Quiz #2: Knowledge Transition - Scholarship of integration (Evidence informed care/decision making Flashcards
Why do we need evidence informed care?
- Optimize pt, community, populations, outcomes
- improve clinical practice
- achieve coast effective
- accountability
- transparency
What are the types of evidence
- Quantitative
- qualitative
- mega-analysis
- consensus doc.
- commission report
- regulation
- experiential info
What is the role of the nurse in research?
- Needs basic competencies
- read & critique evidence informed literature
- make research Q’s
- participate in or conduct research
- evaluate & promote evidence informed practice
What is the role of the professional/ specialty organization in research?
- Use of evidence to create standards/guidelines
- lobby gov’t for money
- healthy policies and regulations
What is the role of the regulatory authority in research?
- Use evidence to create standards & guidelines
- Suppose nurses
What is the role of the researchers in research?
- Identify knowledge gap
- deliver high quality research
- teach new researchers
- achieve effective knowledge transfer
What is the role of the educators in research?
- Support
- Evidence informed curricula
- promote inquiry
- promote critical thinking
- openness to change
- life-long learners
What is the role of health service organizations in research?
- reduce barriers
- evaluate outcome
- support
- provide continuing education
What is the role of the government in research?
- Support systems
- institutions
- funding
What is the role of health info institutions in research?
- Collect
- Store
- Maintain data
What is decision making influenced by?
- Evidence
- theory
- values
- judgement
- client choice
- ethics
- regulation
- legislation
- resources
- environment
What is a guideline
Systematically developed statements to assist a practitioner in decision making about appropriate care for certain circumstances
What is a guideline based on?
Research, opinions, consensus
What is evidence informed decision making?
Continuous interactive process involving explicit, conscientious and judicious of best evidence
What are quality improvement studies?
Nurse or student investigates outcomes of pt’s in a specific settings
Why is quality improvement not research?
Only applies to one facility
What are best practice guidelines?
- Formalized collection of documents
- Enables organizations & health systems to focus on pt. care & clinical excellence, using the latest research to inform practices
- Helps to advance gov’t priorities & outcomes
- most appropriate course of action based on research and evidence from practice
What is the way to remember how to form a good research Q?
PICOT
What does the P stand for in PICOT
population of interest
What does the I stand for in PICOT
intervention of interest
what does the C stand for in PICOT
comparison of interest
what does the O stand for in PICOT
outcome
What does the T stand for in PICOT
time
What are the 5 steps fo successful evidence informed practice?
1) Ask Q that clearly presents problem
2) Identify & gather most relevant and best practice
3) appraise evidence
4) integrate w/ expertise, preference and pt. values
5) evaluate outcome of practice decision
What is research literacy
being able to locate, understand & evaluate literature
What is research capability
being able to do research
what are the three things you critique for?
1) Value
2) Feasibility
4) Unity
What are the 2 aspects of feasibility
1) Scientific merti & clinical applicability
2) determine if they give strong enough basis
What do theories and research do for nursing…?
Improve the practice & overall profession
The best research designs use…
both qualitative & quantitative
what are some examples of quantitative
Pain severity, rate of wound heal, body temp
*These test theories and use stats to eliminate bias
What are some examples of qualitative
anything that cannot be quantified (emotion)
What is validity
did they measure what they tried to measure
what is reliability
can it be replicated
List the hierarchy of evidence
1) systematic review/ mega-analysis
2) 1-2 well designed, randomized control trials
3) 1+ well designed control trial
4) 1+ well designed case control/ cohort study
5) Systematic review of qualitative
6) single qualitative
7) Opinions of experts
What are the critical thinking dispositions?
- Truth seeking
- Open minded
- Analyticity
- systematicity
- self confidence
- inquistiveness
- maturity
What is overall research utilization?
use of any findings, any way
what is instrumental research utilization
use for pt. care
what is conceptual research utilization
used to change thinking or opinion
what is symbolic research utilization
used to persuade others
What is historical trauma
experienced over many years
what is cultural genocide
destruction of practices
what is structural racism
legitamized/normalized spectrum of attributes, practices, polices that consistently result in substandard outcome for indigenous
Some characteristics of an indigenous world view
- Strong land connection
- old knowledge of land & use
- Focused on the good of ppl
- seasons/elastic sense of time
- diversity, matriarchal
- circular view
- interconnectedness, balance, harmony
What are indigenous values?
