Evidence-Based Practice in Nursing: Enhancing Patient Care through Research Utilization, Exams of Nursing

Download Evidence-Based Practice in Nursing: Enhancing Patient Care through Research Utilization and more Exams Nursing in PDF only on Docsity! UPDATED EVIDENCE-BASED PRACTICE IN NURSING QUESTIONS WITH ANSWERS 2024 APPROVED GRADED A+ PASS. Define: Evidence-based practice - Answer Systematic approach to rational decision making that facilitates achievement of best practices Six steps to EBP - Answer 1. Ask a clinical question 2. Collect the most relevant and best evidence 3. Critically appraise the evidence you gather 4. Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change 5. Evaluate 6. Share outcomes of EBP changes with others Ask a clinical question - Answer • A problem or area of interest that could be performed more efficiently, consumes healthcare dollars, or does not make sense • A knowledge focused trigger • Clinical trends • Utilization of PICOT format to state your clinical question Why should I use PICOT format to state my clinical question? - Answer • The questions you ask will eventually lead you to the evidence for an answer • You want to be able to read the BEST four-to-six articles that specifically address your practice question • The more focused a question you ask, the easier it becomes to search for evidence in the scientific literature PICOT question - Answer *P* = Patient population of interest *I* = Intervention of interest *C* = Comparison of interest *O* = Outcome *T* = Time Collect the best evidence- what kind and includes - Answer • Search for evidence! • *Evidence includes but is not limited to*: agency policy and procedure manuals, quality improvement data, existing clinical practice guidelines, agency experts, staff educators, risk managers, infection control nurses, and peer reviewed articles (specifically within the most recent 5 years from the present date) Critically appraise the evidence you gather - Answer • The most difficult step in the EBP process • Involves evaluation, determining if information is valuable and can be easily applied, and if there is enough evidence for making a nursing practice change • Thorough review of elements included in evidence-based articles Integrate the evidence - Answer • How will you incorporate the evidence into practice? • Integrate evidence with use of teaching tools, clinical practice guidelines, policies and procedures, and new assessment documentation tools • Consider staff support and available resources • Conduct a pilot study and attempt to answer your PICOT question Evaluate and share outcomes - Answer • Did it work? Is it effective? • Communicate the results to various groups of nurses or other care providers (facility nursing practice council or research committee) PICO four-step process - Answer *P* - population of interest *I* - intervention *C* - comparison *O* - outcome Utilization of the research process - Answer • Identification of a researchable problem • Review of the literature • Formulation of the research question or hypothesis • Design of the study • Implementation of the study • Drawing conclusions based on findings • Discussion of clinical implications • Dissemination of findings Identification of a researchable problem - Answer • Sources: D. Does not have to follow the sequence of PICOT - Answer *D. Does not have to follow the sequence of PICOT* A well designed PICOT question does not have to follow the sequence of PICOT. In addition, Intervention (I), comparison (C), and time (T) are not appropriate to be used in every question. The aim is to ask a question that contains as many of the PICOT elements as possible. Proper question formatting allows you to identify keys words to use when conducting your literature search Research Utilization (RU) - Answer - Use of study findings in a practical application unrelated to the original research. - Instrumental (direct) - Conceptual (indirect) - Persuasive (symbolic) Evidence Based Practice (EBP) - Answer - Based clinical decisions on best possible evidence typically high quality research. - Use of best evidence unmaking patient care decisions. Research Utilization (RU): Instrumental - Answer - Direct - Explicit application of knowledge gained from research to a practice. Research Utilization (RU): Conceptual - Answer - Indirect - Use of findings to enhance one's understanding of a problem or issue in nursing. Research Utilization (RU): Persuasive - Answer - Symbolic - Use of evidence to change minds, especially decision makers. RU Beginnings - Answer - 1970s research begins to be incorporated in nursing curricula. - 1970s WICHE Western Interstate Commission for Higher Education. - 6 year project to address feasibility of fostering research through regional collaborations. - First major project addressing RU. - Findings: resulted in increase in RU, but not enough sounds, reliable studies with implications for nursing care. - 1970s CURN: Conduct and Utilization of Research in Nursing project (run by MNA, funded by Division of Nursing). - Major objective --> increase use of research findings in clinical nursing practice by: disseminating current findings, facilitating organizational changes, encouraging collaborative research. - Must have relevance to practice and be widely disseminated. Steps of Research Utilization Similarities to Nursing Process - Answer (ADPIE) - Identification of clinical problem (D). - Gathering information form existing studies, critical evaluation of research (A). - Relevance to practice setting/patient population (P), definition of patient outcomes (P). - Education/training (protocol) needed for change (I). - Evaluation/follow-up of new practice (E). RU 1980s-1990s - Answer - 1980s and 1990s RU generally at institutional level, innovation effectiveness evaluation. - 1990s push for EBP. Cochrane Collaboration - Answer - Archie Cochrane - Systematic way to evaluate evidence. - Dissemination of evidence. - Evidence hierarchy. EBM (Evidence Based Medicine) - Answer David Sackett, McMaster Medical School EBP Initiatives - Answer - Institute of medicine's Roundtable on EBM. - US Preventative Services Task Force (USPSTF). - Agency for Healthcare Research and Quality (AHRQ). - Nation Consortium for the Advancement of pEdiatric and Adolescent Evidence Based Practice (NCPAEP). - Magnet Recognition Program by the American Nurses Credentialing Center. Evidence Based Practice - Answer - A life-long problem-solving approach to clinical practice that integrates... - Search, critical appraisal, and synthesis of the most relevant and best research *(external evidence).