Nursing Research Ch 15 16 – Flashcards
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CHAPTER 15
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Weighing in on the Evidence
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deciding what to do
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-adoption -rejection --active rejection --passive rejection -uncertainty -pilot
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adoption
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applying an innovation to a practice
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rejection
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decision not to adopt an innovation
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uncertainty
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degree to which alternatives are perceived relative to the occurence of an event and the probability of these alternatives
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pilot
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small study to test a new intervention with a small number of subjects before testing with larger samples; adopting an innovation on a trial basis
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active rejection
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purposefully deciding not to adopt an innovation
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passive rejection
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lack of consideration given to adopting an innovation; hence, old practices are continued
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appraising the evidence does the study provide good evidence?
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-quantitative designs --meta-analysis --randomized controlled trials (RCTs) --cohort studies --case control studies --descriptive studies -qualitative designs
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meta-analysis
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scholarly papers that combine results of studies, both published and unpublished, into a measurable format and statistically estimate effects of proposed intervention
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randomized controlled trials
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experimental studies that typcially involve large samples and are conducted in multiple sites
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cohort studies
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quasi-experimental studies using two or more groups; epidemiological designs in which subjects are selected based on their exposure to a determinant
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case control studies
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type of retrospective study in which researchers begin with a group of people who already had the disease; studies that compare two groups: those who have a specific condition and those who do not have the condition
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descriptive studies
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nonexperimental studies used to provide information about a phenomenon
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ranking the evidence
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-evidence hiearchies -levels of evidence -systematic reviews -GRADE
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evidence hiearchies
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predetermined scales that guide decisions for ranking evidence; levels of evidence
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levels of evidence
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predetermined scales that guide decisions for ranking evidence; evidence hierarchies
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(AHRQ) Agency for Healthcare Research and Quality
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improve quality, safety, efficiency, and effectiveness of healthcare 1. quality: the aggregate of quality rating for individual studies, predicted on the extent to which bias was minimized 2. quantity: the magnitude of effect, numbers of studies, and sample size or power 3. consistency: for any given topic, the extent to which similar findings are reported using similar and different study designed
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US Prevention Services Task Force (USPSTF)
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A- strongly recommended B- recommends C- no recommendation for or against D- recommended against I- Insufficiet evidence to remend for or against
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systematic review
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rigorous and systematic synthesis of research findings about clinical problems
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GRADE
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grades of recommendations, assessment, development, and evaluation; international, universal system for evaluating evidence strength and quality of evidence: 1. high 2. moderate 3. low 4. very low recommendation 1. strong 2. weak p. 426
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???
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high = random control moderate = downgraded random control or upgraded observational low= observational study (cohort or case study) very low = all other studies (cased series/ case reports) limitations is the design and implementation of available studies imprecision = few participants adn few evetns, and thus have wide confidence intervals publication bias =
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decision to change practice
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-relevance of evidence for practice -consistency in findings across studies -sample characteristics in a significant amount of studies are similar to those to which the finding will be used -consistency among evidence from research and other non-research evidence -feasibility for use in practice -the risk/benefit ratio (potential harm/ benefit)
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table 15-1 five step approach for evidence based nursing practice
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p. 419
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table 15-2 questions to consider when appraising nursing studies
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p. 420-421
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table 15-3 common clinical questions
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p. 427
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table 15-4 Definitions of Clinically SIgnifiicant Statistics
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p. 427
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clinical practice guidelines: moving ratings and recommendations into practice
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-clinical practice guidelines -appraisal of guidelines research and evaluation (AGREE II)
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clinical practice guidelines
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recommendations based on evidence that serve as useful tools to direct clinical practice
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AGREE II
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internationally developed instrument to evaluate clinical practice guidelines
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FYI CPGs
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various professional associations and other clinical entities have developed CPGs to be used in practice setting; CPGs will continue evolving because of the momentum generated by EBP, and they will become more available because of the increased capacity to search the literature through computerinzation
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tble 15-5 domains of quality in the AGREE II instrument
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1. scope and purpose of guidelines 2. stakeholder involvement 3. rigor of development 4. clarity and presentation 5. applicability 6. editorial independence
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keeping it ethical
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-recognize that there are no perfect studies -examine evidence within context of question -incorporate several sources of information at the beside -ask evidence based questions -evaluate generalizability -consider needs and values of population -note any conflict between agency policy and evidence
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CHAPTER 16
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Transitioning Evidence to Practice
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Evidence based practice model
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-florence nightingale -conduct and utilization of research in nursing (CURN) -stetler model -iowa model
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CURN
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early study conducted about how nurses transition research findings into practice p. 440
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stetler model
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step-by-step instructions for integrating research into practice p. 441
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iowa model for EBP to promote quality care
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syteamtic method explaining how organization change practice p. 445
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table 16-1 Stetler Model of Research Utilization to facilitate EBP
