TB Ch: 5. - Concept Map Flashcards
A nurse uses evidence-based practice (EBP) to provide nursing care. What is the best rationale for the nurse’s behavior?
a. EBP is a guide for nurses in making clinical decisions.
b. EBP is based on the latest textbook information.
c. EBP is easily attained at the bedside.
d. EBP is always right for all situations.
ANS: A
Evidence-based practice (EBP) is a guide for nurses to structure how to make appropriate, timely, and effective clinical decisions. A textbook relies on the scientific literature, which may be outdated by the time the book is published. Unfortunately, much of the best evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills.
In caring for patients, what must the nurse remember about evidence-based practice (EBP)?
a. EBP is the only valid source of knowledge that should be used.
b. EBP is secondary to traditional or convenient care knowledge.
c. EBP is dependent on patient values and expectations.
d. EBP is not shown to provide better patient outcomes.
ANS: C
Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience. Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence-based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs.
A nurse wants to change a patient procedure. Which action will the nurse take to easily find research evidence to support this change?
a. Read all the articles found on the Internet.
b. Make a general search of the Internet.
c. Use a PICOT format for the search.
d. Start with a broad question.
ANS: C
The more focused the question is, the easier it becomes to search for evidence in the scientific literature. The PICO format allows the nurse to ask focused questions that are intervention based. Inappropriately formed questions (general search or broad question) will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question.
A nurse has collected several research findings for evidence-based practice. Which article will be the best for the nurse to use?
a. An article that uses randomized controlled trials (RCT)
b. An article that is an opinion of expert committees
c. An article that uses qualitative research
d. An article that is peer-reviewed
ANS: A
Individual RCTs are the highest level of evidence or “gold standard” for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.
The nurse is reviewing a research article on a patient care topic. Which area should entice the nurse to read the article?
a. Literature review
b. Introduction
c. Methods
d. Results
ANS: B
The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The literature review or background offers a detailed background of the level of science or clinical information about the topic of the article. The methods or design section explains how a research study was organized and conducted. The results or conclusion section details the results of the study and explains whether a hypothesis is supported.
The nurse is caring for a patient with chronic low back pain. The nurse wants to determine the best evidence-based practice regarding clinical guidelines for low back pain. What is the best database for the nurse to access?
a. MEDLINE
b. EMBASE
c. PsycINFO
d. AHRQ
ANS: D
The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines.
A nurse writes the following PICOT question: How do patients with breast cancer rate their quality of life? How should the nurse evaluate this question?
a. A true PICOT question regardless of the number of elements
b. A true PICOT question because the intervention comes before the control
c. Not a true PICOT question because the comparison comes after the intervention
d. Not a true PICOT question because the time is not designated
ANS: A
A meaningful PICOT question can contain only a P and O: How do patients with breast cancer (P) rate their quality of life (O)? Note that a well-designed PICOT question does not have to follow the sequence of P, I, C, O, and T. The aim is to ask a question that contains as many of the PICOT elements as possible.
A nurse is reviewing literature for an evidence-based practice study. Which study should the nurse use for the most reliable level of evidence that uses statistics to show effectiveness?
a. Meta-analysis
b. Systematic review
c. Single random controlled trial
d. Control trial without randomization
ANS: A
The main difference is that in a meta-analysis the researcher uses statistics to show the effect of an intervention on an outcome. In a systematic review no statistics are used to draw conclusions about the evidence. A single random controlled trial (RCT) is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted.
A nurse is reviewing research studies for evidence-based practice. Which article should the nurse use for qualitative nursing research?
a. An article about the number of falls after use of no side rails
b. An article about infection rates after use of a new wound dressing
c. An article about the percentage of new admissions on a new floor
d. An article about emotional needs of dying patients and their families
ANS: D
Studying emotional needs is a qualitative study. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness. The number of falls, infection rates, and percentages of new admissions are all examples of quantitative research.
A nurse develops the following PICOT question: Do patients who listen to music achieve better control of their anxiety and pain after surgery when compared with patients who receive standard nursing care following surgery? Which information will the nurse use as the “C”?
a. After surgery
b. Who listen to music
c. Who receive standard nursing care
d. Achieve better control of their anxiety and pain
ANS: C
Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)?
The nurse uses a PICOT question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more evidence than is available at this time. What is the nurse’s best option?
a. Conduct a pilot study to investigate findings.
b. Drop the idea of making the change at this time.
c. Insist that management hire the needed staff to facilitate the change.
d. Seek employment in another institution that may have the staff needed.
ANS: A
When evidence is not strong enough to apply in practice, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines.
The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting?
a. Nonexperimental research
b. Experimental research
c. Qualitative research
d. Evaluation research
ANS: C
Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent’s decision to smoke cigarettes.
In conducting a research study, the nurse researcher guarantees the subject no information will be reported in any manner that will identify the subject and only the research team will have access to the information. Which concept is the nurse researcher fulfilling?
a. Bias
b. Confidentiality
c. Informed consent
d. The research process
ANS: B
Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Biases are opinions that may influence the results of research. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer.
The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information?
a. Abstract
b. Conclusion
c. Study design
d. Clinical implications
ANS: B
During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section.
A nurse is trying to decrease the rate of falls on the unit. After reviewing the literature, a strategy is implemented on the unit. After 3 months, the nurse finds that the falls have decreased. Which process did the nurse institute?
a. Performance improvement
b. Peer-reviewed project
c. Generalizability study
d. Qualitative research
ANS: A
Performance improvement focuses on performance issues like falls or pressure ulcer incidence. A peer-reviewed article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. Generalizability is not a study/research; it is if the results of a study can be compared to other patients with similar experiences. This is a quantitative study, not a qualitative study.
