Test 1 Flashcards
1
Q
How does research influence our clinical practice?
A
research –> EBP guidelines –> hospital policy & procedure manual –> RN clinical practice
2
Q
What is the triad of EBP?
A
- EXTERNAL evidence (research)
- INTERNAL evidence (clinical expertise and QI projects)
- PATIENT preferences & values
3
Q
What is external evidence?
A
evidence generated through rigorous research that is intended to be GENERALIZED to other settings
4
Q
What is internal evidence?
A
Evidence generated through QI or outcomes management that is NOT meant to be generalized to other clinical settings
5
Q
Who started the EBP movement?
A
Dr. Archie Cochrane in 1972, showed that medical profession was very slow in using EBP to change practice
6
Q
What is the triple aim in supporting EBP?
A
- ENHANCING experience of care for patients
- IMPROVING health of populations throughout the nation
- REDUCING per capita costs of health care
7
Q
What are the main national drivers of EBP?
A
- Magnet Recognition program
- IOM roundtable
- preventative services task force
- patient centered outcomes research institute (PCORI)
8
Q
Why do we need EBP?
A
- need to understand evidence for patient outcomes
- need to communicate evidence between colleagues and pts
- evidence protects your licensure
9
Q
What are the 7 steps in EBP?
A
0: spirit of inquiry
1. ask PICOT question
2. search for evidence
3. critically appraise evidence
4. integrate evidence w/ clinical expertise and pt preference
5. evaluate outcomes
6. disseminate outcomes
10
Q
What is the spirit of inquiry?
A
consistently questioning attitude toward practice; a culture that fosters questioning of why things are done
11
Q
What is PICOT?
A
P-pt population I- intervention or issue C- comparison O-outcome T-time frame
12
Q
What are the essential components of PICOT?
A
PIO
13
Q
What does a PICOT question ask for?
A
asks for specific scientific evidence about diagnosing, treating or education pts
14
Q
What are qualitative studies?
A
research involved in collection of data in NON-NUMERIC FORM, SUBJECTIVE DATA
tends to describe a phenomenon
15
Q
What are quantitative studies?
A
Research that collects data in NUMERIC form, data is OBJECTIVE often in form of rigorously controlled studies
16
Q
What is the tier I evidence?
A
systematic reviews/meta-analyses
17
Q
what is tier II evidence?
A
RCT
18
Q
What is tier III evidence?
A
control trial without randomization
19
Q
what is tier IV evidence?
A
case control or cohort study
20
Q
What is tier V evidence?
A
systematic review of qualitative or descriptive studies
21
Q
What is tier VI evidenced?
A
qualitative or descriptive study
22
Q
What is tier VII evidence?
A
expert opinion or case study
23
Q
What 3 questions do we ask to appraise the quality of the study?
A
- are the results VALID (proper design/methods)
- are the results RELIABLE (will you get the same results if you repeat study?)
- are the results APPLICABLE (will it help me care for my patients)
24
Q
Where does the confidence to make an EBP change come from?
A
level of evidence + quality of evidence = strength/confidence to act
25
What is needed to implement EBP?
external evidence, internal evidence/expertise, and patient preferences
26
What "so what" outcomes do we look at when evaluating?
length of stay, readmission, pt complication, staff turnover, cost, outcome measurement
27
What are ways that we can disseminate evidence?
panel presentation, roundtable discussion, grand rounds, community/committee meetings, journal clubs, oral/poster presentations, publication
28
What do you prepare for an oral presentation?
objectives, outline, content for each section, presentation slides, PRACTICE & REVISE
29
What is the typical structure of a research article?
```
abstract
intro/background
methods
results
discussion
references
```
30
What content should be included in an EBP poster?
background, clinical question, search for evidence, presentation and appraisal of evidence, clinical practice implications
31
What content should be included in a presentation of a research study?
intro, purpose, guiding framework, research question, study design & methods, findings, discussion, implications
32
When trying to reduce bias, how should we describe someone (in terms of specificity)?
be more specific rather than less specific
33
how do we avoid labeling?
use adjectival forms (gay men, older adults)
| put the person first followed by descriptive phrase (people diagnosed with schizophrenia)
34
how should we refer to a married man and woman?
husband and wife or man and women (DONT use man and wife)
35
do we want to acknowledge subject participation in our writing?
YES, acknowledge participation and be consistent with traditions in the field you are working in
36
what is gender?
cultural role, NOT the same as biological sex
37
what is transgender?
persons whose gender identity or gender expression differs from their sex at birth, NOT USED AS A NOUN
38
what is transsexual?
transgender persons who life or desire to live full time as members of the sex other than their sex at birth, can be used as a NOUN OR ADJECTIVE
39
what pronouns do we use to refer to a transgender person?
pronouns appropriate to the person's gender identity or expression regardless of their birth sex
40
what is sexual orientation?
enduring pattern of attraction, behavior, etc.; use this instead of SEXUAL PREFERENCE
41
how do we refer to people who are attracted to members of the same sex?
lesbians, gay men, bisexual men, bisexual women...NOT HOMOSEXUAL
42
to designate a racial or ethnic group...
use capitalized proper nouns (Black and White)
43
how do we write about age?
give a specific age range, don't use open ended age definitions
44
how do we refer to someone who is older?
older adults, NOT ELDERLY OR SENIOR
45
what are background questions?
provide general information about a clinical issue, broad scope
this explains WHY this is an important topic
46
What are the two components of a background question?
