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Individuals with which of the following personality styles are most likely to be comfortable in a leadership role? A. D B. I C. S D. C - CORRECT ANSWER- - A. D Individuals with "D" (Driver) personality styles like to take charge of projects and are highly task oriented, making them well-suited to positions of leadership. What model of organizational change would be most likely to prioritize changing nurses' feelings over presenting them with new information? A. The Transtheoretical Model of Health Behavior Change B. Kotter and Cohen's Model of Change C. The Change Curve Model D. Diffusion of Innovations Model - CORRECT ANSWER- - B. Kotter and Cohen's Model of Change Rationale: Kotter and Cohen proposed that the key to organizational change lies in helping people to feel differently (i.e., appealing to their emotions). They assert that individuals change their behavior less when they are given facts or analyses that change their thinking than when they are shown truths that influence their feelings.
T/F: A SCOT analysis helps clarify the goals and beliefs that underlie a proposed change to EBP. - CORRECT ANSWER- - False Rationale: A SCOT analysis aids in the strategic planning for the execution of proposed change. Identification of the goals and beliefs that inform the change should take place prior to formal strategic planning. Feedback loops are a central component of which of the following models for evidence- based practice change? A. The Model for Evidence-Based Practice Change B. The Clinical Scholar Model C. The ARCC Model D. The Iowa Model - CORRECT ANSWER- - D. The Iowa Model Rationale: The Iowa Model includes multiple feedback loops that refer the user back to earlier points in the process. This is not a central feature of the ARCC Model, the Clinical Scholar Model, or The Model for Evidence-Based Practice Change. T/F: Both The Model for Evidence-Based Practice Change and the Iowa Model include the use of a small-scale pilot study during the process of introducing an evidence-based change in practice. - CORRECT ANSWER- - True Rationale: Pilot studies are explicit components of both The Model for Evidence-Based Practice Change and the Iowa Model. When the Stetler Model is used to guide an evidence-based practice change, which of the following activities will constitute the final phase of the process? A. Disseminating the results of the practice change B. Publishing the findings that result from implementation
A. Finance B. Human resources C. Quality management D. Administration - CORRECT ANSWER- - B. Human resources Rationale: Human resource departments are a key source of data surrounding skills mix, staffing levels, staff demographics, recruitment, and retention. Departments such as finance, administration, and quality management would be less likely to provide data on the current skills mix at the hospital. T/F: The Health Outcomes Institute's Outcomes Management Model provides a four-step process for the critical appraisal of evidence. - CORRECT ANSWER- - False Rationale: The Health Outcomes Institute's Outcomes Management Model delineates a process that can be used to guide measurement of the impact of new interventions on improving healthcare outcomes. It does not provide a specific process for critical appraisal of the literature. Which of the following evaluation indicators can be quantified and statistically analyzed? A. Environmental changes B. Professional expertise C. Outcome measures D. Patient-centered quality care - CORRECT ANSWER- - C. Outcome measures Rationale: Outcome measures are quantifiable healthcare results, such as health status, death, disability, iatrogenic effects of treatment, health behaviors, and the economic impact of therapy and illness management. Environmental changes, professional expertise, and patient-centered quality care are measures that equally important, but which are more qualitative in nature.
What is the most effective strategy for engaging care providers in a proposed EBP change? A. Disseminate the evidence that underlies the change B. Remind staff of their obligation to provide optimal care C. Bring in EBP experts to speak to staff members D. Organize discussions and meetings with EBP mentors - CORRECT ANSWER- - D. Organize discussions and meetings with EBP mentors Rationale: Interactive discussions between EBP mentors and care providers are an effective way to increase knowledge and address attitudinal barriers. Other strategies, such as bringing in outsiders to teach, disseminating research findings, or telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change. T/F: Implementation of EBP is the responsibility of graduate-prepared nurses and members of the nursing leadership. - CORRECT ANSWER- - False Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines. Which of the following factors has the greatest bearing on the success or failure of CPG implementation? A. The strength of the evidence that underlies the guideline B. The validity of the process that was used to develop the guideline C. The education level of the nurses who will implement the guideline D. The commitment of the caregivers who will put the guideline into practice - CORRECT ANSWER- - D. The commitment of the caregivers who will put the guideline into practice
A. Dependability B. Confirmability C. Transferability D. Credibility - CORRECT ANSWER- - C. Transferability Rationale: Transferability addresses the question of whether the findings of a qualitative study are applicable to other people who are in similar situations. T/F: Grounded theory is the most appropriate tradition for a study that explores women's coping as they move through different stages of fertility treatment. - CORRECT ANSWER- - True Rationale: Grounded theory often focuses on changes in the human experience as they move through time. Qualitative evidence is most likely to inform which of the following aspects of the care of patients with cancer? A. Cancer patients' perceptions of hope during chemotherapy treatment B. Treatment options for chemotherapy-induced nausea C. Clinicians' choices of chemotherapeutic agents D. The relationship between anxiety and nausea in patients undergoing chemotherapy - CORRECT ANSWER- - A. Cancer patients' perceptions of hope during chemotherapy treatment Rationale: The concept of hope is an aspect of the human responses and meaning that surround a health experience. Treatment options and the relationships between different concepts are likely better addressed by quantitative evidence.
