Download NS3118 Evidence Based Practice Exam With Complete Solutions. and more Exams Advanced Education in PDF only on Docsity!
NS3118 Evidence Based Practice Exam
With Complete Solutions
The classic scientific method has its intellectual roots in: - ANSWER B) Positivism The traditional scientific method is not characterized by which of the following attributes? A) Control over external factors B) Testing of hunches deduced from theory or prior research C) Systematic measurement and observation of natural phenomena D) Emphasis on a holistic view of a phenomenon, studied in a rich context - ANSWER D) Emphasis on a holistic view of a phenomenon, studied in a rich context A descriptive question that a qualitative researcher might ask is: A) What is the average intensity of this phenomenon? B) What are the dimensions of this phenomenon? C) How frequently does this phenomenon occur? D) What is the average duration of this phenomenon? - ANSWER B) What are the dimensions of this phenomenon? One of the criticisms of the scientific method is that it is overly: A) Logical B) Empirical C) Reductionist D) Deterministic - ANSWER C) Reductionist Which answer is false? Evidence-based practice differs from scientific research in that A) EBP should include patient's wishes B) EBP involves integrating clinical expertise C) EBP requires evaluation of research quality and applicability D) Inductive reasoning is not required for EBP - ANSWER D) Inductive reasoning is not required for EBP A researcher wants to study the process by which people make decisions about seeking treatment for infertility. The researcher's paradigmatic orientation most likely is: A) Naturalism B) Determinism
C) Positivism D) Empiricism - ANSWER A) Naturalism According to the Notes on Nursing foreword, which is the most important part of Nightingale's philosophy? A) Nurses should be religious B) The body should be allowed to heal itself C) The character of a nurse is more important than her/his clinical skills D) Nurses should be women - ANSWER B) The body should be allowed to heal itself Which of the following is not a persuasive device? A) illustration with personal account B) use of statistics C) clear, unambiguous writing D) emotive words or phrases - ANSWER C) Clear, unambiguous writing Which statement best describes trial and error? A) Information that passes from previous generations. B) Knowledge that comes from seeing, hearing, touching and doing something ourselves C) 'Hunch' or 'gut feeling' D) Trying out a successive number of ideas to solve a problem - ANSWER D) Trying out a successive number of ideas to solve a problem Complete objectivity is not possible due to difficulties with A) Awareness of cultural paradigms B) Unbiased sampling C) Clear definitions of population variables D) Inaccuracies in data measurement - ANSWER A) Awareness of cultural paradigms Naturalistic qualitative research typically: A) Attempts to control the research context to better understand the phenomenon being studied B) Involves deductive processes C) Involves gathering narrative, subjective materials D) Focuses on the idiosyncrasies of those being studied - ANSWER C) Involves gathering narrative, subjective materials A researcher is studying the effect of massage on the alleviation of pain in cancer patients. The study would be described as: A) Applied B) Basic C) Exploratory D) Descriptive - ANSWER A) Applied
C) Results D) Discussion - ANSWER A) Introduction Which answer is false? A) Randomised controlled trials are the best form of research into interventions because they are less subject to bias than non-experimental studies B) Randomised controlled trials are accurate because they are representative of the population C) Randomised controlled trials are most likely to be able to determine causation D) Randomised controlled trials are widely applicable because variation is reduced - ANSWER D) Randomised controlled trials are widely applicable because variation is reduced The measure of central tendency that is most influenced by outliers is the: A. Mean B. Median C. Mode D. They are all equivalent - ANSWER A) Mean Steps generally employed in the analysis of qualitative data include all of the following, except: A. Developing a coding scheme B. Searching for themes C. Validating themes D. Testing hypotheses - ANSWER D) Testing hypotheses What should researchers do to verify transcription accuracy? A. Transcribe the data themselves B. Listen to the audiotapes as they are reading the transcriptions for accuracy C. Use a word processor's spell-check and grammar-check program D. Ask all study participants to review the transcriptions for accuracy - ANSWER B) Listen to the audiotapes as they are reading the transcriptions for accuracy The use of inferential statistics permits the researcher to: A. Interpret descriptive statistics B. Describe information obtained from empirical observation C. Draw conclusions about a population based on information gathered from a sample D. Estimate risk and relative risk - ANSWER C) Draw conclusions about a population based on information gathered from a sample
Which of the following terms is most controversial to define for qualitative research? A. Auditability B. Credibility C. Validity D. Transferability - ANSWER C) Validity A parameter is a characteristic of a: A. Population B. Frequency distribution C. Sample D. Normal curve - ANSWER A) Population In the study presented by Cate Nagle of the effects of alcohol consumption during pregnancy on offspring facial features, maternal obesity is likely to be a A. Confounding factor B. Mediating factor C. Modifying factor D. All of the above - ANSWER C) Modifying factor A member check involves reviewing data with: A. An external auditor B. A study participant C. A peer of the researcher D. A second member of the research team - ANSWER B) A study participant Which of the following statements is true? A. The results of statistical testing have direct meaning B. Support of a researcher's hypothesis through statistical testing offers proof of its veracity. C. A correlation between two variables indicates that the independent variables caused the dependent variable. D. Evaluating the credibility of a study typically involves a careful assessment of methodologic decisions - ANSWER D) Evaluating the credibility of a study typically involves a careful assessment of methodologic decisions The process referred to as constant comparison involves: A. Comparing two researchers' interpretation of the data B. Comparing data segments against other segments for similarity and dissimilarity C. Comparing data from the study with data and categories from other, similar studies
