Research and EBP Questions Flashcards
“a scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences the delivery of evidence-based nursing practice” (Burns and Grove, 2009)
What is the definition of nursing research?
oriented toward and limited by tangible things or by events that we observe and experience in reality. Focus is immediate events that are limited by time and space
Concrete thinking
Looks for meaning, patterns, relationships and philosophical implications.oriented toward the development of an idea without application to, or associate with, a particular instance.
Abstract thinking
what we experience through our sense and is the concrete portion of existence. AKA ‘reality”
The empirical world
What are the 3 components of evidence-based practice?
Best research evidence, clinical expertise, and patient/family desire/values.
formal, objective, systematic process in which numerical data are used to obtain information about the world. Used to describe variables and determine cause and effect interactions btwn variables.
Quantitative research
systematic, interactive and subjective approach used to describe life experiences and given them meaning. Used to describe and promote our understanding of human experiences.
Qualitative research
the extent to which the findings from a study can be generalized or applied to the larger population (i.e. external validity)
Generalizability
provides an accurate portrayal or account of characteristics of a particular individual, situation, or group. Offers ways to (1) discover new meaning (2) describe what exists (3) determine the frequency with which something occurs (4) categorize information
Descriptive research:
involves the systematic investigation of relationships btwn or among two or more variables that have been identified in theories, observed in practice, or both. Primary intent is to explain the nature of relationships, not to determine cause and effect. They are the means for generating hypotheses to guide quasi-experimental and experimental studies
Correlational research
Test the effectiveness of nursing interventions that can then be implemented to control the patient and family outcomes in nursing practice. Purposes are to (1) identify causal relationships (2) examine the significance of causal relationships (3) clarify why certain events happened; or a combination of 1,2,3.
Quasi-experimental research
an objective, systematic, controlled investigation conduced for the purpose of predicting and controlling phenomena. Examines causality and is considered the most powerful quantitative method due to rigorous control of variables.
Experimental research
What are the three characteristics of experimental research?
- Controlled manipulation of at least one treatment variable (independent variable)2. Administration of the treatment to some of the subjects in the study (experimental group) and not to others (control group)3. Random selection of subjects or random assignment of subjects to groups, or both
A humanistic study of phenomena. Aim is to explore an experience as it is lived by the study participants and interpreted by the researcher
Phenomenological research
An inductive research method; useful for discovering what problems exist in a social setting and the process people use to handle them. Emphasizes observation
Grounded theory research
structured, comprehensive synthesis of quantitative studies in a particular health care area to determine the best research evidence available for use to promote an EBP
Systematic Review
type of study that statistically pools the results from previous, similar studies into a single quantitative analysis that provides on of the highest levels of evidence for an intervention’s efficacy.
A meta-analysis
Levels of research evidence (from highest to lowest)
Level 1: systematic reviews or meta-analysis or EBP clinical guidelines based on RCTsLevel 2: at least one well designed RCT (true experiment)Level 3: well designed controlled trials without randomizationLevel 4: well designed case-control and cohort studiesLevel 5: systematic reviews of descriptive and qualitative studiesLevel 6: a single descriptive or qualitative studyLevel 7: expert opinion.
implies that as one concept changes (increases or decreases), the second concept will also change in the SAME direction.
A positive linear relationship:
implies that as one concept changes (increases or decreases), the second concept will also change in the OPPOSITE direction
A negative linear relationship:
The amount of variation. Sometimes referred to as “effect size”. Usually determined by a correlational analysis and is expressed mathematically by the correlational coefficent “r”.
Strength of relationship btwn variables
Correlational Coefficient (r) =
0 indicated no strength-1 indicates a strong negative relationship1 indicates a strong positive relationship
An intervention, treatment, or experimental variable that is manipulated or varied by the researcher to cause an effect on the dependent variable
Independent variable
The response or outcome variable that is measured to examine the effect created by the independent variable.
Dependent variable
What are the 4 categories of hypotheses?
- Associative vs. causal2. Simple vs. complex3. directional vs. non-directional4. Null vs. research
Are developed to examine relationships among variables in a study.
Associative Hypotheses:
Identify a cause and effect interaction btwn two or more variables (independent and dependent).
Causal relationships:
predicts the relationship (associative or causal) btwn two variables.
Simple Hypotheses:
predicts the relationship (associative or causal) among three or more variables
Complex Hypotheses:
States that a relationship exists but does not predict the nature of the relationship
Nondirectional Hypotheses:
States the nature or direction of the relationship btwn 2 or more variables
Directional Hypotheses:
H0. AKA statistical hypothesis. Used for statistical testing and interpretation of statistical outcome. Always implied even if not directly stated.
Null Hypothesis
H1 or Ha. The alternative hypothesis to the null.
Research Hypothesis
In research ethics what are the 5 human rights?
- Right to self-determination (humans have freedom to conduct their lives as they choose without external controls2. Right to privacy3. Right to anonymity and confidentiality4. Right to fair treatment5. Right to protection from discomfort and harm
In the Belmont report, what are the three ethical principles as relevant to research involving human subjects?
- Respect for persons2. Beneficence3. Justice
The extent to which study findings can be generalized beyond the sample used in the study.
What is external validity?
The extent to which it can be said the the independent variable (intervention) causes a change in the dependent variable (outcome) the results are not due to other factors or alternative explanations
What is internal validity?
Focuses on end results of patient care
Outcomes research
What is the Donabedian Framework?
