Chapter 7 Evidence-Based Practice In Medical Surgical Nursing Flashcards
Quantitative question
A clinical question to ask about the relationship between or among defined, measurable phenomena and includes statistical analysis of information that is collected to answer a question.
Clinical practice guideline
An “official recommendation” based on evidence to diagnose and/or manage a health problem (e.g., pain management).
Define “PDSA”
“P”stands for “plan” and is the first step in introducing a practice change.
“D” stands for “do” and is the action-oriented phase of the process. The new innovation or a portion of it is tested according to the plan
“S” stands for “study” and refers to the review analysis of data collected during the “do” phase of the cycle
“A” is the “analysis” anybody ration of results from the small test the guy decisions about how to proceed.
What does PDSA stand for?
Acronym for plan, do, study, analysis.
Qualitative question
A clinical question that focuses on the meanings and interpretations of human phenomena or experience of people and usually analyzes the content of what a person says during an interview or what a researcher observes.
What does EBP stand for?
Evidence Based Practice
What are the six steps of the evidence-based practice process?
- Asking “burning” clinical questions
- Finding the very best evidence to try to answer those questions
- Critically appraising and synthesizing the relevant evidence
- Making recommendations for practice improvement
- Implementing excepted recommendations
- Evaluating outcomes
What are examples of components of PICO(T) questions in relation to type?
Population: indicates the specific group of patients to him the question applies
Interventions: pertains to the therapeutic effectiveness of a new treatment
Comparison: The comparison component of the clinical question may be either the standard our current treatment or may be another intervention with which the innovative practice is compared
Outcome: specifies the measurable and desired outcomes of your practice innovation, diagnosis, or prevention intervention
Time:
What is the pyramid of evidence for questions of therapy?
Level I: systematic reviews, integrative/meta–analysis, CPG’s based on systematic reviews, large multi-center clinical trials
Level II: single experimental study (RCTs)
Level III: quasi experimental studies
Level IV: non-experimental studies
Level V: case report/program evaluation/narrative literature reviews
Level VI: opinions of respected authorities
What are the “Fantastic Four” databases?
- Cochrane Library of Systematic Reviews
- Joanna Briggs Institute (JBI) systematic reviews
- Midline (or PubMed)
- Cumulative Index to Nursing and Allied Health Literature (CINAHL)
💡Decision-making challenge
Evidence-based practice; quality improvement; safety
An 82-year-old alert and oriented woman was admitted with a diagnosis of congestive heart failure. She also has urinary frequency. You notice on her chart that she is a “high falls risk” Over 70% of patients on your unit are also at high-risk for falls. The written policy and procedure for fall prevention at your hospital states that patients at risk for falling should have
Their health care record flagged with the green star
A green star placed on their room or bed
A bed alarm installed
Their siderails up at all times, except when a visitor, nurse, or nursing assistant is present
The patient felt the urge to urinate and pressed her call light. Someone told her that she would assist her shortly. After 15 minutes, the patient had to A decision to urinate in bed or climb over the side rails to go to the bathroom. She decided to climb over the side rails and fell. The bed alarm went off after she left the bed.
1. Considering that over 70% of patients admitted to your unit are flagged as “at risk for falls,” how do you think the nurses decide that a patient is at risk for falling? Are they using valid, reliable, sensitive, and specific assessment to make this determination?
2. In a population of impatient older adults, what factors can predict patient falls with a high degree of accuracy?
3. Does the best available evidence support the use of bed alarms as an intervention to prevent falls in inpatient adults of any age?
4. In a population of adult inpatients, what are the factors that have been shown by research to be the most predictive of falls?
5. What interventions have been shown to decrease the fall rates in acute care institutions with this population?
What is the EBPI model?
Describe the problem Formulate focused clinical question Search for evidence Appraise in synthesize evidence Develop aim (goal) statement PDSA Disseminate best practices