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p. 442-443
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barriers to connecting research and practice
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factors that limit or prevent change -organizational culture -nursing quality indicators -nurse's belief systems related to practice p. 448 -research related barriers p. 448
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organizational culture
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1. adequate resources for research activities 2. support and encouragement for inquiry 3. expectation for staff to engage in research activites -nursing quality indicators
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nursing quality indicators
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outcomes of nursing care, identified by the ANA, that address patient safety and quality of care -patient satisfaction with pain management -patient satisfaction with educational information -patient satisfaction with overall care -patent satisfcation with nursing care -mix of RNs, licensed practical nurses (LPNs), and unlicensed nursing stafff caring for patients in acute care settings -total nursing care hours provided per patient day -pressure ulcers -patient falls -hospital acquired infection rate -nursing staff satisfaction
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creating change
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-reframing -what is change? -engaging others in change --assessment practice environment --journal club --disciplined clinical inquiry model -making change happen -stakeholder involvement
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change
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process that creates an alteration in a person or environment
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FYI change
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just as nurses need to understand the barriers to research utilization, they need to understand how change can affect EBP; one place to start when engaging others in transitioning to EBP is to conduct an assessment of the practice environment constant organizational change can be stressful, and never making any changes or making changes very slowly can also be frustrating; it is essential to identify strategies that make change desirable to others; an effective strategy is to implement changes in phases: establish urgency, create a coalition, develop a vision and strategy, communicate the vision, empower broad-based action, generate short-term wins, consolidate improvement and produce more change, and anchor new approaches
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journal club
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strategy for disseminating research among nurses by discussing articles in a small group
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disciplined clinical inquiry model
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model developing to empower nurses at the unit level, to transition evidence to practice
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change phases model
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an eight-phase process to describe organizational change
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table 16-1 Assesement of practice environment
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p. 451
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figure 16-3 disciplined clinical inquiry model
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p. 452
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figure 16-4 phases of change model
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p. 454
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table 16-2 stakeholder identification tool
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p. 457
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keeping it ethical
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-cost-benefit ratio --finance --time --personnel --patient preference --relationships -examine all aspects of any proposed change
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cost-benefit ratio
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comparison of benefits to potential costs that might result from change
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CHAPTER 17
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Developing Oneself as an Inovator
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innovator
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one who is willing to try new things
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leader
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one who takes the initiative for change and empowers others
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who is an innovator? innovator characteristics
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-sense of inquiry (curiosity) -flexibility to change -awareness of self and unit (world) -communication skills -critical thinking (involves critical appraisal of situation) -change agent (individual who leads) -self-awareness -socialization (informal/formal rules of behavior)
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FYI innovator
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one who is willing to try new things in practice, using evidence, to enhance the quality of patient care adn to foster nursing knowledge; evolving into an EBP leader on one's unit or practice area is a process that occurs with effort and time
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developing oneself
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engaging in activies that promote longterm professional growth and development -lifelong learning -developing on the job -developing team leadership skills -professionalism
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lifelong learning
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adding skills and knowledge bout profession as it continues to evolve
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mentor
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one who assists with professional growth
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developing on the job
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-ladder program -orientation --preceptors --role model --professionalism -personal development file -career -performance appraisal and reviews
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ladder program
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an organizational process for promotion and career advancement
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preceptors
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knowledgeable nurses who provide clinical orientation for new employees
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role model
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one who demonstrates desired characteristics and skills
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performance appraise and reviews
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-personal development file: compilation of career accomplishments -career development: experience and education that contribute to one's professional growth
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developing team leadership skills
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-establish interprofessional collaboration: engaging with other professional to provide EBP care -involve all unit members -organize common groups -identify change champion
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team leadership skills
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behaviors that collaboratively engage others while working toward a goal
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professionalism
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-models of professionalism --behavioral inventory for professionalism --wheel of professionalism in nursing
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behavioral inventory for professionalism
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measure of education and training, skill, ethics, professional organization, and service 1. education and training 2. skills based on theoretical knowledge 3. code of ethics 4. professional organization 5. service
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wheel of professionalism in nursing
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model depicting behaviors of professional nurse
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information overload
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state of an individual in which excessive communication cannot be processed or used
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figure 17-1 wheel of professionalism in nursing
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p. 477
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keeping it ethical
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-develop self-awareness -promote nursing profession -maintain ethical standards -build a personal development file -pursue opportunities for professional growth -give back to the profession
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FYI ethics
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nurses have the duty to give back to the profession; all nurses have a responsibility to assist novice nurses; EBP is more likely to thrive in environments where nurses feel supported and are provided with resources necessary to develop both personally and professionally
