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EBP > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Common Barriers to EBP

A

Individual and System level

  • Knowledge/Education
  • Low prioritization
  • Time
  • Resources
  • Culture
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2
Q

What is Evidence Based Practice?

A

“Integration of best research evidence with clinical expertise and patient values”

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3
Q

EBP consists of 3 factors

A

Evidence
Patient Preferences
Clinician Expertise

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4
Q

How do we integrate best research evidence into patient care?

What do we need to know? (3)

A

1) Your clinical question
2) How to search for evidence to address clinical question
3) How to appraise evidence for quality

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5
Q

What is research evidence”?

A

Systemic inquiry to identify “truth”

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6
Q

What is “Best” Research Evidence?

A

Has a High level of incidence -> when performed well, certain study designs are inherently stronger than others

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7
Q

Characteristics of high quality research evidence

A 
Study results are credible 
Not due to random chance or 
Non-random error (bias)
or 
Systematic error
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8
Q

Evidence Pyramid

What are the levels top to bottom?

A 
Systems 
Summaries
Synopses 
Syntheses
Studies
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9
Q

What level of the evidence pyramid does this fall into?

Computerized decision support software and Electronic health records

A

Systems

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10
Q

What level of the evidence pyramid does this fall into?

Evidence based textbooks, practice guidelines

ex) Dynamed, National Guideline Clearinghouse, UMHS Practice guidelines

A

Summaries

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11
Q

What level of the evidence pyramid does this fall into?

Pre-appraised Abstracts of Studies & Synthesis

ex) DARE, ACP Journal Club

A

Synopses

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12
Q

What level of the evidence pyramid does this fall into?

Systematic reviews

ex) Cochrane DSR, PubMed Clinical Queries (systematic review)

A

Syntheses

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13
Q

Secondary or Pre-appraised

A

Syntheses

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14
Q

Primary/Original

A

Studies

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15
Q

What level of the evidence pyramid does this fall into?

Primary Research

ex) PubMed Clinical Queries (Studies)

A

Studies

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16
Q

Different types of Studies

A

Randomized Control Trials
Cohort Studies
Case Control Studies
Case reports/Case series

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17
Q

Different types of Syntheses

A

Meta Analyses

Systematic Reviews

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18
Q

Best to start at the ___ of the pyramid!

A

Top

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19
Q

Secondary/Pre-appraised studies are those that?

A

Have multiple articles that are summarized and appraised

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20
Q

Primary/Original studies are those that?

A

One one study is reported

The reader must appraise study for quality

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21
Q

Appraisal =

A

Good Quality

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22
Q

Three discrete steps to appraise an article are?

A

1) Are the results of the study valid?
2) What are the results?
3) How can I apply these results to patient care?

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23
Q

Five Step Evidence Based Nursing Process

A

PEACE model

Problem Identification
Evidence Review
Appraise Evidence
Care Integration 
Evaluate Care Integration
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24
Q

Use ___ to identify the Problem in the peace model

A

PICO

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25
Q

“A consistent systematic way to identify the components of a clinical issue”

A

PICO

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26
Q

What does PICO stand for?

A

P - Population
I - Intervention
C - Comparison
O - Outcome

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27
Q

Identify the parts of this PICO question

Among discharged patients, does the receipt of discharge phone calls, compared to no discharge phone calls improve patient experience scores?

A 
P = discharged patients
I = receipt of discharge phone call
C = no discharge phone call
O = improve patient experience scores
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28
Q

Why is PICO useful to you?

A

Lays the foundation to the 5 step evidence based nursing practice

Helps clarify the actual issue you want to address

Saves time searching - as you can focus your research on evidence that will best address your question

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29
Q

The initial an one of the most difficult steps in evidence based practice

An iterative process

A

Formulating a PICO question

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30
Q

Question Types (4)

A

Intervention or therapy

Etiology

Prognosis/Prediction

Meaning

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31
Q

What study design tries to determine which treatment leads to the best outcome?

Ie) Experimental studies (RCT)

A

Intervention of Therapy

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32
Q

What study design tries to determine the greatest risk factor of a condition?

Ie) Observational studies (eg cohort, case control, observational)

A

Etiology

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33
Q

What study design tries to determine the progression of a disease?

Ie) Observational studies (eg. cohort, case control, observational)

A

Prognosis/Prediction

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34
Q

What study tries to understand the meaning of an experience?

Ie) Qualitative research

A

Meaning

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35
Q

What type of study does this describe?

  • Researchers actively introduce intervention or treatment
  • Often called clinical trials in medical research
  • Can be randomized (RCT) or quasi experimental (when randomization is not performed)
A

Experimental studies

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36
Q

What type of study does this describe?

  • Researchers collect data without intervening or introducing treatments
  • Often called non-experimental research
  • Can be cohort study, case control study, cross-sectional study, they differ in the time frame of how data are collected
A

Observational Studies

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37
Q

Types of Observational studies (3)

A

Cohort
Case Control
Cross Sectional

38
Q

Time Frames for Cross Sectional study

A

Exposure and Outcome is in the present

39
Q

Time Frames for Case Control study

A

Exposure or No Exposure in the Past

Outcome or No Outcome in the Present

40
Q

Time Frames for Cohort study

A

Exposure or No Exposure in the Present

Outcome or No Outcome in the Future

41
Q

Example of what type of observational study?

