

A
  • How is the clinical practice change working?
  • How effective was the change?
  • Do modifications need to be made?
  • Will this change be sustainable?
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13
Q

Step 6: Share the outcomes of EBP changes with others

A
  • communicate the results
  • sustainability more likely when: value is seen by the change, clinical staff “buys in” to the change, and clinical staff is allowed input in the process.
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14
Q

Outcomes Research

A
  • focuses on benefits, risks, costs and holistic effects of a treatment on patients.
  • helps make informed decisions on the basis of current evidence: justifies care practices and systems in terms of improved patient outcomes and costs.
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15
Q

Outcomes:

A

observable or measurable effects of an intervention or action

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16
Q

Focus of outcomes is

A

recipient of care

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17
Q

Scientific Method

A
  • foundation of research; most reliable/objective
  • systematic, step-by-step process
  • minimizes bias or opinion by the researcher
  • verifies findings from a study are: valid, reliable, generalizable to similar subjects researched.
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18
Q

Characteristics of scientific research

A
  • Identifies the problem area of interest.
  • Research is conducted in a systematic and orderly way.
  • Researchers try to control external factors.
  • Researchers gather empirical data through observations and assessments.
  • Ultimate goal is to understand phenomena and applicability to a broad group of patients.
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19
Q

Quantitative Research

A

Precise measurement and quantification

20
Q

Quantitative Research focus on

A
  • Numerical data
  • Statistical analysis
  • Controls to eliminate bias in findings.
  • Precise
  • Systematic
  • Objective
21
Q

Experimental Research

A

tightly controls conditions to eliminate bias

22
Q

Nonexperimental Research

A

describe, explain, or predict phenomena

23
Q

Surveys

A

measure practices, perceptions, education, experience, opinions, and other characteristics of people

24
Q

Evaluation research

A

determines how well a program, practice, procedure, or policy is working

25
Q

Qualitative Research

A
  • study of phenomena that are difficulty to quantify or categorize such as patient perception of illness
  • requires inductive reasoning
26
Q

Qualitative Research is obtained in

A

non-numerical form. ex) written transcripts, interviews and story telling

27
Q

Qualitative Research Methods include:

A

ethnography, phenomenology, grounded theory

28
Q

ethnography

A

explores cultural phenomena

29
Q

phenomenology

A

explores structures of subjective experiences and consciousness

30
Q

grounded theory

A

discovery of theory through analysis data

31
Q

Nursing Process Compare to Research Process

A
  1. Assess vs Identify an area of interest
  2. Diagnose vs Develop research questions
  3. Plan vs Determine how the study will be conducted
  4. Implement vs Conduce the study
  5. Evaluate vs Analyze the results
32
Q

Testing on Human Subjects: The Right of Informed Consent

A
  1. subjects are given full and complete information including potential harm, benefits and alternative methods of treatments.
  2. subjects must be fully capable of understanding the research and its implications.
  3. subjects have the power of free choice to voluntarily consent or decline participation.
  4. subjects must understand how the researcher maintains confidentiality or anonymity.
33
Q

The Belmont Report of 1979: Outline fundamental ethical principles for using any human subject for research including:

A
  1. respect for persons: protecting autonomy
  2. beneficence: benefit
  3. non maleficence
  4. justice: non-exploitive, well-considered procedures
34
Q

Focus of outcomes management to

A

increase patient safety and decrease medical errors.

includes:
- fall rates
- number of medication errors
- incidence of pressure ulcers
- infection rates

35
Q

Quality improvement

A

improvement of health care related processes such as fall prevention

36
Q

Performance improvement

A

Focused improvement actions, clinical projects in response to problems such as identifying patients at risk for falls and implementing a fall prevention protocol (yellow gown, signage etc…)

37
Q

all members of the health care team collaborate in QI activities for

A

recognizing trends, identifying recurrent problems and initiating opportunities to improve

38
Q

QI issues to consider:

A
  • high-risk/high volume
  • high-risk/low volume
  • potential problems (for patients, staff and institution)
39
Q

High risk/high volume

A
  • potential for injury or death

- may be initiated secondary to a sentinel event.

40
Q

sentinel event

A

involving death, serious physical or psychological injury

41
Q

national patient safety goals purpose

A

is to improve patient safety.

Goals focus on problems in health care safety and how to solve them.

42
Q

benefits of joint commision

A

….

43
Q

Quality Improvement Models

A
  • Six Sigma or Lean

- Rapid Cycle Improvement

44
Q

Six Sigma or Lean

A

“bottom up approach” All members of the health care team are responsible for developing and integrating changes utilizing the fewest resources to reduce costs, enhance quality and improve teamwork.

45
Q

Rapid Cycle Improvement

A

A response to a serious problem. Radical changes made in a short period of time.

46
Q

QI Sustainability: Communication

A

ultimately sustainability will not take place without by-in from the end user

47
Q

QI Sustainability: Communication

A

Must establish value in the change

Must utilize stake-holders input and suggestions/ideas

Must communicate results and report findings of of interventions

Must revisit interventions and analyze successes/potentials for improvement

Must utilize statistical data and sound evidence to measure the need for change and the resulting improvements

NURS 305 (30 decks)

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