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Evidence Based Practice Exam 1
Evidence Based Practice - Answer -Conscientious, explicit, & judicious use of theory derived, research based information in making decisions about care delivery to individuals or groups of patients & in consideration of individual needs & preferences (of patient and clinician) Improve patient outcomes, improve cost effectiveness, allow practice to continue to improve, improve level of satisfaction in those who deliver care - Answer -What are the benefits of EBP? Lack of time Lack of value placed on research in practice Lack of knowledge about EBP & research Lack of technological skills to find evidence Lack of resources to access evidence Lack of ability to read research Resistance to change Lack of organizational support for EBP - Answer -What are barriers to EBP?
Qualitative - Answer -Studies Phenomena in context Focus on Meanings, Patterns, Themes Natural setting Researcher directly involved Flexible design Researcher is "Tool" Quantitative - Answer -Studies discreet & selected variables Focus on Measurement Artificial setting Researcher detached, objective Fixed design Precise tools control variables B. What effect does room temperature have on the colonization rate of bacteria in urinary catheter?? D. Does therapeutic touch affect the vital signs of hospitalized patients? - Answer -Which of the following would need to be studied using quantitative methods? Select all that apply. A. What is the decision making process of HIV+patients seeking treatment? B. What effect does room temperature have on the colonization rate of bacteria in urinary catheter? C. What are the sources of stress among nursing home residents? D. Does therapeutic touch affect the vital signs of hospitalized patients? Qualitative Studies - Answer -Smaller sample size Data consists of in-depth interviews, participant observation, diaries, etc. Describe the experience Quantitative Studies - Answer -Larger sample size
C. Nurse's lack of time is the most frequently cited reason for not searching for research findings. D. Most nursing research findings are used in practice soon after they are published. Sampling - Answer -Process of selecting representative units of a population for a study in a research investigation Population - Answer -Well defined set that has certain specified properties Eligibility (inclusion/exclusion) criteria - Answer -Attempt to control extraneous variables Defines the population of interest Inclusion criteria—characteristics necessary to be in the study Exclusion criteria—characteristics that would make someone ineligible for the study Target Population - Answer -Group researcher would like to generalize to Established by the eligibility criteria Accessible Population - Answer -Those readily available to the researcher. Sampling unit - Answer -Element of population Non probability Sampling - Answer -Convenience Sampling Quota Sampling Purposive Sampling Theoretical Sampling Convenience Sampling - Answer -Most readily accessible persons or objects Easy to obtain Risk of bias is great
Threat to generalizability Most common Quota Sampling - Answer -Identified strata of the population Proportions of elements needed determined Recruit subjects until each strata filled Enhances representativeness of sample Purposive Sample - Answer -Researcher uses knowledge of population to hand pick cases Risk of bias is great Often used in qualitative designs Snowball or network sampling Theoretical Sampling - Answer -Only in grounded theory. Just for theory Probability Sampling - Answer -Simple Random Stratified Random Sample Cluster Sampling Systemic Sampling Simple Random - Answer -Need sampling frame (list, have to have!) -Actual list of population elements Subjects randomly chosen -Table of random numbers, etc. Time consuming & inefficient NOT the same as random assignment to group under design Stratified Random Sample - Answer -Strata developed as in quota sampling Random selection of subjects
Response rates - Answer -What are problems with sampling? Nursing Research problem - Answer -An area of concern when there is a gap in knowledge that requires a solution that can be described, explained or predicted to improve nursing practice. Consists of information as originally written - Answer -Primary Source Someone else's description of a primary source - Answer -Secondary Source Measurable characteristic that varies among subjects being studied - Answer -Variable Often proposes relationship between variable - Answer -Purpose statement of quantitative research Variable that has presumed effect on dependent variable. -In experimental studies manipulated by researcher. -In non experimental studies not manipulated. - Answer -Independent variable Consequence or presumed effect -It is not manipulated - Answer -Dependent variable general meaning of the concept, reflects theory used - Answer -Conceptual Definition how variable will be measured -Found in instruments or measures section of article - Answer -Operational definition Mediators - Answer -Extraneous variables that come between the independent and dependent variable. Necessary to complete the cause and effect link between independent and dependent variable