- Kindness
- sharing
- non-competition
- non-interferance
- responsibility
What are the 7 grandfathers?
Wisdom Love respect bravery honesty humility truth *Must develop trust first
What is a proximal determinant
on an individual level
what is an intermediate determinant
infrastructure, resources, system
what is a distal determinant
historical, social, economic
What is a proportional approach
more invasive = more care should be taken to review
what are the 3 value systems for a nurse
1) Society
2) Nursing
3) science
What does the society value system mean
human rights
what does the nursing value system mean
ethics of caring
what does the science nursing value mean
research & inquiry
What are the 4 major ethical issues in research
1) Informed consent
2) beneficence
3) respect for autonomy/confidentiality
4) respect for privacy
What are ethics
System of principles which can critically change previous considerations about choices or actions
what is the nuremberg code
forbidded non-therapeutic research
what is the helsinki code
- reminded the public of the need for non-therapeutic research
- BUT subject well being i more important the scientific or social interest
What is informed consent
knowingly, voluntarily, intelligently and in a clear way, gives consent
what is right to autonomy
self determination in action, according to a personal plan
Informed consent seeks too…
1) Rights of autonomous individuals
2) self-determination
3) prevent assaults on integrity of pt.
4) protect liberty & veracity
Informed consent needs to incorporate…
1) intro & purpose of study
2) why the subject was selected
3) the procedure
4) any harm or discomfort
5) invasion of privacy or threat to dignity
6) compensation
7) disclosure of alternative
8) noncoersive disclaimer
9) no withdraws penalty, freedom
What are the 4 ESSENTIAL PARTS of consent
1) disclosure
2) comprehension
3) competency
4) volunaryness
what are the nursing conflicts to do with informed consent
- nurses may have to witnesses
- if the nurse tries to give consent, the pt. may feel obliged
- if they have to withhold info
- advocate for pt. but don’t prevent research
What is beneficence
the benefits of the research
What is non-maleficence
the potential risks
***** Higher level of sensitivity to harm
What is the whole beneficence of research?
Do effective & significant research to better serve & promote welfare
What are the nursing conflicts about beneficience
- vulnerable people
- prohibition of advocacy
- don’t prevent nursing knowledge
- best care practices don’t align with non-therapeutic studies
- patients who find out their best interests weren’t fulfilled may lose their faith in the HC system
What is anonymity
protected the subjects identify cannot be linked to a response
what is confidentiality
management of private info by the researcher
***SOMETIMES broken to protect the moral good of society
what is utilitarianism
good for all (eg. confidentiality: U’d tell)
What is deontology
moral duty to pt (eg. during confidentiality: U’d not tell)
What are the nursing conflicts of anonymity and confidentiality
- reporting in court
- interest of society
- always practice privacy to form trust
What is privacy
freedom to decide when private information will be shared
what is a privacy breech
- beliefs, attitude, opinion & record shared w/o knowledge or consent
- *some ppl have different def of privacy
- respectful refusal
- *don’t study pt. without permission
If you don’t respect privacy it may cause loss of..
- dignity
- friendship
- employment
if you don’t respect privacy it may cause feelings of..
anxiety, guilt, embarrassment, shame
Who are the vulnerable groups
- Unable to protect own rights & welfare
- captive (prison, school)
- mentally ill
- old
- children
- dying
- poor
- learning disabilites
- sedated
- unconsious
What are researcher skills
- inexperienced work under qualified researchers
- lack of knowledge stated
- ensure validity and reliability
- ethics
1) Competency
2) Careful design
3) worthwhile outcomes
What are nursing conflicts about vulnerable groups
- not responsible fro pt. care
- only intervene in harmful situations
- exclude a subject if you end up caring for them
