EBP final Flashcards
evidence based practice
practice using best available evidence, patient preference and clinical judgement
EBP components
- research based information
- clinical expertise
- patient preference
EBP barriers
- individual
- organizational
- research related
individual EBP barriers
resistant to change
lack value / knowledge of EBP
lack of skills to obtain evidence
organizational EBP barriers
resistant to change
lack resources to access evidence
research related EBP barriers
communication gap b/t researcher and clinician
writing associated with reports
lack of telling research findings
research
systematic study that leads to new knowledge / solutions to problems or questions
quality improvement project
structured continuous activity designed to improve how care is delivered to pts
-change at systematic level
research difference
-generates new knowledge
-research question
-participants
-describe phenomenon, find relationship, test intervention
-evaluates findings in light of research question
EBP difference
-applies new knowledge to care
-based on literature evidence
-clinical question
-patients
-change practice in clinical setting
-evaluates change based on pt outcomes
impetus for change
- new knowledge
- safety concern
- healthcare outcomes
- healthcare cost
- societal need for professional nursing
- conferring with others
overcoming change barriers
- engage stakeholders
- engage admin
- culture of safety
- care bundles
- interprofessional collaboration
- overcome research barriers
- ensure nurses meet EBP competencies
knowledge translation
collaborative process that includes
-synthesis
-dissemination
-exchange
-ethically sound application of knowledge
change process attributes
- collaboration
- action
- receptivity
- process
- translation
- improved health outcomes
hierarchy of evidence
seven level scale used to rate strength of evidence
level I
highest quality of evidence
-summarizes more than one study
-synopses
-meta-analysis
-systematic reviews
-clinical practice guidelines
level II
randomized control trials
level III
quasi-experimental designs
level IV
no manipulation of IV
-correlational design
-cohort study
-case control study
-quantitive findings from mixed method
level V
consists of synthesis
-integrative reviews
-metasynthesis
level VI
descriptive research
-descriptive survey design
-qualitative findings from mixed method
-single qualitative studies
-EBP projects
-quality improvement projects
-case studies
-concept analysis
level VII
evidence from authority opinions, reports of expert committees, manufacturer’s recommendation
-narrative reviews
meta-analysis
estimates effect of intervention by using statistical methods to analyze data from published and unpublished studies
**study about studies!!
systematic review
systematic synthesis of research findings from experimental and quasi-experimental studies on a clinical problem
quasi-experimental
has manipulation of the IV but lacks randomization of experimental and control groups
mixed method design
combines quantitative and qualitative data
correlational design
nonexperimental design used to study relationships b/t two or more variables
cohort study
participants are selected based on their exposure to a particular factor
case control
participants are grouped on presence / absence of particular disease
integrative review
scholarly papers that include published nonexperimental studies to answer clinical question
metasynthesis
systematic review of qualitative studies
narrative review
papers based on common / uncommon elements of work without concern for research methods, design, or setting
research types by aims
descriptive
explanatory
predictive
descriptive research
no intervention, description of natural setting
explanatory research
explains relationships among variables
predictive research
predicts differences with intervention
research types by method
qualitative
quantitative
mixed method
qualitative research
non-numerical, gets meaning from words
quantitative research
uses statistics, presented in graphs / tables
mixed method research
combines quantitative + qualitative
research types by time
longitudinal
cross sectional
longitudinal research
data is collected at multiple points
cross sectional research
data is gathered once / period of days
inductive reasoning
moves from particular to general
ex: daisy is a swan and white, danny is a swan and white, dante is a swan and white —–> all swans are white
deductive reasoning
moves from general to particular
ex: all swans are white –> daisy is a swan —-> daisy is white
research article
- title
- abstract
- keywords
- introduction
- literature review
- method
- result
- discussion
- conclusion
- references
abstract
100-150 words , brief overview of study
keywords
5-10 keywords that represent the article
introduction
background of research problem
purpose of study - address significance of study
literature review
previous recent studies - what is known about the problem
method
study design
sample
measurement / tool
process of data collection
analysis method
results
findings from data analysis
discussion
interpretation of results, any limitations
conclusion
summary of findings, suggestions, implications
in APA citation what is italicized….