d) Antidepressant use - ANSWER d) Antidepressant use The independent variable in the research question, "What is the effect of nurse handling on blood pressure fluctuations in neonatal patients?" is: a) Nurse handling b) Blood pressure c) Neonatal patients d) There is no independent variable - ANSWER a) Nurse handling Which statement is false? Confidence intervals can give you an indication of a) Whether there is a statistically significant effect b) Whether there is a clinically significant effect c) The variability of the data d) The precision of the population estimate - ANSWER b) Whether there is a clinically significant effect In the study about the effect of skin to skin contact between fathers and neonates by Chen, Gau, Liu & Lee (2017), which variable did NOT have the potential to confound the results? a) Mode of birth (caesarian/vaginal) b) Paternal education c) Method of feeding (ie breast/bottle) d) Paternal smoking habit - ANSWER d) Paternal smoking habit This study is classified at which level of the NHMRC evidence hierarchy? a) Level I b) Level II c) Level III- d) Level III-2 - ANSWER b) Level II Evaluate the applicability of this study to the Australian Health context (ratings from NHMRC, 2009) a) Directly applicable to Australian healthcare context b) Applicable to Australian healthcare context with few caveats c) Probably applicable to Australian healthcare context with some caveats d) Not applicable to Australian healthcare context. - ANSWER c) Probably applicable to Australian healthcare context with some caveats Guidelines must include all of the following except: a) Rigorous evidence based best practice suggestions b) Recommendations for choosing between options for the management of a condition or health issue c) Decision aids to use with patients d) Current research - ANSWER c) Decision aids to use with patients
In the JBI Grades of recommendation, Grade B evidence is defined as: a) Moderate support that warrants consideration of application b) Moderate support that merits application with consideration to context c) Moderate support that merits application with few caveats d) Strong support that warrants application with consideration to context - ANSWER a) Moderate support that warrants consideration of application Which of the following would not be a current priority for clinical nursing research? a) Health promotion b) Prevention of illness c) Nurses' personalities d) Pain management - ANSWER c) Nurses' personalities The AGREE II tool recommends 2-4 appraisers because... a) Reviewers may be biased so multiple reviewers will give a fairer appraisal b) Judgement is required in assigning scores, so slight variation in scores is expected c) One reviewer may make a mistake, this will be detected by other reviewrs d) All of the above - ANSWER b) Judgement is required in assigning scores, so slight variation in scores is expected In calculating overall scores for a guidelines with the AGREE II tool a) Domain scores are kept separate as they are independent items b) Domain scores are aggregated to provide a single summary measure - ANSWER a) Domain scores are kept separate as they are independent items Which of the following studies are mostly likely to be based on quantitative research) A) A study measuring the effects of sleep deprivation on patients healing b) A study examining the bereavement experiences of children with cancer c) A study exploring the factors that influence illegal drug taking behaviours d) A study examining patient's feelings after traumatic amputation of a limb - ANSWER a) A study measuring the effects of sleep deprivation on patients healing In the JBI Best practice information sheet on Children's experiences of postoperative pain management advice did not suggest that a) Children should be engaged as active participants in the management of their pain b) Nurses should provide parents with information about pain management c) Parents can use non-pharmacological pain relieving strategies with children
c) The failure of hospitals and other organizations to reward nurses for EBP efforts or to give them adequate release time d) The inadequate preparation of many nurses for critically evaluating nursing studies - ANSWER b) The absence of clinically relevant nursing studies Which statement is true? a) Being able to assess the relevance of the literature about a given topic is more important than that literaure'smerit and applicability b) Assessing the quality of the literature is not as critical as ensuring that you find all of the available information c) One of the most important activities in evidcen-based practice is locating the best evidence to inform clinical practice d) One key to amassing targeted evidence is to be skilled not at defining the clinical question but rather at being able to search the literature efficiently - ANSWER c) One of the most important activities in evidcen-based practice is locating the best evidence to inform clinical practice What is the process of incorporating research findings into clinical practice called? a) Research utilisation b) Research translation c) Conceptualisation of research d) Commonsense use of research - ANSWER b) Research translation What is research literacy? a) One way flow of knowledge from researchers to potential users b) Development of knowledge through research c) Development of the skills needed to conduct research d) The capacity to find, understand and apply research - ANSWER d) The capacity to find, understand and apply research There are many barriers to the utilisation of research. Which of the following is not a barrier? a) There is little time during clinical practice to research the literature b) Nurses often lack confidence with regard to accessing and evaluating research c) The conflicting recommendations from literature, guidelines and policy can be difficult to reconcile d) Research often fails to change clinical practice - ANSWER d) Research often fails to change clinical practice What is the first step in formulating an evidence-based question? a) Looking at current clinical practices and outcomes that you think are in need of change.
