EBP Flashcards
Why does EBP matter?
Problem-solving approach to clinical decision making
Using the best available evidence, with your expertise and patient’s preferences, to make decisions and improve patient outcomes
Steps of the EBP Process
1) Ask the clinical question using the PICOT format.
2) Search for the best evidence based on the clinical question.
3) Critically appraise and synthesize the evidence.
4) Implement the evidence in practice.
5) Evaluate the practice decision or change.
6) Share the outcomes of the decision or change.
How many steps are there in EBP?
6
How do you form a clinical question?
P = patients/populations/problem
I = intervention
C = comparison/control (opt.)
O = outcome (opt.)
T = time period (opt.)
In Step 3) A successful critical appraisal process focuses on three essential questions:
1) What are the results?
2) Are the results reliable and valid?
3) Will the results help me in caring for my patients?
In step 5, you need to evaluate the outcomes to determine?
the effectiveness of the change improving outcomes
Does this question include all of the PICOT to form a clinical question?
In patients who have experienced an acute myocardial infarction, how does being a smoker compared with being a non-smoker influence death and infarction rates during the first 5 years after the myocardial infarction?
Yes
What are the levels of evidence from broadest to strictest?
Opinion of authority or exert committees
Internal organization (quality/risk management data
Systemic reviews of descriptive/qualitative studies
Well-designed case-control studies
Well-designed controlled trials w/o randomization
1 well-designed RCT
Systematic reviews and meta-analysis of RCTs
RCT means
randomized controlled trials
What are the best levels of evidence?
1 well-designed RCT
Systematic reviews and meta-analysis of RCTs - worldwides
Inclusion Criteria
elements of an article that must be present in order for it to be eligible for inclusion in a literature review
Inclusion criteria must include
compared certain tx
certain types of data (only RCTs)
located in a specific geographic area
published in the last 5 years
Exclusion Criteria
elements of an article thatdisqualifythe study frominclusionin a literature review
Exclusion Criteria examples
observational design
qualitative methodology
published more than 5 years
language other than English
Observational study
looking at the effect of some intervention, risk, diagnostic test, or treatment, without trying to manipulate who is, or who isn’t, exposed to it
Quantitative
numbers and statistics
systematically measure variables and test hypothesis
Qualitative
words and meanings
explore concepts and experiences in more detail
EBP closes the gap between
research and practice
by providing more reliable and predictable care than base don tradition, opinion, and trial or error
T/F: EBP does not mean that you conduct a research study.
TRUE
depends on active role with best available evidence with care
valid evidence
solve problems
support pt outcomes
Step 1 of EBP
the clinical question in PICOT
- SETS CONTEXT for evidence, clinical judgment, and preferences
Guides the best evidence
Step 2 of EBP
Search for the best evidence applying to the clinical question
credibility and reliability
Step 3 of EBP
critically appraising evidence
strength of evidence and synthesized findings
Step 4 of EBP
IMPLEMENT EVIDENCE
Step 5 of EBP
eval outcome of practice change
require documentation
Step 6 of EBP
sharing results
An example of a nursing activity that best reflects the American Nurses Association’s definition of nursing is
a. treating dysrhythmias that occur in a patient in the coronary care unit.
b. diagnosing a patient with a feeding tube as being at risk for aspiration.
c. setting up protocols for treating patients in the emergency department.
d. offering antianxiety drugs to a patient with a disturbed sleep pattern.
b
A nurse working on the medical-surgical unit at an urban hospital would like to become certified in medical-surgical nursing. The nurse knows that this process would most likely require
a. a bachelor’s degree in nursing.
b. formal education in advanced nursing practice.
c. experience for a specific period in medical-surgical nursing.
d. membership in a medical-surgical nursing specialty organization.
c
The nurse is assigned to care for a newly admitted patient. Number in order the steps for using the nursing process to prioritize care. (Number 1 is the first step, and number 5 is the last step.)
___ Evaluate whether the plan was effective. ___ Identify any health problems.
___ Collect patient information.
___ Carry out the plan.
___ Decide a plan of action.
5
2
1
4
3
Using the SBAR format, number in order the steps for how the nurse would communicate information with the provider. (Number 1 is the first step, and number 4 is the last step.) ____ “I would like you to order an IV medication and come evaluate the patient as soon as possible.”
____ “This is Nurse M.H. I am calling from the unit because your patient, D.R., has a new onset of atrial fibrillation.”
____ “The atrial fibrillation started about 10 minutes ago. The heart rate is 124; BP is 90/60. The patient is experiencing dizziness.” ____ “D.R., who is 2 days postoperative for a bowel resection for diverticulitis, has a history of mitral valve disease.”
4,1,3,2,5
The nurse is caring for a diabetic patient in the ambulatory surgical unit who has undergone wound debridement. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?
a. Check the patient’s vital signs.
b. Assess the patient’s pain level.
c. Palpate the patient’s pedal pulses.
d. Monitor the patient’s IV catheter site.
a
- The nurse’s role in addressing the National Patient Safety Goals established by The Joint Commission includes (select all that apply)
a. answering all patient monitoring alarms promptly.
b. memorizing all the rules published by The Joint Commission.
c. obtaining a correct list of the patient’s medications on admission.
d. encouraging patients to be actively involved in their own health care.
e. using side rails and alarm systems as necessary to prevent patient falls.
a, c, e
- Advantages of using informatics in health care delivery are (select all that apply)
a. reduced need for nurses in acute care.
b. increased patient anonymity and confidentiality.
c. the ability to achieve and maintain high standards of care.
d. access to standard plans of care for many health problems.
e. improved communication of the patient’s health status to the health care team.
c, d, e
When using evidence-based practice, the nurse
a. must use clinical practice guidelines developed by national health agencies.
b. should use findings from randomized controlled trials to plan care for all patient problems.
c. uses clinical decision-making and judgment to decide what evidence is appropriate for a specific clinical situation.
d. analyzes the relationship of nursing interventions to patient outcomes to discover evidence for patient interventions.
c
