Chapter 5: Evidence Based Practice [Practice Test] Flashcards
If you format your questions to match pico format it will help you identify keywords to use when conducting _____ _______.
Literary Research
Which is the preferred research standard for selecting Evidence Based Practice?
Multiple RCTs with the randomization Vs. One RCT
Multiple RCTs with the randomization
When performing evidence-based practice always remember to?
Critique the evidence
Who would you seek for scientific literature and what kind of articles would you read?
Medical Librarians
Peer Reviewed Articles
In caring for patients, it is important for the nurse to realize that evidence-based practice is
a. The only valid source of knowledge that should be used.
b. Secondary to traditional or standard care knowledge.
c. Dependent on patient values and expectations.
d. Not shown to provide better patient outcomes
ANS: C
Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience, or the standard, “It has always been done this way.”
Although these sources have value, it is important to learn to rely more on research evidence than on non-research evidence. Patients who receive care based on the most recent and best evidence experience 28% better outcomes
After abdominal surgery what 4 things should you encourage your patient to do and when should they be done? why?
- Get out of bed
- Walk
- Sit in a chair
- Pass Gas or Bowel Movement
When: Do all of these on first post-op day.
Why: Prevents paralytic ileus.
The nurse is doing a literature review related to a potential problem that has been identified on the nursing unit. The nurse realizes that nursing research is important in that it is designed to (Select all that apply.)
a. Enhance the nurse’s chance at promotion.
b. Identify new knowledge.
c. Improve professional practice.
d. Enhance effective use of resources.
e. Lead to decreases in budget expenditures
ANS: B, C, D
Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Effective use of resources does not always result in lower budget expenditures, but rather more effective use of resources. A promotion is not a direct result of research.
What is the best way to improve patient satisfaction?
Is this proper or improper PICOT question formatting?
Improper formatting
Name these parts of a literary article?
- Detailed background of the level of science and clinical background that exists on the topic?
- Explains the purpose or intent of study?
- Brief summary of the article?
- Explains outcomes or if the was answered?
- Used to explain the therapy or new technology this can differ based on the intervention?
- This contains more information on the purpose of the paper?
- This explains the findings and if they can be used in the clinical setting?
- This explains how the research study was organized and conducted Ex. RCT or Case Study
- Literature Review
- Purpose Statement
- Abstract
- Results of Conclusions
- Manuscript Narrative
- Introduction
- Clinical Implications
- Methods of Design
The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which of the following methods will provide the nurse with the right kind of data? (Select all that apply.)
a. Experimental research
b. Surveys
c. Evaluation research
d. Phenomenology
e. Grounded theory
ANS: A, B, C
Experimental research, surveys, and evaluation research are all forms of quantitative research. Phenomenology and grounded theory are forms of qualitative research
This is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with clinical expertise. What is this defined as?
Evidence Based Practice
Give examples of where you can find evidence for an evidence-based practice question? (9)
Which is the best option when doing research?
Patient Assessment Patient History Patient Physical Clinical Expertise Textbooks Research Journals (BEST OPTION) Articles Non-Research Evidence Patient preferences and values
The hospital quality improvement committee has noted that the incidence of needlestick injuries on a particular unit has increased. When faced with issues, the committee applies the PDSA model, a formal model for exploring and resolving quality concerns. Because the committee is multidisciplinary in nature, and few members are nurses, it is imperative that the committee first
a. Plan.
b. Do.
c. Study.
d. Act.
ANS: A
“Plan” is the first step of the process; it involves a review of available data to understand existing practice conditions or problems to identify the need for change. “Do” involves
selecting an intervention on the basis of the data reviewed and implementing the change. “Study” means to evaluate the results of the change. “Act” involves incorporating the change if it is successful.