T/F: Meta-analysis results in evidence that is applicable to a larger patient population than individual studies. - CORRECT ANSWER- - False Rationale: In meta-analyses, combining the results of several studies produces a larger sample size and thus greater power to accurately determine the magnitude of the effect. This does not, however, increase the size of the relevant patient population. A team of researchers have received a grant to investigate the potential links between diet and the development of stomach cancer. What methodology is most likely to answer the researchers' clinical question? A. Case control B. Case study C. Randomized controlled trial (RCT) D. Qualitative study - CORRECT ANSWER- - A. Case control Rationale: A case control study often selects individuals with a particular disease (e.g., stomach cancer) and looks back to identify factors that may underlie that disease (e.g., diet). Neither a case study nor a qualitative study would inform this relationship and an RCT would be unethical and impractical. T/F: The smaller the p value, the less likely the null hypothesis is true. - CORRECT ANSWER-
- True The findings of a quantitative study testing a high school-based sexual health program reveal that for every 140 female students who take the program, one pregnancy is prevented. This conclusion indicates the: A. OR B. NNT
Rationale: Patient preferences and experiences are an important consideration and are a form of evidence. While the patient's preference does not likely constitute the "final word" on treatment choices, it must be weighed carefully and integrated into the nurse' choice of intervention. Which of the following sources of knowledge would a nurse prioritize when determining the turning schedule for an immobilized patient? A. The traditional practice on the unit B. The nurse's knowledge of skin breakdown C. The preferences of the patient and the patient's family D. A clinical practice guideline for preventing skin breakdown - CORRECT ANSWER- - D. A clinical practice guideline for preventing skin breakdown Rationale: EBP encompasses patient preferences and the clinical expertise of individual practitioners, but the primary source of knowledge is research evidence. Clinical practice guidelines synthesize this evidence in order to guide practice. Which of the following online evidence sources is most likely to provide pre-appraised evidence? A. CINAHL B. MEDLINE C. PubMed D. Cochrane Library - CORRECT ANSWER- - D. Cochrane Library Rationale: The Cochrane Databases consist of systematic reviews that synthesize evidence from multiple peer-reviewed sources. CINAHL, MEDLINE, and PubMed may
contain evidence at a synthesis level, but are more often sources of individual articles that a nurse must appraise. T/F: A controlled-vocabulary system may yield fewer hits than a keyword search, but these hits are more likely to be relevant to the clinical question. - CORRECT ANSWER- - True Rationale: Controlled vocabulary systems exist to increase the relevance of search results while limiting the number of less-relevant hits. Which of the following sources of evidence is best able to inform a nurse's clinical practice? A. A well-designed randomized controlled trial (RCT) B. A systematic review that encompasses multiple studies C. Expert opinion of experienced and educated nurses D. A case study that addresses an unique clinical scenario - CORRECT ANSWER- - B. A systematic review that encompasses multiple studies Rationale: Systematic reviews are considered to be higher on the hierarchy of evidence than expert opinion or individual RCTs and case studies. Which of the following components of a PICOT question is absent from this clinical question? "Among patients with dementia, how does use of reorientation therapy compared to regular, supervised mobility affect patient agitation?" A. P B. I
Rationale: The EBP process culminates with the dissemination of results. Searching the literature, consulting with patients, and evaluating costs are actions that should already have been performed earlier in the EBP process. An obstetrical nurse wants to implement EBP around the fetal monitoring practices on the unit. How should the nurse begin the EBP process? A. By reviewing the literature around the practice B. By consulting with expert nurses C. By fostering an attitude of curiosity D. By evaluating the outcomes of current practices - CORRECT ANSWER- - C. By fostering an attitude of curiosity Rationale: Cultivating an attitude of inquisitiveness, curiosity, and inquiry is foundational to the EBP process and is considered to be "step 0." This should occur prior to reviewing the literature, seeking expert opinion, or critically evaluating the current practice on the unit. T/F: A rigorous randomized controlled trial (RCT) constitutes the highest level of evidence and the most reliable guide to nursing practice. - CORRECT ANSWER- - False Rationale: Meta-analyses and systematic reviews that synthesize the results of multiple RCTs or experiments are considered to be the highest form of evidence. A single RCT is classified at Level II evidence. T/F: Consulting a nursing journal article to determine the recommended turning frequency for immobile patients is an example of utilizing an external resource. - CORRECT ANSWER-
- True Rationale: External evidence includes publications that present the findings of rigorous research, and which are intended to be generalized to and used in other settings.