1. starting place of question (what, where, when, why, how)
| 2. outcome of interest
47
What are foreground questions?
ask for specific scientific evidence about diagnosing, treating or educating patients
use the PICOT format!!!
48
What do intervention questions tell us?
what intervention most effectively leads to an outcome
49
What does a prognosis/prediction PICOT tell us?
what indicators are most predictive of an outcome
50
what does a diagnosis PICOT tell us?
what test most accurately diagnoses an outcome
51
what does an etiology PICOT tell us?
to what extent is a factor associated with an outcome
52
what does a meaning PICOT tell us?
how does an experience influence an outcome
53
What is unique about an intervention PICOT?
usually has the word effect/affect
54
what is unique about the prognosis PICOT?
usually has the word influence/predict
55
what is unique about the diagnosis PICOT?
usually says: more accurate in diagnosing
56
What is unique about an etiology template?
usually has something about increased/decreased risk
57
what is unique about a meaning template?
usually has the word perceive in it
58
example: how do young males with a diagnosis of below the waist paralysis perceive their interactions with SOs during first year after diagnosis?
meaning
59
in pts 6mo - 9 yo, how does receiving two doses of flu vaccine compared to one dose influence the risk of influenza infection during flu season?
prognosis
60
in pts with recurrent UTI, do prophylactic antibiotics compared to standard treatment reduce the recurrence rate?
intervention
61
in school age kids, what is the effect of physical activity programs on reduction of childhood obesity compared to no intervention within a 1 year period?
intervention
62
is a yearly mammogram more effective in detecting breast cancer compared to a mammogram every 3 years in women under age 50
diagnosis
63
are 30-50 yo women who have HTN compared to those without HTN at increased risk for acute MI during first year after hysterectomy?
ETIOLOGY
64
what type of research do we prioritize when answering clinical questions?
pre-appraised literature
65
What is pre-appraised literature?
evidence that has already been appraised for validity & reliability; systematic reviews, meta-analyses or syntheses, integrative reviews, etc.
66
What do we use google for?
background questions apparently
67
what is grey literature?
unpublished evidence that has not been included in databases that clinicians routinely search... BE CAREFUL! not peer reviewed
68
what should we ask about databases that we use for searching?
1. is the evidence current
2. what search strategies can I use
3. how frequently is it updated
69
What is keyword searching?
uses words generated from PICOT, can include common terms/synonyms, phrases, etc.
70
What are strengths to keyword searching?
provides a quick snapshot of how helpful a database will be
71
what are weakness to keyword searching?
may miss studies that don't exactly match authors keyword choices, or may find irrelevant studies
72
What is subject heading searching?
uses a standardized set of preselected terms for search
73
What is another term for subject heading searching?
CONTROLLED VOCABULARY
74
What are major strengths of controlled vocabulary searching?
searches are automatically broadened, more relevant studies found
75
what are the major weaknesses of controlled vocabulary searching?
newer phrases and acronyms may not be included
76
what is title searching?
using keywords from the PIO to search titles with same keywords
77
what are the major strengths to title searching/
increases likelihood of articles being relevant, effective
78
what are the major weaknesses to title searching?
misses studies that don't have keywords in title
79
T/F: subject heading searching may yield fewer hits than keyword search, but hits are more likely to be relevant to clinical question?
TRUE
80
what online evidence source is most likely to provide pre-appraised research?
Cochrane library
81
what is best practice?
effective practice that is constantly changing and is focused on critically appraised evidence
82
how do we grade the strength of a body of evidence?
QUALITY
QUANTITY
CONSISTENCY
83
What is quality?
the extent to which the study's design, conduct and analysis have minimized selection, measurement and confounding biases (the internal validity of the study)
84
what is quantity?
number of studies that have looked at a clinical issue
85
What is consistency?
whether investigations with both similar and different study designs report similar findings
86
how do we generate internal evidence?
1. outcomes management
2. QI projects
3. EBP implementation projects
87
what is the goal of collecting internal evidence?
to evaluate outcomes SOLELY at the site where the improvement effort was conducted...NOT MEANT TO BE GENERALIZABLE
88
how do we combine internal and external evidence?
the PDSA cycle
89
What is the PDSA cycle?
plan-do-study-act
a way to quickly develop, test and implement changes on a small scale first
90
What are national quality indicator monitoring systems?
AHRQ, NQF, NDNQI
91
what do we track quality?
to ID trends, spot weak points in care, track projects that improve care
92
for a powerpoint, what size title font do we want?
44 pt or larger
93
for a powerpoint, what size text font do we want?
36 pt or larger
94
What is the best color scheme for a powerpoint?
dark background and light colored font
95
how many lines of text should be on a powerpoint slide?
no more than 6 lines of text
96
what is important to remember with graphics in powerpoint?
ALWAYS have a caption to explain them
97
If you have a chart in powerpoint, what should follow it?
a slide describing the chart
98
What size font should chart labels be?
20 pt or larger
99
For a poster presentation, what is the font size for the title?
72 pt (minimum) to 158 pt (ideal)... should be viewable from 10-15 ft away
100
For a poster presentation, what size font should section titles be?
46 pt (minimum) to 56 pt (ideal)
101
For a poster presentation, what size font should the body text be?
24 pt (min) to 36 pt (ideal)
102
What color should a poster presentation be?
black text on a white background, color used sparingly in headings & titles
103
What should the line spacing be in a poster?
MINIMUM of 1.2, but double space is best
104
What type of fonts should you use in presentations?
SANS SERIF fonts, avoid serif fonts