name of periodical
volume #
***do not italicize the issue number
research question
comes from…
1. personal clinical experience
2. professional literature / previous evidence
3. current nursing theories
4. national initiatives
research question W5H1
- who
- what
- when
- where
- how
formulating a research question
-population
-setting
-problem
-intervention / solution
-method
hypotheses
formal statement about expected / predicted relationships b/t two or more variables
**must be testable and measurable
associative relationship
type of relationship where one variable changes the other one does as well
**can be positive or negative
causal relationship
when one variable determines the presence / change in another
simple hypothesis
describes relationship b/t only TWO variables
complex hypothesis
describes relationship b/t THREE or more variables
null hypothesis
no relationship between variables exists
research hypothesis (alternative)
there is a existing relationship between variables
variables
can be measured
-directly : BP, WBC count, RR
-indirectly : questionnaires or scales
independent variable
influences the DV
dependent variable
is influenced by the IV
confounding variable
interferes with the relationship between the IV and DV
population
refers to all members of a group of interest whom you intend to generalize the results of your study
accessible population
part of population you can access
sample
part of population that you will investigate
sampling frame
list of all possible elements in the accessible population
sample must represent…
the population to maximize generalizability and reliability
probability sampling methods
- simple random
- systematic sample
- stratified sample
- cluster sample
simple random sampling
randomly selecting elements from accessible population
probability sampling
occurs when elements in accessible population have equal chance of being selected for the study
stratified random sampling
selecting elements from accessible population that has been divided into groups (strata)
cluster sampling
selecting elements from larger to smaller subsets of accessible population
systematic random sampling
every “kth” element is selected from a numbered list of accessible population , starting point on list is randomly selected
nonprobability sampling methods
- convenience sampling
- quota sampling
- snowball sampling
- purposive sampling
convenience sampling
elements are selected because they are easy to access
nonprobability sampling
does not require random selection of elements
quota sampling
selection of elements from accessible population that has been divided into groups
purposive sampling
used in qualitative studies to select distinct group of people who have lived the experience or expertise in what is being studied
snowball sampling
recruitment of participants based on word of mouth or referrals from other participants
recruitment
process of contacting / enrolling participants in a study
recruitment process
-must screen participants based on inclusion / exclusion criteria
-methods such as flyers, ads, emails, letters
-participants must represent population
-maximize retention
-check why some individuals did not participate
research process steps
- identify question
- conduct literature review
- identify theoretical framework
- select research design
- implement study
- analyze data
- draw conclusion
- tell findings
level I-IV studies
quantitative studies
level V-VII
qualitative / descriptive studies
level I and V
synthesis (secondary) study
level II, III, IV, VII
individual (primary) study
effective searching
-database : NO sentences
-major concepts : keywords / PICO
-synonyms
-subject headings
-limits
qualitative research characteristics
- extensive data collection : months - years
- occurs in natural setting
- researcher is key instrument
- data obtained via multiple methods
- emergent design
- holistic account
qualitative data collection
-interviews
-observation
-documents
purposive sampling
method to recruit specific persons who could provide inside information
**qualitative data
phenomenology
qualitative research describing lived experiences to achieve understanding from participants perspective
grounded theory
develop a theory grounded from data in the field
-studies a process, interaction, action involving many individuals
-no set sample size
ethnographic research
describes a culture, study groups (immersing yourself into culture)
historical research
based on documentation of sources, used to examine events / people to understand the past
qualitative interviews
structured vs. semistructured
structured interview
going in with a script and cannot go off of it
semi-structured interview
going in with a plan but can branch off and ask your own questions
qualitative research ethics
-do not pressure participants
-respect cultures
-respect sites
-do not “use” participants
qualitative evaluation
-prolonged engagement / persistant observation
-triangulation
