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Research 3900 > Unit 1: Ch. 2 > Flashcards

Unit 1: Ch. 2 Flashcards

1
Q

Research Utilization (RU)

A

Use of study findings in a practical application that’s unrelated to the original research. Small department in the hospital does just this

1980s

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2
Q

Utilization Review (UR)

A

Small department in the hospital that focuses on just research.

1980s

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3
Q

Evidence-Based Practice (EBP)

A

Use of the best evidence to make pt care decisions. Relies heavily on research, nursing experience, and pt preferences. 1990s gradually switching to this after several years

Broader than RU b/c it integrates research findings w/ other factors

Starts w/ a clinical question (what does the evidence say is the best approach to solving this problem?)

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4
Q

Archie Cochrane

A

Did systematic reviews on a large scale. Used standardized instruments that they used to collect data

British epidemiologist in 1970s

Called for efforts to make research summaries about interventions available to health care providers –> Cochrane Collaboration

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5
Q

What’s the aim of the Cochrane Collaboration?

A

Help providers make good health care decisions by preparing and disseminating systematic reviews of health care interventions

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6
Q

David Sackett, McMaster Medical School, and Evidence-Based medicine

A

McMaster Medical school in Canada developed clinical learning strategy called Evidence-Based Medicine (occurred about the same time as Cochrane Collaboration began)

Evidence based medicine pioneered by Dr. David Sackett, has broadened to the use of best evidence by ALL health care practitioners. W/ EBP skillful clinicians can no longer rely on a repository of memorized info but rather must be adept in accessing, evaluating, and using new research evidence

Teaching from evidence-based medicine perspective changed everything - nursing didn’t make the switch as quickly

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7
Q

Harris Cooper

A

Worked at MU, wrote books about step-by-step ways to do systematic reviews, where nursing started to participate in systematic reviews

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8
Q

Evidence Hierarchies

A

Involve ranking evidence sources according to the strength of evidence they provide

Ranking may depend on the type of question being asked

Within each level, evidence quality may vary considerably

Different ways of ranking articles on their quality. In order to do a systematic review there has to be a lot of research done. If it’s a newer topic you may not be able to go high up the pyramid b/c there isn’t enough evidence to do so. You can go higher up as evidence is found.

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9
Q

Systematic review is the #__ form of research for EBP

A

1

This is because the strongest evidence comes from careful syntheses of multiple studies

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10
Q

Level 2 evidence depends on?

A

The nature of inquiry

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11
Q

What is under level 2 for the evidence hierarchy?

A

Single randomized controlled trial (RCT)
-theory and some etiology questions

Single non-randomized trial (quasi-experiment)

Single prospective/cohort study
-prognosis and some diagnosis questions

Single case-control study

Single cross-sectional study

  • e.g. survey
  • descriptive quantitative questions
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12
Q

What is under level 3 for the evidence hierarchy?

A

Single in-depth qualitative study
-meaning/process questions

Expert opinion, case reports, etc.

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13
Q

Best evidence refers to research findings that are?

A

Methodologically appropriate, rigorous, and clinically relevant for answering pressing questions

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14
Q

EBP Challenges: Research Related Barriers

A

Scarcity of strong research evidence, the info you need sometimes doesn’t exist

Limited availability of strong research evidence for some practice areas. The need for research that directly addresses pressing clinical problems and for replicating studies in a range of settings remains a challenge.

Most studies are in English (barrier for non-English speaking countries)

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15
Q

EBP Challenges: Nurse Related Barriers

A

Some nurses don’t recognize research articles when they need to, recognizing that there is a problem and that nursing can do something about the problem, nurses being able to scale down the problem to something that is manageable.

The biggest barrier!
-partly b/c of attitude, most people don’t have a desire to do research

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16
Q

EBP Challenges: Organizational Barriers

A

Lack of funding, lack of release time (do it on your own or it doesn’t get done), time to evaluate the evidence, time to research

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17
Q

Primary Studies

A

Published in journals and are not pre-appraised for quality and use in practice.

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18
Q

Preprocessed (pre-appraised) evidence

A

Evidence that has been selected from primary studies and evaluated for use by clinicians

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19
Q

Pre-appraised Research: Systematic Reviews

A

Methodical, scholarly inquiry.

Narrative (qualitative) form integration merges and synthesizes findings

Evidence about a topic in a rigorous, systematic way

  • meta-analyses: integrating quantitative research findings statistically
  • meta-syntheses: qualitative studies; less about reducing info and more about interpreting it
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20
Q

Pre-Appraised Research: Clinical Practice Guidelines

A

Give specific recommendations for evidence-based decision making
-often based on systematic reviews

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21
Q

Meta-Analysis

A

Technique for integrating quantitative research findings statistically

Use statistics to combine findings from different studies
-NUMBERS

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22
Q

Meta-Synthesis

A

Less about reducing information and more about interpreting it

Qualitative, put together in WORDS

23
Q

Unit of Analysis

A

The most basic entity on which the analysis focuses

24
Q

Clinical practice guidelines are often based on?