Moderators - Answer -Extraneous variables that affect the direction or strength of the relationship between independent and dependent variables Confounding Variables - Answer -Factors that interfere with or distort the relationship between the independent and dependent variables Tells how researcher thinks the study will go - Answer -Directional hypothesis Tells just that there is a relationship between the variables - Answer -nondirectional hypothesis Backward in time, qualitative design - Answer -Retrospective Forward in time, experimental, quasi experimental - Answer -Prospective Design Give survey and research done in one day - Answer -cross sectional Give and then keep giving survey year after year - Answer -longitudinal hybrid, following people in time but only for a short time - Answer -repeated measures History Maturation Testing Instrumentation Mortality Selection Bias - Answer -What are threats to internal validity? History - Answer -Events that take place concurrently with the introduction of the independent variable -Can affect the dependent variable
Experimenter Reactivity - Answer -Researchers who have expected or desired outcomes may affect how research is conducted Effects of Selection - Answer -Is sample representative of population? Sample is not random Interaction of treatment and selection - Answer -Can only generalize results to those who do have similar characteristics. Convenience samples limit generalizability Interaction of treatment of setting - Answer -Can results from an intervention in one setting be generalized to another setting when the same intervention is used Interaction of treatment of history - Answer -Can results of the study be generalized to different period in the past or future?
- Systemic Reviews, Meta-Analysis, EBP Guidelines
- Randomized Controlled Trials
- Controlled Trials without Randomization
- Cohort Studies or Case Control Studies
- Evidence from Systemic Reviews of Descriptive Studies
- Evidence from Single Descriptive or Qualitative Studies
- Evidence from the Opinion of Authorities and/or Reports of Expert Committees - Answer -What are the levels of evidence? Experimental Designs - Answer -Researcher actively brings about desired effect. Causality Causality - Answer -Causal variable & effect variable must be associated with each other Cause must precede effect
Relationship must not be explainable by another variable Random assignment to group Control Manipulation - Answer -What are the identifying properties of experimental designs? True or classic experimental design Solomon four group design After only or posttest only design Randomized Controlled Trial - Answer -What are the types of experimental designs? Mortality, testing - Answer -What are the risk to internal validity of true or classic experimental design? Mortality, need a lot of people - Answer -What are the risks for internal validity of Solomon four group design? do not know if groups were similar before because there was no pretest - Answer -What are the risks for internal validity of after only or posttest only design? Randomized Controlled Trial - Answer -What is the gold standard for interventions/treatments? Single Blind - Answer -Researcher knows who got the drug and the patient doesn't know. Double Blind - Answer -No one knows who received the drug or placebo. Quasi-experimental Designs - Answer -Full experimental control is not possible. Lack either a random assignment or control group Weakened confidence in making causal assertions Threats to internal validity
-test new hypotheses -explore new relationships between variables -create new insights Advantage—avoids costly data collection Disadvantage—"stuck" with data as they are Meta-Analysis - Answer -Uses findings from several studies to create a data set Variables must be measured/ defined in a similar way This data set then analyzed as a single piece of data Used to integrate knowledge Randomized Control Trials - Answer -What design works best for therapy, diagnosis, or prevention questions? Cohorts or Case Control - Answer -What design works best for prognosis or etiology questions? Survey - Answer -What design works best for meaning questions? Likert Scale Semantic Differential Scale Visual Analogue Scale (VAS) - Answer -What are the different scales? Consistency - Answer -Data collected from each subject in the study in the same way or as close to the same way as possible Reliability - Answer -The extent to which the instrument yields the same result on repeated measures. Expresses in terms of a correlation coefficient between 0- -The closer to 1 the score is the more reliable the instrument -If do not give coefficient then it is a weakness in the research.