* - One's own clinical expertise, which includes *internal evidence* generated from outcomes management or quality improvement projects, patient assessment, and evaluation. - Patient preferences and values. Evidence Based Medicine/Evidence Based Practice - Answer - Distinct - Not just RCT's - Evidence hierarchies - Philosophical differences EBP Continuum - Answer - Nurses actively doing research - Assisting researchers, collecting information. - Participate in journal club. - Informed readers, up to date practice. EBNP - Answer - Best evidence: findings of quantitative research studies. - Clinical expertise: expert panels; consensus statements; practice groups; practitioner experience. - Patient preferences: satisfaction; QOL; treatment burden; Qualitative studies. Research Process - Answer - Problem identification - Conduct research - Follow steps of research process. - Findings usually not immediately applicable - need to be translated through RU/EBNP. Research Utilization - Answer - Clinical Problem ID - Use existing research to solve problem. - Follow steps of RU - Findings usually applied at organizational level. Evidence Based Nursing Practice - Answer - Clinical problem ID - Use existing research - Synthesize all evidence, integrate patient preference and clinical expertise. - Findings applied at bedside, tailored to individual patient. Evidence Hierarchies - Answer - Rank evidence according to strength of evidence provided. - *C*omparison intervention or group - *O*utcome - *T*ime frame - not always specified. Components for Qualitative Evidence - Answer - Population - Situation (processes, experiences, cultures, history, condition of interest). Question Templates - Answer - Templates can greatly facilitate wording of questions, e.g., an intervention question: In (population), what is the effect of (intervention), in comparison to (comparison) on (outcome) in (timeframe)? Search For Evidence - Answer - CINAHL - MEDLINE - Cochran collaboration (www.cochrane.org) - Agency for Healthcare Research and Quality (www.ahrg.gov) - National Guideline Clearinghouse (www.guidelines.gov, www.guidelines.gove/content.aspx?id=32669&search-falls) Appraising the Evidence - Answer - What is the quality of the evidence? - What is the magnitude of effects? - How precise are estimates of effects? - Is there evidence of side effects? - What are the costs? - Is there relevance to my clinical situation? Rating the Strength of Evidence - Answer - Not necessarily synonymous with "hierarchy of evidence." - High-level study design does not necessarily mean high quality. - Grading the strength of a body of evidence addresses three domains - quality, quantity, and consistency. Rating the Strength of Evidence: Quality - Answer The event to which a study's design, conduct, and analysis has minimized selection,measurement and confounding biases (internal validity). Rating the Strength of Evidence: Quantity - Answer The number of studies that have evaluated the question, overall sample size across all studies, magnitude of the treatment effect, strength from causality assessment, such as relative risk or odds ratio. Rating the Strength of Evidence: Consistency - Answer Whether investigations with both similar and different study designs report similar findings (requires numerous studies). Integrate Evidence, Clinical Expertise, Pt. Preference - Answer - This is the "implementation" step. - EBP is not based solely on research and published evidence. - Patient's histories and circumstances have a significant bearing on the nurse's choice of intervention. - Availability of resources must also be considered: feasibility, cost benefit, transferability. EBP Models - Answer - Dozens of models exist. - The *Stetler Model* of research utilization to promote evidence based practice. - The *IOWA Model* of evidence based practice to promote quality of care. - Rogers' *Diffusion of Innovations Theory*. Evaluate Outcomes of the Practice Decision or Change Based on Evidence - Answer - Measurement of outcomes is important to determine and document impact of the EBP change on healthcare quality and/or patient outcomes. - Essential in determining whether the change based on evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting. Disseminate Outcomes of the EBP Decision or Change - Answer - Too often in healthcare, positive outcomes are not shared with others. - There are numerous strategies for accomplishing this goal, from personal communications, conference presentation, and peer reviewed article publication. Rogers' Theory of Diffusion of Innovations - Answer - Theory for communicating knowledge developed through research. Includes a five stage process: 1) Knowledge - knows but lacks info, not inspired to find info. 2) Persuasion - interested, seeks info. 3) Decision - weighs advantages/disadvantages, accepts of rejects. 