Evidence Based Practice - CORRECT ANSWER- -- A lifelong problem-solving approach to clinical practice that integrates: ~~ Search, critical appraisal, and synthesis of the most relevant and best research (external evidence, i.e. rigorous research) ~~ One's own clinical expertise, which includes internal evidence generated from practice initatives, such as outcomes management, quality improvement projects, patient assessment and evaluation. ~~ Patient preferences and values Steps of the EPB Process - CORRECT ANSWER- - 0. Cultivate a spirit of inquiry
- Ask the burning clinical question in PICOT format.
- Search for and collect the most relevant best evidence.
- Critically appraise the evidence (i.e. rapid critical appraisal, evaluation, and synthesis).
- Integrate the best evidence with one's clinical expertise and patient preferences and values in making practice decision or change.
- Evaluate outcomes of the practice decision or change based on evidence.
- Disseminate the outcomes of the EBP decision or change. Steps of the EPB Process
- Ask the burning clinical question in PICOT format. - CORRECT ANSWER- - P Patient population I Intervention or issue of interest C Comparison intervention or group O Outcome T Time frame Steps of the EPB Process
- Essential in determining whether the change based on evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting Steps of the EPB Process 6: Disseminate the Outcomes of the EBP Decision or Change - CORRECT ANSWER- -- Too often in healthcare, positive outcomes are not shared with others
- There are numerous strategies for accomplishing this goal, from personal communication to conference presentation Background questions - CORRECT ANSWER- -- Ask for general information about a clinical issue
- Specify the staring point and the outcome of interest Foreground questions - CORRECT ANSWER- -- Can be answered from scientific evidence about diagnosing, treating, or assisting patients with understanding their prognosis
- Focus on specific knowledge
- Types of Foreground questions: ~~ Intervention questions ~~ Prognosis/prediction questions ~~ Diagnosis questions ~~ Etiology questions ~~ Meaning questions Clinical Inquiry - CORRECT ANSWER- -- An outcome of uncertainty
- Defined as a process in which clinicians gather data together using narrowly defined clinical parameters to appraise the available choices of treatment for the purpose of finding the most appropriate choice of action
External Sources of Evidence - CORRECT ANSWER- -- textbooks and journals
- consolidated resources Cochrane Databases (Library) - CORRECT ANSWER- -- A collection of 6 different databases
- "Gold standard" database is the Cochrane Database of Systematic Reviews (CDSR)
- Systematic reviews are based on critical appraisal National Guideline Clearinghouse - CORRECT ANSWER- -- A comprehensive database of evidence-based clinical practice guidelines
- Guidelines are systematically developed statements about a plan of care for a specific set of clinical circumstances involving a particular population
- Developed in partnership with the American Medical Association and the American Association of Health Plans
- Of all the guidelines sources, the NGC contains the most descriptive information about guidelines Criteria for Inclusion of Clinical Practice Guidelines in NGC
- All of the criteria below must be met for a clinical practice guideline to be included in NGC.
- The clinical practice guideline contains systematically developed statements that include recommendations, strategies, or information that assists physicians and/or other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances.
- The clinical practice guideline was produced under the auspices of medical specialty associations; relevant professional societies, public or private organizations, government agencies at the Federal, State, or local level; or health care organizations or plans. A clinical practice guideline developed and issued by an individual not officially sponsored or supported by one of the above types of organizations does not meet the inclusion criteria for NGC.
The PDSA Cycle - CORRECT ANSWER- - The PDSA Cycle Plan: Plan the change and observation Do: Try out the change on a small scale Study: Analyze the data and determine what was learned Act: Refine the change based on what was learned and repeat the testing Rating the Strength of a Body of Evidence Consistency: - CORRECT ANSWER- - whether investigations with both similar and different study designs report similar findings (requires numerous studies) Rating the Strength of a Body of Evidence Quantity: - CORRECT 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 a Body of Evidence Quality: - CORRECT ANSWER- - the extent to which a study's design, conduct, and analysis has minimized selection, measurement, and confounding biases (internal validity) Evidence - CORRECT ANSWER- -- Research evidence
- Clinical knowledge gained via the individual practitioner's experience
- Patients' and practitioners' preferences
- Basic principles from logic and theory Internal Evidence - CORRECT ANSWER- -- Evidence that is generated by outcomes management, quality improvement, or EBP implementation projects
- Aimed at improving outcomes at the site where improvement efforts are conducted Quality Indicator Systems: AHRQ National Healthcare Quality Report National Quality Forum (NQF) National Database of Nursing Quality Indicators® (NDNQI®) Quantitative approach to research - CORRECT ANSWER- -- systematic
- objective
- deductive
- generalisable
- numbers
- Cause & effect
- Fixed data gathering
- Uniform reporting style
- Hypotheses guide research
- Hierarchical Qualitative approach to research - CORRECT ANSWER- -- systematic
- subjective
- inductive
- not generalisable
- words
- Meaning, understanding
- Use of open ended questions
- Multiple reporting styles
