Week 1 Flashcards
what is the definition of evidence
- a testimony of facts tending to confirm or disprove any conclusions, or something that furnishes verification
what 4 concepts are related to evidence
- health policy
- health care economics
- technology & informatics
- safety
describe the relationship between health policy and evidence
- evidence informs health policy
- however, health policy is not always driven by evidence: ex. resources, politics
describe the relationship between health care economics and evidence
- may have good evidence about the best way to provide care but poor economics prevent that = moral distress
- we want evidence to drive economics (suggest where funding should be, how can we provide care most cost-effectively, etc.)
- economics may impact evidence by impacting the way research is done
describe the relationship between evidence and safety
- very important
- need to consider outcomes and adverse effects w research studies
- evidence shows us how to provide safe care
describe the relationship between evidence & technology and informatics
- technology influences how we use evidence
- when providing care we collect info, evidence delves into that info collected
describe the hierarchy of scientific evidence
- not all evidence produced is of equal quality
- hierarchy outlines the quality of different types of research and how much trust can be placed in the results of various types of research
- top = subject to less bias due to more control of independent variables
what type of knowledge is nursing practice based on? (4)
- tradition and authority
- clinical experience and intuition
- trial and error
- disciplined research
what needs to be considered w tradition and clinical experience
- they can have some truth, but they need to be tested thru conventional lens
describe the role of intuition on nursing practice
- still important but do not standardize care based on “gut”
describe the role of disciplined research in nursing care
- provides a specialized body of knowledge for use in delivery of health care
what is the best method of acquiring reliable knowledge on which to base a clinical practice
- disciplined research
define evidence informed practice
- a problem solving approach to practice that integrates research evidence w clinical expertise, local data & resources, and pt preference and values
- considers the whole scenario
define evidence-based practice
- the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual pts
- it means integrating individual clinical expertise with the best available external clinical evidence from systematic research
- does not consider pt preferences and values
- main focus is what the research says
what are exemplars of EIP (5)
- kangaroo care
- dressing change frequency
- ambulation after surgery or labor
- decision making in treatment choices
- central line care
what are the 4 key elements of the EIP definition when adapted for nursing
- best available evidence from research
- clinical expertise
- pt preferences and values
- local data & resources
why is EIP significant to clinical decision making (4)
- only half of US citizens receive recommended care based on practice guidelines
- outcomes improve when clinical care is based on research
- large regional variations in practices –> what works in 1 setting may not work in the next
- rapid development of knowledge but slow adoption of EBP –> takes a long time for evidence to be incorporated into practice (15-17 years)
list important people in the history of EBP (3)
- florence nightingale
- James Lind
- Archie Cochrane
describe the contribution of Florence Nightingale to EBP
- one of the 1st people to collect data
- advanced the idea of supporting health care decisions based on evidence
describe James Lind’s contributions to EBP
- conducted the first randomized controlled trial to discover the effectiveness of vitamin C for scurvy
- recognized the need to appraise and synthesize all trials
describe Archie Cochrane’s contribution to EBP (2)
- called for critical summaries of evidence
- “one should be delightfully surprised when any treatment at all is effective, and always assume that a treatment is ineffective unless there is evidence to the contrary” –> belief that treatment is ineffective until proven otherwise
- encouraged the use of synthesized studies
describe the role of nurses in EIP (3)
- researches
- consumers of evidence
- should be participants in research
what are the 5 aspects of the EIP process
- ask
- acquire (evidence to answer the question)
- appraise (the quality, see if it is good research)
- apply (to your practice)
- assess (did it work? how? why?)
and then restart
define paradigm
- world view or general perspective of the world’s complexities
- lens or way to look at phenomenom in the world
what are 2 key paradigms for nursing research
- positivist paradigm
- constructivist paradigm
describe the positivist paradigm and characteristics of it
- philosophical view that all knowledge must be verified through scientific methods such as experiments, observations and logical/mathematical proof
describe the constructivist paradigm and its characteristics
- concept that humans construct knowledge through their intelligence, experiences and interactions with the world
describe the nature of reality in a positivist vs constructivist paradigm
- positivist = reality exists, there is a real world driven by real, natural causes
- constructivist = reality is multiple and subjective, mentally constructed by individuals
describe the relationship between researcher and those being researched in a positivist vs constructivist paradigm
- positivist = researcher is independent from those being researcher
- constructivist = researcher interacts w those being researched, findings are the creation of the interactive process
describe the role of values in the inquiry in a positivist vs constructivist paradigm
- positivist = values and biases are to be held in check, objectivity is sought
- constructivist = subjective and values and inevitable and desirable
describe the best methods for obtaining evidence in a positivist paradigm (9)
- deductive processes –> hypothesis testing
- emphasis on discrete, specific concepts
- focus on the objective & quantifiable
- corroboration of researchers’ predictions
- fixed, prespecified design
- controls over context
- measured, quantitative info
- statistical analysis
- seeks generalizations
describe the best methods for obtaining evidence in a constructivist paradigm (9)
- inductive processes –> hypothesis generation
- emphasis on the whole
- focus on the subjective and nonquantifiable
- emerging insight ground in participants’ experiences
- flexible, emergent design
- context-bound, contextualized
- narrative info
- qualitative analysis
- seeks in-depth understanding
define: research methods
- the techniques used to structure a study and to gather, analyze, and interpret info
what are 2 types of research methods
- quantative
- qualatative
define quantitative research; which paradigm is it most closely allied with
- research strategy that focuses on quantifying the collection and analysis of data
- most closely allied w the positivist tradition
define qualitative research; which paradigm is it associated w
- relies on data obtained by the researcher from first-hand observation, interviews, questionnaires
- associated w the constructivist tradition
describe characteristics of quantitative research (6)
- orderly procedures
- systematic/pre-specified plan
- control over context –> might do in an enviro where factors can be controlled
- formal measurement
- empirical evidence –> measured and captured objectively, numerical
- seeks generalizations –> do research in small samples, hoping it is a representation of a larger population
describe characteristics of qualitative research (6)
- dynamic design –> changes depending on data collected, changes over time
- holistic
- context bound
- humans as instruments
- qualitative info –> based on a narrative (text, words, etc.)
- seeks patterns
what are common features in both the positivist and constructivist paradigm (5)
- ultimate goal = understanding
- need for evidence
- relies on human cooperation
- ethical constraints –> need to go thru the ethics review board
- fallibility –> there is no perfect study, limitations in all studies
what are “mixed-methods”
- the use of both quantitative and qualitative methods within one study
when is a mixed-method used
- when research questions or hypotheses cannot be answered by one method alone
what is the benefit of mixed-methods
- can expand understanding of findings or offer new insight
describe the use of the two methods in mixed-methods
- can occur simultaneously, parallel, or sequentially
- depends on purpose of study
list 9 purposes of nursing researc
- identification and description
- exploration of whether certain relationships exist
- explanation
- prediction and control
- therapy, treatment, intervention, screening, prevention, promotion
- diagnosis & treatment
- prognosis
- etiology
- meaning and process
what 4 types of questions might healthcare practitioners ask
- questions of feasibility (is it feasible? have resources? risks?)
- questions of appropriateness (right intervention? try something else?)
- questions of meaningfulness
- questions of effectiveness
who was one of the first nurses to advocate for health care workers to create, interpret, and use research findings to give the best care
- Florence Nightingale