b) Speaking to a nurse in charge to identify an area of clinical practice that he or she thinks should be changed c) Getting a team of nurses together to work on a problem area of clinical practice d) Having the support of your colleagues to identify an area of clinical practice that is in need of change - ANSWER a) Looking at current clinical practices and outcomes that you think are in need of change. Evidence-based practice requires you to do which of the following? a) Define the parameters of your clinical practice topic, obtain the assistance of colleagues to investigate it, make recommendations for change based on the literature and evaluate the effects of the change that is implemented. b) Develop a broad question around the clinical practice topic to be investigated, conduct a search of the literature, report findings and implement the change. c) Formulate a specific question, perform a systematic search and critique of literature, develop a change in clinical practice where indicated and evaluate the effects of that change. d) Undertake a quick search of the literature that addresses a clinical practice, report the findings to your colleagues and together develop new ways of clinical practice that will improve patient outcomes. - ANSWER c) Formulate a specific question, perform a systematic search and critique of literature, develop a change in clinical practice where indicated and evaluate the effects of that change. Which of the following do you need to do to implement a change to clinical practice? a) Identify your colleagues' level of support for the suggested change before you start. b) Obtain the support of your colleagues and administration c) Have plenty of time to convince administration of the merits of the change. d) Resist pressure from your colleagues to not 'rock the boat'. - ANSWER d) Resist pressure from your colleagues to not 'rock the boat'. Which of the following is a key point to consider when using research to inform your clinical practice? a) The research should always define the clinical problem and state what is to be done to improve clinical practice. b) The research must always use language and methods of investigation that you can understand and the implications for clinical practice should always be clearly stated. c) The research must explain exactly how clinical practice can improve patient outcomes.
c) People who do not speak English d) Paediatric patients - ANSWER d) Paediatric patients Which statement is false? a) Before undertaking research the researcher must be mindful of the ethical standards for research. b) The researcher has the right to decline the withdrawal of the participant c) Informed consent ensures participants are not deceived in any way d) If a researcher has a relationship with a participant, the researcher must provide the participant with the opportunity to give consent to another member of the research team. - ANSWER b) The researcher has the right to decline the withdrawal of the participant What is the over-riding principle governing ethical research behaviour? a) To protect research participants from harm b) To avoid dealing with sensitive topics c) To obtain the informed consent of the participants d) To preserve the anonymity of participants - ANSWER a) To protect research participants from harm Which statement best describes vulnerability in respect to research participants? a) Someone who has a mental illness b) Someone who has a child c) Someone with diminished capacity to give informed consent or not completely free to give consent d) An older adult - ANSWER c) Someone with diminished capacity to give informed consent or not completely free to give consent If a researcher unobtrusively studies interactions among patients in a psychiatric hospital, which ethical principle may be violated? a) All of the below b) Confidentiality c) Freedom from harm d) Right to self-determination - ANSWER d) Right to self-determination Dependent Variable: A dependent variable is what you measure in the experiment and what is affected during the experiment. The dependent variable responds to the independent variable. It is called dependent because it "depends" on the independent variable. In a scientific experiment, you cannot have a dependent variable without an independent variable. - ANSWER Example: You are interested in how stress affects heart rate in humans. Your independent variable would be the stress and the dependent variable would
be the heart rate. You can directly manipulate stress levels in your human subjects and measure how those stress levels change heart rate. An independent variable is a variable that is manipulated to determine the value of a dependent variable s. The dependent variable is what is being measured in an experiment or evaluated in a mathematical equation and the independent variables are the inputs to that measurement. - ANSWER Here's a simple example: A teacher wishes to compare the number of tardy students wearing black with the number of tardy students wearing pink. In this scenario, clothing color is the independent variable and the difference in the number of students, categorized by clothing color, is the dependent variable. Constructivism Research Philosophy. - ANSWER "Constructivism is the recognition that reality is a product of human intelligence interacting with experience in the real world. As soon as you include human mental activity in the process of knowing reality, you have accepted constructivism" Davis Elkind. Constructivism Research Evidence-based practice - ANSWER Evidence-based practice acknowledges that it involves the integration of the best research evidence with clinical expertise and the patient's values and circumstances. 