Most care is based on ______ and _____ which is ineffective.
convenience
tradition
The quality improvement committee has been alerted to an increased number of falls in the
hospital. Most of these falls have occurred at night and have involved patients who were trying to crawl over bedrails. A literature review brought out that most falls occur because patients are trying to go to the bathroom. The committee created a practice change that bedrails should be left in the down position, and hourly nursing rounds should be conducted. What is the committee’s next step?
a. Evaluate the changes in 1 month.
b. Wait a month before implementing the changes.
c. Implement the changes as a pilot study.
d. Communicate to staff the results of this inquiry.
ANS: D
Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a QI committee makes a practice change, it is important to communicate the results to staff. Practice changes will not likely last when QI committees fail to report findings and results of interventions. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either fully or as a pilot study) and as soon as practical; this should be followed by re-evaluation.
Evidence-based practice states touch is therapeutic. But the patient has a culture barrier and doesn’t like touch. What would the nurse do in this situation?
Seek alternative evidence to practice
The hospital’s quality improvement committee has identified a problem on one of the units. In
using the PDSA method to help determine ways to deal with the issue, the committee decides to do a literature review. This is an example of quality improvement
a. Combined with evidence-based practice.
b. With inability to make the right decision.
c. With delay in the action needed.
d. With no designated method for dealing with issues.
ANS: A
Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a committee defines a problem, it applies a formal model for exploring and resolving quality concerns. One part of the PDSA cycle is the “Do” section,
which requires the selection of an intervention on the basis of data reviewed. Therefore the committee is taking the right action and is not unduly delaying action; data must be obtained that are needed to make the right decision as part of the PDSA method, which is in place.
What are some examples of clinical questions? (4)
What does not make sense to you during care?
What needs to be clarified in care?
Think deeply about what is time-consuming, costly, or not logical during care?
What problem focused and knowledge focused triggers should I use to think clinically about the care problem?
In conducting a research study, the researcher must guarantee that any information the subject
provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. This concept is known as
a. Anonymity.
b. Confidentiality.
c. Informed consent.
d. The research process.
ANS: B
Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Anonymity occurs when even the researcher cannot link the subject to the data. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer.
The nurse is trying to identify common general themes relative to the effectiveness of cardiac
rehabilitation for patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. What type of research is the nurse conducting?
a. Evaluation research
b. Experimental research
c. Qualitative research
d. Nonexperimental research
ANS: C
Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent’s decision to smoke cigarettes
What are the six steps of evidence-based practice?
- Ask a clinical question.
- Collect the most relevant and best evidence.
- Critically appraise the evidence you gather.
- Integrate all evidence with clinical expertise patient values and preferences in making a practice decision or change.
- Evaluate the practice decision or change.
- Share the outcomes of evidence-based practice with others.
This type of data does not give you evidence in finding a solution to a problem but it will inform you of the severity of problems that will help you develop an EBP question?
Quality and Risk Management Data
The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the
a. Abstract.
b. Introduction.
c. Literature review or background.
d. Results
ANS: B
The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The abstract is a brief summary of the article. The literature review or background offers a detailed background of the level of science or clinical information that is available about the topic of the article. The results section is the summary section of the article.
Due to scrutiny in the media this helps nurses make effective timely and appropriate clinical decisions.
Evidence Based Practice
This part of the PICOT question identifies what to implement when utilizing EBP practice?
Ex. Treatment, Diagnostic Test, or a Prognostic Factor?
Intervention of Interest
This part of the PICOT question identifies what is the usual standard of care or current interventions used now and practice?
Comparison of Interest
The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurse’s best option?
a. Drop the idea of making the change at this time.
b. Insist that management hire the needed staff to facilitate the change.
c. Seek employment in another institution that may have the staff needed.
d. Conduct a pilot study to develop evidence to support the change.
ANS: D
When evidence is not strong enough to apply in practice, or if resources are limited, the next option is to conduct a pilot study to investigate the PICO question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and
could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines.
This part of the PICOT question identifies what amount of time is needed for an intervention
EX. Amount of time needed to change quality-of-life or patient behavior?
Timing of Interest