Is use of public transport system in NYC associated with covid 19 sx?

A

Case Control

Outcome = covid 19 -> look back overtime through their travel patterns

42
Q

What study design would be most appropriate to address this question type?

You work in the inpatient setting and observe suboptimal environmental cleaning practices. You wonder if patients are at increased risk for infection if the individual they are rooming with has an active infection

A

Observational study

43
Q

Purpose of a ______ Study

  • To explain and predict
  • To confirm and validate
  • To test theory
  • Seeks generalizations
A

Quantitative

44
Q

Purpose of a ______ Study

  • To describe and explain
  • To explore and interpret
  • To build theory
  • Seeks patterns
A

Qualitative

45
Q

What are the methods of data collection for a Quantitative study?

A

Representative
Large sample
Standardized Instruments

46
Q

What are the methods of data collection for a Qualitative study?

A

Informative
Small Sample
Observations, Interviews

47
Q

What is the form of reasoning in the anaylsis for a Quantitative study?

48
Q

What is the form of th reasoning in the analysis of a Qualitative study?

A

Inductive (deductive and inductive)

49
Q

How are findings communicated in a Quantitative study?

A

Quantitative (numerical) information
Statistics
Aggregated data

50
Q

How are findings communicated in a Qualitative study?

A

Qualitative (non-numerical) information
Narratives
Individual quotes

51
Q

Quantitative Research Concepts

A 
Study purpose/Aim
Study population and sampling 
Variables
Measurement 
Error
Hypothesis Testing
52
Q

States an expectation, a predicted answer to the research question

A

Research hypothesis

53
Q

Subset of people in a defined setting

54
Q

People in a defined setting

A

Population

55
Q

Attributes of patients and clinical events that vary and can be measured

56
Q

Independent variable

A

purported cause or predictor variable

57
Q

Dependent variable

A

outcome variable

58
Q

Extent to which a tool measures the actual condition it is meant to measure

59
Q

Consistency of measures over time

A

Reliability

60
Q

Bias ie systemic error

A

“The systematic introduction of error into a study that can distort the results in a non-random way”

61
Q

Error (2)

A 
Bias (systematic error) 
Random error (chance)
62
Q

Null hypothesis

A

Assume no relationship; akin to “presumed innocence”

63
Q

P values

A

likelihood results due to chance

64
Q

Confidence intervals

A

contains range of true value

measure of precision

65
Q

Directional hypothesis

A

Predicts direction of a relationship

66
Q

Non-Directional hypothesis

A

Predicts the existence of a relationship, not its direction

67
Q

Are Hypothesis proven?

A

Never proved or disproved

68
Q

Used only in statistical testing
Expresses the absence of a relationship
Statistical testing performed to provide the probabilistic information to support or reject it

A

Null Hypothesis

69
Q

Face Validity

A

Does an instrument appear to measure phenomenon of interest, weakest form of validity

70
Q

Content Validity

A

Extent to which an instrument includes dimensions of the phenomenon under study

ie) scale for measuring pain includes questions about severity and sensation of pain (dull, throbbing, itching)

71
Q

Construct Validity

A

Does the instrument perform as expected between similar and dissimilar constructs

72
Q

Convergent validity

A

like constructs have similar scores

ie) expect to see similarities between pain and distress scores

73
Q

Discriminant vailidity

A

unlike constructs do not have similar constructs

ex) pain scores would differ from intelligence scores

74
Q

Instrument reliability

A

The consistency with which an instrument measures the target attribute

75
Q

Internal consistency

A

The extent to which all items on an instrument are measuring the same attribute

appropriate for most multi-item instruments

76
Q

Cronbach’s alpha

A

Used to assess reliability

77
Q

Alphas >/- ____ are highly desirable

A

0.80

Alpha of 1 = total agreement of all items (this is not desirable bc then their just duplicates of each other)

78
Q

Stability

A

The extent to which scores are similar on two separate administrations of an instrument

(test, retest- taking your BP twice are they similar)

79
Q

Measurement

A

The assignment of numbers to represent the amount of an attribute present in an object or person, using specific rules. Used to operationalize or MEASURE variables in a quantitative study

80
Q

4 classes of measurement

A

Nominal
Ordinal
Interval
Ratio

81
Q

Colors of the rainbow
Race
Gender

82
Q

Likert scale strongly agree to disagree

Letter grades

83
Q

What class of measurement?

Temperature

84
Q

What class of measurement?

Weight

85
Q

Nominal

A

Classify characteristics into categories, no inherent order

86
Q

Ordinal

A

Ranking objects based on their relative standing on an attribute; inherent ordering between categories, but size of intervals not specified

87
Q

Interval

A

Objects ordered on a scale that has equal distances between points on a scale (but no absolute zero)

88
Q

Ratio

A

Equal distances between score units; there is a rational, meaningful zero

89
Q

Selection bias

A

Flawed sample selection procedures; preexisting differences exist between groups being compared; study sample not representative of a larger population

90
Q

Measurement bias

A

Biases arise when measures are not valid or reliable
Or are performed inconsistently between study groups

ex) before and after compliance of hand hygiene not measured the same, before by cameras, after by self report

91
Q

Social desirability bias

A

Biases that stem from desire to report favorable informatin

EBP (1 decks)

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