-peer debriefing
-member checking
-negative case analysis
-reflexivity
control
ability to manipulate / regulate / statistically adjust for factors that can affect dependent variable
manipulation
treatment / implementation / IV in a study to determine effect on DV
bias
influence that distorts the results of the study
random assignment
equal chance of being assigned to either the treatment or control group
single blinding
participants do not know which study group they are in
double blind
blinding both experimenter and participants
experimental (true) research
designs involving random assignment to groups and manipulation of the IV
correlational research
non-experimental research that is used to study relationships between two variables
experimental design includes…
- manipulation
- control
- randomization
experimental design strength
gives level II evidence
good in examining cause and effect relationship
nonexperimental design
IV is not manipulated
subjects not random
no control group
no cause and effect claims
nonexperimental design use…
describing
explaining
predicting
data collection plan
- set timeline
- determine collection method
- develop data management plan
data analysis process
- prepare data and enter into computer
- clean data file
- run descriptive stats
- run inferential stats
categorical measurement
nominal and ordinal
nominal
different in name only, CANNOT rank or order
**weakest kind of measurement
ordinal
can be ranked or ordered, still in categories
continuous measurement
interval and ratio
interval
fixed unit of measurement WITHOUT meaningful zero
ratio
fixed unit of measurement WITH meaningful zero
ex: money , age
descriptive statistics
numbers that summarize data, does not generalize beyond data
-mean, median, mode, percentage, standard deviation, range
inferential statistics
make predictions about a population based on sample
chi-squared test
nominal and ordinal data
t-test
compares the mean of the two groups
analysis of variance
used for more than 3 groups
pearson’s r test
two variables of interval or ratio data
multiple regression
many IVs to only one DV
alpha
significance level
MUST be identified before running stats
0.05 = 5%
P-value
probability of obtaining results at least as extreme as results actually observed
p < 0.05
statistically significant , REJECT THE NULL
p > 0.05
statistically not significant , do not reject the null
PICOT
-patient population
-intervention of interest
-comparison of interest
-outcome of interest
-time
study validity
measure of truth / accuracy of a claim
-ability to accept result as logical, reasonable, justifiable
internal validity
degree to which one can conclude that the IV produced changes in the DV
internal validity threat
-selection bias
-history effect
-maturation
-mortality
-testing effect
-instrumentation
history effect
effects of unexpected events that take place concurrently of IV
instrumentation
inaccurate data collection / changes in methods of measurement / collector b/t two data points
construct validity
if selection or measurement measures concept accurately
construct validity threats
-bias
-confounding variable
-reactivity
-experimenter expectancies
reactivity (hawthorne effect)
participants change their behavior or performance in response to what is being observed
statistical conclusion validity
degree to which results of statistical analysis reflect true relationship among IV and DV
type 1 errors
rejecting a true null hypothesis
type 2 errors
accepting a false null hypothesis
external validity
degree to which results of the study can be generalized to other participants, settings, times
external validity threats
-selection effects
-interactions
selection effects
sample does not represent population
reliability
consistency of a research study or measuring test
study appraisal
studies will have flaws / limitations
-evidence is powerful and effective , need to consider feasibility based on policy / pt preference / ethical issues
belmont report
- respect for persons
- beneficence
- justice
respect for persons
individuals should be treated as anonymous
-recognition that persons with diminished autonomy are entitled to protection
beneficence
do no harm
-maximize possible benefits and minimize harm
justice
equity or fairness in distribution of burdens and benefits
full review
necessary when vulnerable populations are involved or when risks are not minimal
expedited review
option when there is minimal risk to human subjects
minimal risk
probability and magnitude of discomfort are not greater than those of encountered in daily life during performance of routine physical / testing
synthesis
written paper including discussion from several sources
-shows connection, patterns, themes from a source that have relationship to one another
writing a synthesis
- start with summarizing info from the sources
- think of similarities and differences
- compare and contrast their ideas giving credit to their own ideas and your own
