Evidence-Based Practice in Nursing, Exams of Nursing

Download Evidence-Based Practice in Nursing and more Exams Nursing in PDF only on Docsity! nur 400 exam 1 study: Evidence-Based Nursing Practice (unit 1)100% Accurate Nightingale - ANSWER________________ discovered that the majority of deaths in the Crimea were due to poor sanitation rather than casualties in battle. She persuaded the need for better hygiene in hospitals. She realized though that just looking at the numbers was unlikely to impress ministers. But once those numbers were translated into a picture (diagram) the message could not be ignored. A good diagram is certainly worth 1000 numbers. Every nurse ought to be careful to wash their hands very frequently during the day. Nightingale is credited with having reduced the mortality rate in Scutari, the military hospital where she led a team of voluntary nurses, from forty percent to two percent - largely because, at her petition, the British government sent out a sanitary commission that cleared a broken sewer contaminating the water supply and improved ventilation on the squalid wards. Nightingale is also the pioneer as a statistician. The published Rose diagram showed clearly that far more soldiers in the Crimea fell victim to disease than to the Russian cannons - but that, even in peacetime, soldiers living in cramped, unsanitary barracks died at a quicker rate than civilians. What forms of data you have seen in our time of pandemic? Archie Cochrane - ANSWERcalled for efforts to make research summaries about interventions available to health care providers Efforts led to the development of Cochrane Center in Oxford and the Cochrane Collaboration. David Sackett - ANSWERdeveloped a learning strategy called evidence-based medicine, which has broadened to the use of best evidence by all health care practitioners Evidence-based practice (EBP) - ANSWERthis is the use of the best clinical evidence in making patient care decisions this is the basis for nursing decisions, which influences many recent clinical practice changes produces decisions that are: - clinically appropriate - cost-effective - result in positive client outcomes ---> the use of EBP optimizes wellbeing and decision making for patients - ex. Vital signs Q4H is a practice that evidence supports now Do you ever wonder why nurses engage in practices that aren't supported by evidence, while not implementing practices substantiated by a lot of evidence? - ANSWERIn the past, nurses changed hospitalized patients' IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients' sleep, which is important for restorative healing, to document blood pressure and pulse rate because it's hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications. In fact, clinicians often follow outdated policies and procedures without questioning their current relevance or accuracy, or the evidence for them. Evidence-Based Practice need to know ******** - ANSWERBest research evidence - EBP evolves from the integration of the best research evidence with clinical expertise and patients' needs and values - the best research evidence is the empirical knowledge generated from the synthesis of quality study findings to address a practice problem. -Applied ----> Basic research = ex. structure of cells, nature of human beings ~ no manipulation Applied = some kind of intervention - ex. Have pt do yoga to see if it improves anxiety, study correlation between smoking and lung cancer 4 General Purposes of Research -Describe -Explain -Predict -Control ----> Describe the relationship Explain correlation Predict whether drinking is related to liver failure Control group compared to intervention group Basic research - ANSWERExtending information for sake of knowledge Applied research - ANSWERDiscovering solutions to immediate problems Describe - ANSWERIdentify and understand nursing phenomena. Example: identify the incidence of infection in health care facilities. -Measure at least 1 thing Explain - ANSWERClarify relationship(s) among phenomena, identify possible reasons why events occur. Example: determine the relationship between health risks, health behaviors, and health status -Measure at least 2 things -Connect them (analysis) Predict - ANSWEREstimate the probability of a specific outcome in a given situation. Example: Which behaviors promote health and prevent illness? -Measure at least 2 things -One thing happens before the other -Connect them (analysis) Control - ANSWERManipulates the situation to produce the desire outcome. Example: testing interventions to improve healthcare delivery -Do something (manipulate) -See what happens to something else (measure) Purposes of Research - ANSWER1. Describe: -Measure at least 1 thing 2. Explain: -Measure at least 2 things -Connect them (analysis) 3. Predict: -Measure at least 2 things -One thing happens before the other -Connect them (analysis) 4. Control: -Do something (manipulate) -See what happens to something else (measure) Key Evidence-Based Practices - ANSWERTreatment/Intervention Assessment and Diagnosis Prognosis Harm and Etiology Meaning and Process Therapy/Intervention - ANSWERWhat therapy or intervention will result in better health outcomes or prevent an adverse health outcome? ex. Kwon and colleagues (2016) tested the effects of an acupressure wristband for postoperative nausea and vomiting among patients undergoing thyroidectomy. Diagnosis and Assessment - ANSWERWhat test or assessment procedure will yield accurate diagnoses or assessments of critical patient conditions and outcomes? ex. Sitzer (2016) developed and evaluated an automated self-assessment questionnaire for assessing the risk of falling in hospitalized patients. Prognosis - ANSWERDoes exposure to a disease or health problem increase the risk of subsequent adverse consequences? ex. Storey and Von Ah (2015) studied the prevalence and impact of hyperglycemia on hospitalized leukemia patients, in terms of such outcomes as neutropenia, infection, and length of hospital stay. Etiology/Cause/Harm - ANSWERWhat factors cause or contribute to the risk of a health problem or disease? ex. Hagerty and colleagues (2015) undertook a study to identify risk factors for catheter-associated urinary tract infections in critically ill patients with subarachnoid hemorrhage. The risk factors examined included patients' blood sugar levels, patient age, and levels of anemia requiring transfusion. Meaning and Process - ANSWERWhat is the meaning of life experiences, and what is the process by which they unfold? 2. Search for best evidence - after the PICO questions have been defined, you're ready to begin searching the literature - this is the second step of EBM - you will search your PICO questions, and most of the search terms and limits applied will come directly from your questions - literature review provides a foundation of the current knowledge base Databases Evidence-based Web Sites Organization Web Sites Electronic Journals Textbooks Benchmarking 3. Critically appraise evidence / evaluate the evidence - review criteria for exclusion of evidence ~~~avoid bias ~~~assess validity, soundness of design, weaknesses - identify the levels of evidence - state the main results concisely - after we've identified the relevant studies in the literature, we then move to step three of the process: ~~~ the systematic and critical appraisal of our evidence ~~~ this can be the most time consuming part of the process, but it's also the heart of evidence- based medicine. 4. Synthesize evidence - make a Practice Recommendation considering extent to which intervention is Feasible, practical, affordable, available Appropriate ethically and justifiably Meaningful to the context in which care is given and the personal experience, opinions, values, beliefs and interpretations of patients Effective in achieving desired outcomes ---> find a reference for this! 5. Evaluate outcomes 6. Disseminate - journal papers, conference papers Asking Clinical Questions: PICOT need to know ********** - ANSWERP: Population of interest - people with cancer, obesity, diabetes, etc. I: Intervention or issue of interest - exercise, smoking, etc. C: Comparison of interest - exercise vs. no exercise O: Outcome expected T: Time needed for the intervention to achieve the outcome or the time in the course of the disease/symptom that the intervention is applied NOTE: Since the purpose of the PICOT is to guide the systematic search of databases, time is option as it can limit your search E. T (Time) Rationale: This question specifies the patient population (patients with dementia), the intervention (reorientation therapy), the comparison (regular, supervised mobility), and the relevant outcome (patient agitation), but does not provide the time frame for an expected outcome. - ANSWERWhich of the following components of a PICOT question is absent from the following clinical question? "Among patients with dementia, how does the use of reorientation therapy compared with regular, supervised mobility affect patient agitation?" A. P (Population) B. I (Intervention) C. C (Comparison) D. O (Outcome) E. T (Time) PICO - ANSWER