'The three pillars' 1. The best available evidence 2. Patient values 3. Clinician experience Qualitative research - ANSWER Qualitative research that focuses on patients' (and health professionals') experiences, behaviours and concerns, A phenomenological research approach values human perception and subjectivity and seeks to explore what an experience is like for the individual concerned. Quantitative research - ANSWER Quantitative research methods emphasize objective measurements and the statistical, mathematical, or numerical analysis of data collected through polls, questionnaires, and surveys, or by manipulating pre-existing statistical data using computational techniques. Over time. Mixed Methods - ANSWER Mixed Methods- In general, mixed methods research represents research that involves collecting, analyzing, and interpreting quantitative and qualitative data in a single study or in a series of studies that investigate the same underlying phenomenon. Non-experimental research - ANSWER Non-experimental research is the label given to a study when a researcher cannot control, manipulate or alter the predictor variable or subjects, but instead, relies on interpretation, observation or interactions to come to a conclusion.
based on that hypothesis. 4.Testing our predictions - measuring data of samples P.I.O - ANSWER P.I.O-Population/Patient, Intervention/exposure, Outcome (Qualitative) A blind or blinded-experiment - ANSWER A blind or blinded-experiment is an experiment in which information about the test is masked (kept) from the participant, to reduce or eliminate bias, until after a trial outcome is known. ... If both tester and subject are blinded, the trial is called a Double- blind experiment. Reducing Bias - ANSWER Reducing Bias-Randomization is a true estimate of a sample of a population - Uses a Treatment Group and Control Group. If not Random then there will be a Systematic Error as the participants could have be placed into a specific group (Systematic Error can be caused by using a group in one place rather that general population) Double-blind experiment. - ANSWER If both tester and subject are blinded, the trial is called a Double-blind experiment. Instrument - ANSWER Instrument The intervention, Test, Drug, survey etc. Relative risk - ANSWER Relative risk, risk ratio (risk of event for treatment/control Parsimony - ANSWER Parsimony-Adoption of the simplest assumption in the formulation of a theory or in the interpretation of data, especially in accordance with the rule of Ockham's razor. Hypothesis - ANSWER Hypothesis- possible relationship between the variables in the observation. Hypothesis by measuring and examining a random sample of the population being analyzed. Summary measures - ANSWER Middle Measures Content analysis - ANSWER Content analysis is quantitative, CONSORT - ANSWER CONsolidated Standards Of Reporting Trials. MeSH - ANSWER -Medical Subject Headings Hierarchy of evidence - ANSWER Hierarchy of evidence • Numerous • NH&MRC (1999) widely recognised IV Case series III-3 Comparative studies (no control)
III-2 Cohort studies or case-control studies III-1 Pseudo-randomised controlled trial(s) II Randomised controlled trial(s) I Systematic review or meta-analysis Key principles for developing guidelines - ANSWER There are nine basic principles for developing guidelines. Guideline development - ANSWER Guideline development - When selecting guideline topics, there must be a clear problem or concern that would be redressed if guidelines were developed Document, Describe, Identify, Detail, Ensure, Describe the support services, Include information, for consumers and clinicians, Compare the costs associated, Provide a statement of the scientific basis of creation, Document the uncertainty, Document the economic appraisals An evidence based clinical practice guideline - ANSWER An evidence based clinical practice guideline has been systematically developed based on the best available scientific evidence and the evidence base for the recommendations has been documented. While all NHMRC approved guidelines are based on the best available scientific evidence this category is used on the Portal to differentiate evidence-based guidelines from those which are not considered evidenced based, and not approved by the NHMRC. Clinical practice guidelines - ANSWER Clinical practice guidelines are evidence-based statements that include recommendations intended to optimise patient care and assist health care practitioners to make decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines should assist clinicians and patients in shared decision making. Developed by multidisciplinary experts and key stakeholders. Systematic review of evidence. Transparent process. Cover alternative care options. Recommendations: rate strength of evidence. Current - Written about single conditions in isolation. An NHMRC approved clinical practice guideline - ANSWER An NHMRC approved clinical practice guideline has been approved by the NHMRC Chief Executive Officer under Section 14A of the National Health and Medical Research Act 1992 (the NHMRC Act). By granting approval NHMRC is satisfied that these guidelines are based on the systematic identification and synthesis of the best available scientific evidence, and make clear recommendations for health professionals practising in an Australian health care setting. The NHMRC Act requires that all NHMRC approved guidelines must undergo public consultation. The purpose of the AGREE II - ANSWER The purpose of the AGREE II, is to provide a framework to: 1. Assess the quality of guidelines; 2. Provide a
