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Nursing 385 > Evidence-based practice > Flashcards

Evidence-based practice Flashcards

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1
Q

evidence based practice

A

integrating best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care

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2
Q

Evidence based practice (tanner)

A

Analytical processes
Intuition
Narrative thinking

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3
Q

Analytical processes

A

Measurable phenomena yielding measurable patient outcomes

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4
Q

Intuition

A

Experience, observation, expectations

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5
Q

Narrative thinking

A

Stories and accounts of patient experiences, nurses’ experience

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6
Q

Evidence based practice requires…

A 
The need for nurses and nursing students to be capable of “locating and critiquing research studies including systematic reviews, identify gaps between current practice and best practice, and develop the skill set to address these gaps and make the appropriate changes in nursing practice”
EBP knowledge and skills 
Belief in the value of EBP
Saltire and resources to support EBP
EBP mentors
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7
Q

Evidence informed decision making

A

A continuous interactive process involving the explicit, conscientious and judicious consideration of the best available evidence to provide care

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8
Q

Decision making in nursing practice is influenced by…

A

Evidence and also by individual values, client choice, theories, clinical judgement, ethics, legislation, regulation, health-care resources and practice environments

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9
Q

History of evidence based practice

A

Cochrane
Guyett and sackett
British medical journal

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10
Q

Cochrane

A

Medical researcher
1972
Initiated the need for treatment decisions to be based on a systematic review of clinical evidence
Proposed = international collaboration of researches to systematically review all the best clinical trials specialty by specialty
Cochrane centre for systematic review opened in 1992 in the United Kingdom

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11
Q

Guyett and sackett

A

McMaster university
1980
Introduced term “evidence-based medicine”

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12
Q

British medical journal

A

Identified evidence-based practice as one of the 15 greatest breakthroughs since the journal’s launch in 1840

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13
Q

Evidence was originally directly related to

A

Quantitative research evidence

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14
Q

Elements of evidence based practice

A

Research evidence = quantitative, qualitative, mixed methods
Clinical expertise/judgement/expertise
Patient perspectives/values
Local context and environment

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15
Q

Research as evidence for practice

A

Needs to be interpreted within the context of the situation
Is not the only factor that informs decision making
Research alone will not change practice

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16
Q

Strengths of evidence based practice

A

Increased patient safety
Higher quality care, better health outcomes
Greater efficiency and reduced health care costs
Increased autonomous practice
Higher levels of job satisfaction

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17
Q

Criticisms of evidence based practice

A

Serves cost clutters and suppresses clinical freedom
Keeping up to date with literature is impossible
Insufficient time for evidence based practice with demanding case loads and staffing shortages
Lack of evidence that it improves health outcomes
Difficult to make happen
Emphasizing research over clinical judgement and family-cantered approaches = cookbook approach
Values randomized control trials and systematic reviews above all other research
Disconnect between evidence based practice and the theory guiding practice

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18
Q

Challenges of evidence based practice

A

Researchers expertise in doing research is not equal to their expertise in interpreting and knowing whether the findings make a meaningful difference in practice
Starting with a known or preferred intervention and then find research to support it
Evidence may not be meaningful in daily practice- disconnected
Using a general recipient without consideration for specific needs/preferences of the family and the context of care
Ensuring evidence is kept current
Appropriate evidence for one profession may be different than others- interprofessional conflict

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19
Q

Complexity of evidence based practice use

A

Need for rapid decisions
Multiple and diverse (sometimes conflicting) decisions
Conflicting evidence from different practitioners
Lack of complete information on which to base decisions
Availability of evidence-based guidelines
Need to explain decision-making processes

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20
Q

What would help nurses develop evidence based practice

A

A spirit of inquiry = consistently questioning practices
Strong belief in the value of EBP
Knowledge and skills in EBP
Commitment to deliver highest quality care to patients and families
An organizational culture that supports EBP

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21
Q

Evidence based practice seven steps

A 
Zero = cultivate a spirit of inquiry 
One = formulate practice questions 
Two = search for best evidence 
Three = critically appraise evidence 
Four = integrate evidence with other knowledge 
Five = evaluate outcomes of change 
Six = disseminate EBP results
22
Q

Evidence is…

A

That which tends to prove or disprove something; grounds for belief; proof
Something that makes plain or clear; an indication or sign
Data or information used to determine whether a claim or view should be trusted
Knowledge derived from research

23
Q

Evidence of…

A 
Feasibility = economic and policy research 
Appropriateness = ethical and philosophical research 
Meaningfulness = interpretive research 
Effectiveness = randomized control trials and cohort research
24
Q

4 types of evidence

A

Research evidence-based
Clinical experience practice
Service user/carer perspectives
Local context

25
Q

Two types of questions

A

Background = broad and asks the question: who, what, where, when, how, why. About a situation or a medical condition
Foreground questions = more specific

26
Q

PICO(T) question

A 
P = population/patient/problem, disease/condition, population and setting 
I = intervention, treatment, activity, procedure, action 
C = comparison (implicit/explicit), alternative intervention for comparison, usual intervention/control
O = outcome, results 
T = time frame, over a period of time
27
Q