Test-retest reliability - Answer -Same results are obtained on repeated administration of an instrument Kuder-Richardson (KR-20) Cronbach's alpha - Answer -What measures internal consistency? at least 0.80 - Answer -What should Cronbach's alpha be for well established tools? At least 0.70 - Answer -What should Cronhach's alpha be for newly developed tools? Equivalence - Answer -Consistency among observers, interrater reliability Cohen's kappa At least 0. Validity - Answer -Degree to which an instrument measures what it is supposed to be measuring RELIABLE - Answer -A tool must be what to be valid? Content (face) validity - Answer -Measures the universe of the content Panel of experts Has the least weight in research, but is easiest to evaluate. Criterion related validity - Answer -Degree to which subjects' performance on tool & actual performance are related Concurrent Predictive Coefficient calculated between 0- Construct Validity - Answer -Extent to which an instrument measures a theoretical construct
Variance Standard deviation -68-95-99. -Weakness of study if they do not give standard deviation when they give you the mean. Type I error - Answer -rejection of null hypothesis when it is actually true usually considered more serious in practice discipline Type II error - Answer -acceptance of null hypothesis which is actually false Significance - Answer -P Value Percentage of time result would have happened by chance alone
- probability of making a Type I error at least p< 0.05 - Answer -What should the p value be for significance? confidence intervals - Answer -Range of values for a variable of interest constructed so that this range has a specified probability of including the true value of the variable 95% confidence interval - Answer -What is the usual confidence interval? Sample size Spread in the data - Answer -What are factors that affect confidence intervals? Smaller the range (without zero in it) - Answer -When can we be more confident in our confidence intervals? Parametric - Answer -Focus on population characteristics Interval scale Assumes normal distribution
Nonparametric - Answer -Less restrictive assumptions Use with nominal & ordinal data T-test - Answer -Difference of mean between 2 groups Correlation--Pearson's R - Answer -Coefficient correlation between -1.0 (one goes up the other goes down) and 1.0 (if one goes up the other goes up & vice versa) Indicates association NOT cause ANOVA - Answer -Difference in means of 3 or more groups Chi-square - Answer -Category frequency Regression - Answer -Measures how much 2 or more independent variables explain the variation in a dependent variable Allows us to predict future values of the DV based on values of the IV R2 = how much of the variation is explained by the variable Speculation - Answer -The process of reflecting on the results of a study and offering some explanation for them Alternative explanations for findings Rationale for the author's judgments about the best explanation Research designs - Answer -Direct the sampling and data collection processes Provide a plan to answer the research question Provide the structure to ensure the rigor and validity of the results of the study Researcher is data collection instrument -Attempts to keep personal opinions contained at the beginning
Data obtained from informants -Small purposive sample most common -Saturation or data redundancy sets size -Open ended, multiple interviews of the same person - Answer -How is data obtained in phenomenology? themes, identify exemplars and paradigm cases - Answer -what does phenomenology look for? Exemplars - Answer -cases that identify meaning of situation Paradigm cases - Answer -strong examples of patterns of meaning Hermeneutic analysis - Answer -Text analysis -The meaning is in the metaphor Grounded Theory - Answer -Basis is sociology -Symbolic interactionism Derive a theory about basic social processes -What is the process of____________? -What is the chief concern or problem of people in this area? -What accounts for most of the variation in processing the problem? Through interview or observation - Answer -How is data collected in grounded theory? Constant comparative analysis - Answer -in grounded theory: Data gathering & analysis proceed simultaneously (start analysis with the first interview which gives the direction with the other interview) Gathered data can determine direction of questioning or sampling
Coding of data to find categories -Look for Core category -Other categories are causal categories, strategies, consequences Often results in schematic drawing -Ideally, outcome is a theory - Answer -How is grounded theory data used? Ethnography - Answer -Basis is cultural anthropology Scientific descriptions of cultural groups -Researcher enters world of study participants Goal is to examine native's view—epic view Questions about patterns of behavior in a social context Through participant observation/interviews -Gaining access -Field notes -Ethical issues Data collected & analyzed simultaneously -Search is for Domains -Analysis of contrasts between categories - Answer -How is data collected in ethnography? Historical Method - Answer -Understand past through collection, organization & critical appraisal of facts Basis is philosophy, art & science Data from primary sources & secondary sources Primary Sources - Answer -Written records, life history from individual Secondary Sources - Answer -Newspaper articles, descriptions by others
