Evidence-Based Practice in Nursing, Exams of Advanced Education

Download Evidence-Based Practice in Nursing and more Exams Advanced Education in PDF only on Docsity!

Evidence Based Practice Exam

What Is Evidence-Based Practice? - The collection, interpretation, and integration of valid research evidence, combined with clinical expertise and an understanding of patient and family values and preferences to inform clinical decision making. Clinical Decision Making - Nurses are using best available evidence, combined with their clinical judgment and patient preferences to influence the nature and direction of health care delivery, and document outcomes related to the quality and cost effectiveness of patient care. What is Quality Improvement? - The systematic use of data to monitor the outcomes of care processes as well as the use of improvement methods to design and test changes in practice, the aim of which is to continuously improve the quality and safety of health care systems. Quantitative research - Uses research ques/hypo to describe phenomena, test relationships, assess differences, & seek to explain cause-&-effect relationships between variables, & test for effectiveness of interventions. Use numeric data to describe and analyze the results summarized and analyzed using statistics. Data collected from large # of subjects. Uses questionnaires, equipment Used for testing theories. Uses objective approach Efficiency, but may miss contextual details Qualitative research - Aims to understand meaning of a human experience: grief, hope, loss. Uses words rather than numeric data to describe experience. Data collected from small # of subjects allowing for in-depth study of a phenomenon. Generally conducted in natural settings. Researcher as instrument Data assist in generating theories. Uses a subjective approach.

Information rich, but time consuming, lack of generalizability. Research - qualitative, quantitative, or mixed Systematic Research - a summation & assessment of a group of studies that used similar designs based on a focused clinical question Meta-analysis - summarizes a number of studies focused on a topic using a specific statistical methodology to synthesize findings in order to draw conclusions. Integrative review - a focused review & synthesis of lit without statistical analysis. Can include both qual & quant articles Meta-synthesis - Synthesis of a no. of qual studies on a focused topic using specific qualitative methodology Preliminary understanding - Familiarize self with the study. Skim abstract and article. Comprehensive understanding - Understand research purpose/intent, clarify unfamiliar terms/concepts. Analysis Understanding: - Understand parts, critique soundness. Synthesis Understanding - Understand whole article & each step of RP Critical reading requires four stages of understanding. What is the last stage? o Analysis o Preliminary (skimming) o Synthesis o Comprehensive - Answer: C

Rationale: Critical reading requires four stages of understanding: preliminary (skimming), comprehensive, analysis, and synthesis. What is an assessment of a group of research studies that test a similar research question? o Systematic review o Meta-analysis o Integrative review o Meta-synthesis - Answer: A Rationale: A systematic review is a summation and assessment of a group of research studies that test a similar research question. A meta-analysis summarizes a number of studies focused on a question/topic using a specific statistical methodology to synthesize the findings in order to draw conclusions about the area of focus. An integrative review is a focused review and synthesis of either research or theoretical literature on a particular area that follows specific steps of literature integration and synthesis without statistical analysis and can include both quantitative and qualitative articles. Both meta-synthesis and meta-summary are the synthesis of a number of qualitative research studies on a focused topic using specific qualitative methodology. What is PICO? - PICO is an acronym used for patient-centered problems based on four areas of knowledge and action: o Patient or Problem o Intervention, cause or prognosis o Comparison or Control o Outcome or results A 28-year-old male presents with recurrent furunculosis (skin boils) for past 8 months; these episodes have been treated with drainage and several courses of antibiotics but keep recurring. He asks if recurrences can be prevented. To convert this to an answerable question, use the P I C O method as follows Question: In patients with recurrent furunculosis, do prophylactic antibiotics, compared to no treatment, reduce the recurrence rate?' - • P: Patients with recurrent furunculosis

• I: prophylactic antibiotics.
• C: No treatment

• O: Reduction in recurrence of furunculosis Mabel is a 6-week-old baby at her routine follow-up. She was born prematurely at 35 weeks. You want to tell the parents about her chances of developing hearing problems. Question: n infants born prematurely, compared to those born at full term, what is the subsequent lifetime prevalence of sensory deafness?' - • P: Infants
• I: Premature
• C: Full term
• O: sensory deafness Research problem - Enigmatic, perplexing, or troubling condition. Research question - Specific queries researchers want to answer in addressing the research problem. Purpose - Researcher's summary of the overall goal. May identify several aims/ objectives. Hypothesis - Specific prediction about answers to the research questions Variables - Properties researchers study. Something that varies. Properties that differ from each other (age, wt, ht.) Should be relevant, of interest & measurable. Independent variable: IV (X) - Has presumed effect on DV Can be manipulated
• The presumes cause
• Has effect on the DV
• Predictor variable

• Control variable
• Varies or manipulated by the researcher Dependent variable: DV (Y) - Often referred to as consequence. Observed & assumed to vary with change. Not manipulated.
• The presumed effect/result
• Changes in response to IV
• Response variable
• Outcome variable
• Being observed or measured directional research hypothesis - A directional research hypothesis predicts the expected direction of the relationship between X and Y. nondirectional research hypothesis - A nondirectional research hypothesis does not predict the anticipated direction of the relationship between X and Y but differences Primary Literature - Research articles and books by the original author Secondary Literature - Published articles or books that are written by persons other than the individual who conducted the research study or developed the theory Researcher - Develop the knowledge foundation necessary to design a sound study. Generate research questions and hypotheses Consumer - Answer a clinical question or solve a problem to improve patient outcomes CINAHL - is great for nursing research

MEDLINE - is great for medical research PubMed - for life sciences and biomedical topics. Cochrane - for systematic reviews - in search for Evidence based practice. PsycINFO - is used for research on human behavior Boolean Operators - Boolean operators define the relationships between words or groups of words in a literature search. Boolean operators dictate the relationship between words and concepts:

• "AND" requires both concepts to be located within the results that are returned.
• "OR" allows the grouping together of like terms or synonyms.
• "NOT" eliminates terms from the search. Which source provides the most information on evidence-based practice? o CINAHL o MEDLINE o PsycINFO o Cochrane Systematic Review - • ANSWER: D
• RATIONALE: Cochrane Systematic Review according to the Search for Evidence critical thinking decision path. CINAHL is great for nursing research, MEDLINE is great for medical research, and PsycINFO is used for research on human behavior. But the systematic review, even though it is a secondary source, is a higher-level information resource. Evidence-based nursing would be a higher and better selection. Although systematic reviews are considered to be examples of secondary sources because they represent a body of completed research studies that have been critically appraised and synthesized by a team other than the original researchers, they often represent the best available evidence on a particular clinical issue. A nurse researcher finds four useful resources. What is an appropriate next action? o Decide whether the four resources provide a strong enough base for the topic. o Review the resources in the articles.

o Talk to the librarian. o Expand the topic. - • ANSWER: B

• RATIONALE: Review references in the resources. Although a few articles may be comprehensive, it is not likely. Before talking to the librarian, review the references in the resources. They often lead to another path of resources. And if all else fails, you may need to expand your topic. The author of the nursing theory on which you are basing a review is in attendance at a social function. What might you do next? o Introduce yourself and ask a few questions about your topic. o Introduce yourself and ask for an appointment at a later date. o Listen on the fringe of the discussion. o Realize that this is a social function and do not talk "business." - • ANSWER: B
• RATIONALE: Introduce yourself and ask for an appointment at a later date. This would be most appropriate after you explain your intention. The theorist may prefer to discuss your project at the function, but asking for an appointment allows the theorist some flexibility. Never underestimate yourself by not introducing yourself. Also, a nursing function is an opportunity to meet other nurses and to discuss pertinent topics. Grand Nursing Theories - o Theories from related disciplines o Nursing theories used in practice and research o Sometimes referred to as "nursing conceptual models" o Include the theories/models that were developed to describe the discipline of nursing as a whole o Grand nursing theories are all-inclusive conceptual structures that tend to include views on person, health, and environment to create a perspective of nursing. o Most abstract level of theory has established a knowledge base for the discipline. o These works are used as the conceptual basis for practice and research and also are tested in research studies. Middle-Range Nursing Theories - o Contain a limited number of concepts and are focused on a limited aspect of reality o More readily used as frameworks for research studies o Pender's health promotion model, theory of uncertainty in illness, and theory of holistic comfort

Situation-Specific Theories - o Sometimes referred to as "micro-range," "practice," or "prescriptive" theories o More specific than middle range theories; composed of a limited number of concepts o Narrow in scope; explain a small aspect of phenomena and processes of interest to nurses; usually limited to specific populations or field of practice Application to Research and Evidence-Based Practice - o Provides parameters for the research and enables the researcher to weave the facts together o Identify whether Intent is to (1) generate a theory, (2) use the theory as the framework that guides the study, or (3) test a theory Application of Theory in Qualitative Research - o Grounded theory o Findings grouped into "themes" o Framework or theory usually found at the end of the manuscript in the discussion section Theory as Research Framework - When the researcher uses quantitative methods, the framework is typically identified and explained at the beginning of the paper, before the discussion of study methods. Theory Testing Research - Research expressly conducted to test a theory is relatively rare in nursing literature A set of interrelated concepts that provide a systematic view of a phenomenon is: o Theory o Construct o Operational definition o Model - Answer: A Rationale:

• Theory: Set of interrelated concepts that provides a systematic view of a phenomenon. Construct: Complex concept; constructs usually comprise more than one concept and are built or "constructed" to fit a purpose.
• Operational definition: Specifies how the concept will be measured.

• Model: A graphic or symbolic representation of a phenomenon. Which type of theory would be best to use when studying self-care habits of patients with type 1 diabetes mellitus? o Leninger's theory o Situation-specific theories o Grand theories o Middle range theories - • Answer: B
• Rationale:
• Situation-Specific Theories are narrow in scope, explain a small aspect of phenomena and processes of interest to nurses, and are usually limited to specific populations or field of practice. Grand nursing theories are sometimes referred to as nursing conceptual models and include the theories/models that were developed to describe the discipline of nursing as a whole. Middle range nursing theories contain a limited number of concepts and are focused on a limited aspect of reality. Madeline Leninger's theory focuses on cultural diversity and is from the social sciences. What is the first question to ask when critiquing the theoretical framework of a research study? o Is the framework for research clearly identified? o Is the framework consistent with a nursing perspective? o Is the framework appropriate to guide research on the subject of interest? o Are the concepts and variables clearly and appropriately defined? - Answer: A Johnson's Behavioral System - framework based on systems concerned with behavioral function; nursing focuses on helping patients balance in system and in subsystems King's Interacting Systems Model - framework based on systems personal interacting systems. Focus on social aspects, mutual goal setting, and patients' perception of situation. Neuman's Health Care Systems Mode - framework based on systems deals with systems response to stressors; nurses help patients adapt and deal with stressors

Parse-model of man-living-health - framework based on systems man as open system that places meaning on a situation Roy's Adaptation Model - Framework based on adaptation describes 4 subsystems that lead to adaptation Orem's Self-Care Theory - Eclectic/Nurse Therapeutics focus on self-care needs and deficits. Goals of nursing is to help patients meet self-care needs and return to caring for self Martha Rogers Model of Unitary Man - Holistic focus on holistic human in interaction with environment and on human development.