Considerations prior to developing a question

A

Re-examine aspects of the practice issue

What is the context and basis for the question

28
Q

Research is a systematic process of…

A

Collecting, analyzing, and interpreting information in order to increase our understanding of the phenomenon about which we are interested or concerned
Informally = as we assess, acquire, and interpret information in daily practice
Formally = as we participate in research, and as we assess, critique, and acquire information from research studies

29
Q

History of nursing research: Florence nightingale

A

1859

Focused on improving physical and emotional well being

30
Q

History of nursing research: 1900-1940

A

Research focused on nursing education

31
Q

History of nursing research: 1950s

A

Research focused on nurses- supply, demand, and time involved in nursing activities; and the identity of the professional nurse
Research advanced with increased academic preparation, development of greater research skills and founding of the nursing research journal

32
Q

History of nursing research: 1960s

A

Research focused on nursing practice - clinical nursing problems, practice-orientated concerns

33
Q

Florence nightingale and evidence based nursing

A

Statistician
Epidemiologist
Made decisions based on best available evidence/best possible research
Made efforts to collect data for evidence to influence public policy and healthcare
Made attempt to demonstrate the value of having trained nurses caring for patients
The start of nursing sensitive outcomes

34
Q

History of nursing research: worldwide publications

A 
1963 = the international journal of nursing studies 
1968 = the Canadian journal of nursing research 
1970s = advances in nursing science; the western journal of nursing research; the journal of advanced nursing 
1983 = first volume of the annual review of nursing research 
1980s = applied nursing research 
1993 = national institute of nursing research initiated 
1990s = qualitative health research; clinical nursing research; clinical effectiveness in nursing
35
Q

Future of nursing research

A

Increased focus on outcomes research
Advancement of evidence-based practice
Improving multidisciplinary/interprofessional collaboration
Increasing dissemination of research findings
Making nursing research more visible

36
Q

Increased focus on outcomes research

A

Research assessing and monitoring the quality and cost-effectiveness of health care delivery and safety in patient care

37
Q

Advancement of evidence-based practice

A

Using research and nursing knowledge to provide quality, appropriate, effective, safe patient care capturing the uniqueness of the individual

38
Q

Improving multidisciplinary/interprofessional collaboration

A

To improve research and quality and safety in patient care

39
Q

Increasing dissemination of research findings

A

Through internet access, open access journals

40
Q

Making nursing research more visible

A

Recognizing and supporting research opportunities; advancing and promoting use of research findings; facilitating development of nursing researchers

41
Q

Quantitative research

A

Used to answer questions about relationships among measurable variables with the purpose of explaining, predicting, and controlling phenomena
Randomized control trials - to evaluate the effectiveness of an intervention
Case-control studies - to investigate the cause of a disease or the adverse effects of treatment
Cohort studies - to study a group of people over a period of time
Cross-sectional studies - to study a phenomena at one point in time
Longitudinal studies - to study a phenomena over an extended length of time
Descriptive studies - to observe, describe, and document a situation

42
Q

Qualitative research

A

Used to answer questions about the complex nature of phenomena with the purpose of describing and understanding phenomena from the participants point of view
Case study - to understand one person or situation
Ethnography - to understand how behaviours reflect the culture of a group
Phenomenological study - to understand an experience from the participants point of view
Grounded theory study - to derive a theory from data collected in a natural setting
Content analysis - to identify the specific characteristics of a body of material

43
Q

Mixed research

A

An integration of both quantitative and qualitative research
The qualitative approach emphasizes the capacity of the human to know, understand and reflect, encompassing context, interaction, and connection
The quantitative approach strives for precision by focusing on things that can be counted

44
Q

Peer review

A

Systematic distribution, evaluation, and reaching of consensus on the merits of a submitted manuscript or abstract
Editors direct the process - select reviewers, make final decisions on publication
Reviewers selected based on expertise and availability
Look for technical and stylistic flaws, novelty of study, make recommendations for acceptance, rejection, or revision

45
Q

Pre-appraised evidence (secondary research)

A

Systems, summaries, synopses of syntheses, syntheses, and synopses of studies
Data has undergone a filtering process to include only research of higher quality
These resources are regularly updated so that the evidence is current

46
Q

Systems

A

Computer decision support systems which would match information from individual patients with the best evidence from research that applies to the clinical situation
Ideal system would summarize all relevant research evidence about a clinical problem and link to the individual patient’s situation through an electronic health record

47
Q

Summaries

A

Provide a critical appraisal synthesis of research evidence eon a specific topic, so that practitioners can easily determine validity and reliability
Integrate best available evidence from the lower levels of the pyramid
Gather from systematic reviews to provide a comprehensive rename of evidence concerning management options for a given health problem

48
Q

Synopses of syntheses

A

Edited, short, structured descriptions and critical commentaries of systematic reviews
Usually accompanied by a commentary on quality of the synthesis and clinical applicability of findings
Comprehensive summary of research evidence to focused clinical question

49
Q

Syntheses

A

Systematic reviews that summarize scientific studies

Comprehensive literature searches with critical appraisal

50
Q

Synopses of single studies

A

Brief summary of high quality study with commentary
Summary is brief and detailed to inform practice
Has screened study for quality

Nursing 385 (9 decks)

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