Data collected destroyed if possible. Privacy (Privacy act, principle of respect) (patient information, storage, de-identification, pseudonyms pooling of data, Informed consent regarding invasion of privacy) Confidence Interval - ANSWER Confidence Interval The group in question and the % indicates likelihood of success, I.E. 95% versus 10% is 5 step model - ANSWER 5 step model -
- Translation of uncertainty to research question 2. Search and retrieval of evidence
- Critical appraisal of evidence for validity, clinical relevance and applicability
- Application of appraised evidence to practice, relevant implementation
- Evaluation of performance and effectiveness Barriers to research translation - ANSWER •Time - Allocate yourself a small amount of time on a regular basis to persue research literature on your area of clinical practice. •Lack of confidence, expertise, interest - Access the hospital library •Time lags within research eg ethics •Publication time lags - Make a list of journals that regulaly contain research articles relevant to your clinical area of interest •Lack of critical approach - Develop a list of authorative websites, search engins and professional journals that fit with your area of clinical practice •Complex organizational issues. - C.A.S.P - - ANSWER Critical Appraisal Skills Programme - Qualitative What is involved in critically appraising evidence - ANSWER What is involved in critically appraising evidence 1.Convert your information needs into an answerable clinical question.
- Find the best evidence to answer your clinical question. 3.Critically appraise the evidence for its validity, impact and applicability. Integrate the evidence with clinical expertise; the patient's values, preferences and circumstances; and information from the practice context. 4.Evaluate the effectiveness and efficiency with which steps 1-4 were carried out,and think about ways to improve your performance of them next time.
- Internal validity-This refers to whether the evidence is trustworthy. That is, can you believe the results of the study?
- Impact-If you decide that the validity of the study is sufficient that you can believe the results, you then need to look closely at those results.
- Applicability-If you have decided that the validity of the study is adequate and that the results are clinically important,
- The final step of critical appraisal is to evaluate whether you can apply the results of the study to your patient. C.A.S.P - Q1. - ANSWER 1.Was there a clear statement of the aims or the research, • What was the goal of the research? • Why it was thought important? • Its relevance C.A.S.P - Q2 - ANSWER 2. Is a qualitative methodology appropriate? • If the research seeks to interpret or illuminate the actions and/or subjective experiences of research participants • Is qualitative research the right methodology for addressing the research goal? C.A.S.P - Q3 - ANSWER 3. Was the research design appropriate to address the aims of the research? • If the researcher has justified the research design (E.g. have they discussed how they decided which method to use)? C.A.S.P - Q4 - ANSWER 4. Was the recruitment strategy appropriate to the aims of the research? If the researcher has explained how the participants were selected • If they explained why the participants they selected were the most appropriate to provide access to the type of knowledge sought by the study • If there are any discussions around recruitment (e.g. why some people chose not to take part) C.A.S.P - Q5 - ANSWER 5. Was the data collected in a way that addressed the research issue? If the setting for data collection was justified • If it is clear how data were collected (e.g. focus group, semi-structured interview etc.) • If the researcher has justified the methods chosen • If the researcher has made the methods explicit (e.g. for interview method, is there an indication of how interviews were conducted, or did they use a topic guide)? • If methods were modified during the study. If so, has the researcher explained how and why? • If the form of data is clear (e.g. tape recordings, video material, notes etc) • If the researcher has discussed saturation of data C.A.S.P - Q6 - ANSWER 6. Has the relationship between researcher and participants been adequately considered? If the researcher critically examined their own role, potential bias and influence during (a) Formulation of the research questions (b) Data collection, including sample recruitment and choice of location • How the researcher responded to events during the study and whether they considered the implications of any changes in the research design