4) Implementation - determines usefulness, many seek more info. 5) Confirmation - finalizes decision. May be interpersonal (cognitive dissonance) or interpersonal (good job group!). Iowa Model - Answer - Ask clinical question. - Search literature - Critically appraise literature - Implement practice change - Evaluate - Organizations change practice Stetler Model - Answer - Preparation - Validation of credible evidence - Comparative evaluation/decision making phase - Translate or apply the research - Evaluate outcomes - Individuals change practice Other Models of Quality Improvement - Answer - Six Sigma: a disciplined, data-driven approach and methodology for eliminating defects (driving toward six standard deviations between the mean and the nearest specification limit) in any process - from manufacturing to transactional and from product to service. - Currently in use at UHS. Other Quality Measurements - Answer - You may hear the following terms in regard two quality improvement at hospitals: - HCAPS - Hospital Consumer Assessment of Healthcare Providers and Systems --> National survey analyzed by centers for medicare and medicaid services (CMS). - Press Ganey - Private, for profit organization that polls health care consumers to assess quality of care (HCAPS included in survey). *Case Study:* Chris was caring for a 27 year old woman who just delivered her first infant by emergency Cesarean birth. The mother was upset because she believed she would have to deliver subsequent children by cesarean birth. She asked Chris about the risks of birth complications with vaginal birth A. "Quantitative research involves systematic distortion of a finding from the data." B. "Quantitative research is known as naturalistic inquiry." C. "Qualitative research requires standardized experimental designs." D. "Qualitative research does not involve manipulation of variables." - Answer D. "Qualitative research does not involve manipulation of variables." 2. The nurse professor is presenting a lecture on pure science. Which statement from one of the students indicates that the teaching has been effective? A. "Pure science involves systematic distortion of a finding from the data." B. "Pure science involves manipulation of variables." C. "Pure science summarizes and explains the universe without regard for whether the information is immediately useful." D. "Pure science is the practical application of scientific theory and laws." - Answer C. "Pure science summarizes and explains the universe without regard for whether the information is immediately useful." 3. The student nurse is listening to a lecture on inductive and deductive reasoning. Which statement indicates that further teaching is needed? A. "Inductive reasoning begins with a particular experience and proceeds to generalizations." B. "Research requires the use of only inductive reasoning." C. "Deductive reasoning proceeds from the general case to the specific." D. "Conclusions drawn from deductive reasoning are called valid rather than true." - Answer B. "Research requires the use of only inductive reasoning." [Research requires both inductive and deductive reasoning] 4. The nurse professor is giving a lecture on the difference between research and problem solving. Which statement by one of the students indicates that teaching has been effective? A. "Research is specific to a given situation." B. "Research is designed for immediate action." C. "Problem-solving is generalizable." D. "Research deals with long-term solutions." - Answer D. "Research deals with long-term solutions." [Research is generalizable, can be used in other situations and deals with long-term solutions.] 5. How should the nurse initiate the research process? - Answer Identify a researchable problem. [The first step in the research process is to identify a researchable problem.] 6. The nurse researcher is presenting a lecture on data-collection instruments. Which statement indicates the need for further education? A. "Data collection tools must be high tech and complex to be accurate." B. "Researchers must consider how the data will be collected." C. "The selected instrument must be reliable." D. "The tool must be valid." - Answer A. "Data collection tools must be high tech and complex to be accurate." [data collection tools, range from simple survey forms to complex radiographic scanning devices. ] 7. The nurse is listening to a lecture on the outcomes of research in the nursing practice. Which statement indicates a need for further education? A. "Research has not created a lot of changes in nursing." B. "Research has improved the care of patients with skin breakdown." C. "Research has prevented sleep deprivation by decreasing light and noise." D. "Research has led to scheduling pain medication more frequently after surgery." - Answer A. "Research has not created a lot of changes in nursing." 8. Which statement by the nurse indicates an understanding of how nursing research positively affects nursing? A. "Research creates changes that are not always good." B. "Research expands the nursing profession." C. "Research creates more work for staff nurses." D. "Research leads to less pay for union nurses." - Answer B. "Research expands the nursing profession." 9. Which statement about financial support for nursing research indicates a need for further teaching? A. "Nursing research is often fairly inexpensive." B. "Over the years, more funding for nursing research has been identified." C. "It is difficult for new researchers to obtain funding." D. "Nursing associations fund nursing research." - Answer A. "Nursing research is often fairly inexpensive." [Nursing research can be EXPENSIVE, and often support takes many different forms] 10. The nurse is would like to research how to best keep confused patients from wandering. What is the first step that the nurse should take? A. Review the literature. B. Create a study design. C. Call the local community college about funding. D. Identify a researchable problem - Answer D. Identify a researchable problem PPT: A nurse compares patient compliance after an interactive video instruction compared to usual verbal instructions among patients with a new diagnosis of diabetes mellitus. The study design most likely describes: 1. Descriptive research design 2. Exploratory research design 3. Modified experimental design 4. True experimental design - Answer 3. Modified experimental design Scientific Method - Answer step by step process with observable results used by scientists to solve problems Quantitative Research - Answer Measurable variables Qualitative Research - Answer Because there are no variables being manipulated - qualities of the human experience are described and interpreted. 5 Components of the Nursing Process - Answer -assessment -nursing diagnosis -planning