Structure, process, outcomes. Used as an appraisal of quality assessment.
an epidemiological study in which the researcher identifies a group of people who are at risk for experiencing a particular event. The entire group is followed over time to determine the point at which the event occurs, variables associated with the event, and outcomes for those who experienced the event compared with those who did not
Prospective cohort study
an epidemiological study in which the researcher identified a group of people who HAVE experienced a particular event. (could be a procedure, an episode of care, nursing intervention or a diagnosis). Cohort is evaluated after the event to determine the the occurrence of changes in health status.
Retrospective cohort study
lowest level of measurement. Categories must be unorderable. Example: race.
Nominal scale measurement
Data can be assigned to categories of an attribute that can be ranked. Example: pain score, level of mobility.
Ordinal scale measurement
Assumed to be a continuum of values and distances between intervals are numerically equal. No absolute zero point. Example: temperature.
Interval scale measurment
highest level of measurement. Has an absolute zero point. Example: weight, length, volume, lab values
Ratio level measurement
What is sensitivity?
Probability that disease is present
What is specificity?
Probably that no disease is present
Mistakenly rejecting the null hypothesis when it is actually true
What is a Type 1 Error?
Mistakenly accepting the null hypothesis when it is actually false
What is a Type II Error?
The observed level of significance (determined by setting an a (alpha) and noting the results).
What is a p value?
the set level of significance: the probability of making a type 1 error.
what is an a (alpha) value?
What is a power analysis and why is it done?
Power is the probability that a statistical test will detect a significant difference that exists (determines risk of Type II error). A power analysis is done to determine the sample size that is needed in a statistical analysis to have a low risk of a type II error.
What are the 4 parameters of power?
- Significance level (alpha) 2. Sample size 3. Effect size 4. Power
What is the most common desirable power level?
80%
What are the 5 steps to critically appraising a research study? And to which educational level do they apply?
- comprehension (baccalaureate)2. comparison (baccalaureate)3. analysis (master’s)4. evaluation (master’s)5. conceptual clustering (doctorate)
What is reliability
The consistency of the measure obtained. Reliability testing measures the amount of random error in measurement technique. [interrator reliability}
What is validity?
The measure of the truth or accuracy of a claim.
What are the 7 steps of EBP?
- Cultivate a spirit of inquiry1. Ask the clinical question in the PICOT format2. Search for and collect the most relevant and best evidence3. Critically appraise the evidence for validity, reliability, and applicability (aka generalizability)4. Integrate the evidence with one’s clinical expertise and the patient’s preferences and values5. Evaluate outcomes of the practice decision or change 6. Disseminate the outcomes of the EBP decision or change
What does PICOT stand for?
Patient population; Intervention or Issue of interest; Comparison intervention or group; Outcome; Timeframe
What is the difference btwn incidence and prevalence?
Incidence: how often the outcome occurs during a specific time periodPrevalence: the total number of people at risk for the outcome in a given population in a specific time period
A theory and method of interpretation. Generally, views human ‘lived experiences’ as a text that is to be understood through the interpreters dialogical engagement.
What are hermeneutics?
What are the 6 areas of evidence that the IOM states are EBP evaluation indicators?
- Outcome measures2. Quality care improvement3. Patient-centered quality care4. Efficiency of processes5. Environmental changes6. Professional expertise
3 main steps in the research process
- identify topic/problem. Propose hypothesis, review literature 2. choose your methodology (design, sample, tools, intervention, data) 3. results (analyze, interpret, summarize, communicate findings)
content validity refers to
the adequacy of coverage of the content
construct validity refers to
if an instrument measures the construct it’s testing. Example: does the ACT measure high school intelligence?
the mean, median, standard deviation and range is a good statistical test to use when
you have data to describe one group
a one sample t test is a good statistical test to use when
you need to compare one group
a paired or unpaired t test is a good statistical test to use when
you need to compare two groups (a pair…)
a one-way ANOVA statistical test is good to use when
you need to compare three or more unmatched groups
a repeated measures ANOVA statistical test is good to use when
you need to compare three or more matched groups
A pearson correlation statistical test is good to use when
you need to quantify association btwn two variables
a simple linear or nonlinear regression is good to use when
you need to predict value from another variable
multiple linear or nonlinear regression is good to use when
you need to predict value from several variables
The Iowa model of EBP
Problem-focused and knowledge focused triggers initiates need for change in practice. Considers entire healthcare system.
Process by which an innovation is communicated over time. Synonymous with dissemination.
Diffusion. (Rogers’ theory of diffusion of innovations)
This quality process identifies and removes the causes of defects (errors) by minimizing variability. 99.99% of products are statistically expected to be free of defects
Six Sigma
This quality process is a systematic, proactive method for evaluating how failure may occur.
FMEA
This quality process is used to identify and analyze an event with the goal to develop a method to prevent it from happening again
Root-cause analysis.
Characteristics of complex adaptive systems
nonlinear, dynamic, independent but related related relationships (can cause conflicting goals and behaviors), no single point of control, use adaptation and learning for self organization.
Steps in the PDCS/PDSA
Plan: recognize and opportunity Do: Test the change. Carry out a small scale study Study: Review the test, analyze ther results, identify what’s been learned. Act: Adopt, refine, or reject change
This quality improvement methodology is designed to eliminate unnecessary steps and redundancies. Eliminate waste in all forms
LEAN
What are the six steps of Positive Deviance?
Define, Determine, Discover, Design, Discern, Disseminate
Risk relates to probability of failure occurrence, degree of severity of the failure, and the ease with which the failure might occur again.
FMEA
Unexpected occurrence involving death or serious physical/psychological injury or risk thereof.
sentinel event (TJC)