A

Systematic reviews

25
Q

Those who wish to adopt clinical practice guidelines should appraise them to identify ones that are based on?

A

The strongest evidence, have been meticulously developed, are user-friendly, and are appropriate for local use or adaptation.

26
Q

What are the 2 widely referenced models of EBP?

A

Stetler

Iowa

27
Q

Stetler Model

A

Stetler model of RU to promote EBP

28
Q

Iowa Model

A

Iowa model of EBP to promote quality care

29
Q

Steps of EBP (7)

A
  1. Cultivate a spirit of inquiry
  2. Formulate a clinical question
  3. Search for best evidence
  4. Evaluate the evidence (critique)
  5. Integrate the evidence
  6. Evaluate the outcomes
  7. Disseminate the outcomes
30
Q

Background questions

A

Foundational questions about a clinical issue

ex: what is cancer cachexia and what is its pathophysiology?

31
Q

Foreground questions

A

Those that can be answered based on current best research evidence on diagnosing, assessing, or treating patients, or on understanding the meaning or prognosis of their health problems

ex: is fish oil-enhanced nutritional supplement effective in stabilizing weight in patients with advanced cancer?

32
Q

What are the components for quantitative evidence?

A 
Population
Intervention (exposure, issue)
Comparison*
Outcome
Time*

*not always specified

33
Q

PICO Question Templates

A

In ____ (population), what is the effect of ____ (intervention), in comparison to ____ (comparison), on ____ (outcome)?

34
Q

For an individual EBP endeavor, the best place to begin is?

A

By searching for evidence in a systematic review, clinical practice guideline, or other preprocessed sources because this approach leads to a quicker answer - and, if your methodologic skills are limited, potentially a superior answer as well.

35
Q

T/F: Evidence should be appraised before clinical action is taken.

A

True

36
Q

Appraising the evidence for EBP

A

What is the quality of evidence?
-how usable the findings are. How much can you trust the findings?

What is the magnitude of effects?
-how big is the effect? Effect size you’ll see in intervention articles not descriptive articles

How precise are estimates of effects?
-looking at the range of the effect. ex: odd ratios

Is there evidence of side effects?
-are there other things that may be influencing the outcome of that study?

Is there relevance to my clinical situation?
-is it relevant to me?

37
Q

The overriding appraisal issue is the extent to which the findings are ____.

A

Valid

Were the study methods sufficiently rigorous that the evidence can be believed?

38
Q

Research evidence needs to integrate with?

A
  1. Your own clinical expertise and knowledge of your clinical setting
  2. Pt preferences and values
  3. Evidence from qualitative and quantitative studies
39
Q

Evidence Quality

A

This criterion considers not whether the results are “real,” but how powerful the effects are and whether study findings are clinically important

40
Q

Precision of Estimates

A

Relevant when the evidence is quantitative

How precise the estimate of effect is.

41
Q

Peripheral Effects

A

Even if the evidence is judged to be valid and the magnitude of effects is sizable, peripheral benefits and costs may be important in guiding decisions.

42
Q

Clinical Relevance

A

It’s important to appraise the evidence in terms of its relevance for the clinical situation at hand - that is, for your patient in a specific clinical setting.

43
Q

EBP is most challenging when?

A

Findings from research are contradictory, inconclusive, or “thin” - that is, when better quality evidence is needed

44
Q

Part of the evaluation process involves?

A

Following up to determine if your actions achieved the desired outcome

45
Q

Several EBP models (such as Iowa Model) have distinguished 2 types of stimulus (“triggers”) for an EBP endeavor. What are those two types of stimulus triggers?

A

1) problem-focused triggers
- the identification of clinical practice problem in need of solution

  1. knowledge-focused triggers
    - readings in the research literature
46
Q

Implementation Potential

A

Some EBP models recommend a formal assessment of organizational “fit” known as implementation potential (or environmental readiness)

47
Q

Pilot Test

A

Trial run

48
Q

Implementing and evaluating the innovation (5 steps)

A
  1. Developing an evaluation plan
  2. Measuring client outcomes prior to implementing the innovation, so that there is a comparison against which the outcomes of the innovation can be assessed
  3. Training relevant staff in the use of the new guideline and, if necessary, “marketing” the innovation to users
  4. Trying the guideline out on one or more units or with a group of clients
  5. Evaluating the pilot project, in terms of both processes and outcomes
49
Q

Methodologically Appropriate

A

Using the right research method in the right situation. Like a recipe, you can’t use a cake recipe to make chicken.

50
Q

Rigorous

A

Thorough, accurate, consistent, and detail oriented. Something more rigorous has higher standards

51
Q

Clinical relevant

A

Do the things in the study that match the clinical situation

52
Q

What is the biggest EBP challenge barrier?

A

Nurse-related barriers

-partly b/c of attitude, most people don’t have a desire to do research

53
Q

T/F: Clinical guidelines put evidence into a usable form.

A

True

Research 3900 (5 decks)

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