Ch 5 Evidence-Based Practice – Flashcards
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Evidence from what 2 things provides a basis for nursing care?
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Research Opinions of experts
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What 3 things does evidence based practice challenge to obtain?
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The very best information The most current information Information at the right time, when you need it for patient care
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EBP is a problem-solving approach to clinical practice that integrates what 3 things?
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Conscientious use of best evidence Clinician's expertise Patient preferences and values in making decisions about pt care
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Without evidence-based practice, nursing would be a practice based solely on?
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Tradition
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EBP allows nurse to structure how to do what three things?
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Make: Accurate, timely, and appropriate clinical decisions
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EBP is a response to?
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societal forces
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EBP is what kind of approach to practice?
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problem-solving approach
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How many steps are there to EBP?
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6
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What is the first step to evidence based practice?
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Ask the clinical question
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What is the second step to evidence based practice?
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Collect the best evidence
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What is the third step to evidence based practice?
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Critique the evidence
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What is the fourth step to evidence based practice?
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Integrate the evidence
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What is the fifth step to evidence based practice?
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Evaluate the practice decision or change
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What is the sixth step to evidence based practice?
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Share the outcomes of EBP changes with others
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What 3 questions should you ask when critiquing evidence?
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Do the articles obtained offer evidence to explain the question? Is the evidence reliable and true? Can the evidence be used in practice?
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All articles should contain what 6 things?
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1) abstract, (2) introduction, (3) literature review or background, (4) manuscript narrative with purpose of statement and method/design, (5) results or conclusion, and (6) clinical implications
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What are ways to integrate evidence? Step 4
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Use evidence to: make new policy and procedure guide clinical practice develop new teaching assessment documentation tools
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Evaluation practice decision or change can be conducted on what sort of scale?
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A small or grand scale
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What should you do to enhance professional development and promote positive patient outcomes beyond the unit level?
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Share the results with various groups of nurses or other care providers such as the *nursing practice council* or the *research council*.
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What does the P stand for in PICOT?
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Patient population of interest
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What does the I stand for in PICOT?
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Intervention of interest
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What does the C stand for in PICOT?
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Comparison of interest
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What does the O stand for in PICOT?
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Outcome
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What does the T stand for in PICOT?
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Time
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How should you identify pt's according to PICOT?
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By: age gender ethnicity disease or health problem
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Give an example question for Intervention of interest
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Which intervention is worthwhile to use in practice?
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Give an example of question for comparison of interest
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What is the usual standard of care or the intervention used now in practice?
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Give an example of an outcome question
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What result do you wish to achieve or observe as a result of an intervention?
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Give an example of a time question
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How much time is needed for an intervention to achieve an outcome?
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The more ___ a PICOT question is, the easier it will become to ______ for evidence in the scientific literature
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Focused/specific Search
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_____ are a rich source of evidence because they use it frequently to build their own practice and solve clinical problems
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Expert clinicians
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The _________ includes determining the ______ ______ and ____ of evidence in making a practice change
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Critique or evaluation of evidence Value Usefulness Feasibility
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What should you do after critiquing all articles of a PICOT question?
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Synthesize or combine findings to consider the scientific rigor of the evidence and whether it has application in practice
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What offers a guide to the types of literature or information that offer the best scientific evidence?
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The hierarchy of available evidence
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The diagram of the hierarchy of evidence shows that
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stronger evidence is farther up the triangle
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What is the highest level of experimental research?
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A randomized controlled trial
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What do EBP articles include?
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Abstract Introduction Literature review or background Narrative (clinical or research) Purpose Methods or design Results and/or conclusion Clinical implications
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What is an abstract?
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A brief summary of the article that quickly tells you if it is *research* or *clinically* based. An abstract summarizes the purpose of the article.
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What does the introduction contain?
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Contains more information about the purpose of the article.
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A good author offers a what in their article?
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detailed background of the level of science or clinical information that is available on the topic.
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The _________ or narrative of an article differs according to what?
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Middle section Type of evidence-based article it is
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What are the 2 types of articles?
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Clinical or research
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A clinical article _____
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Describes a clinical topic, often including a description of a patient population, the nature of a certain disease or health alteration, how patients are affected, and appropriate nursing therapies.
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A research article contains _______
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contains *several subsections within the narrative*, including the following: A purpose statement explains the focus or intent of a study and includes hypotheses—predictions made about the relationship or difference between studies—and questions or variables—concepts, characteristics, or traits that vary within or among subjects.
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The methods or design explains
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how a research study was organized and conducted to answer the research question or test the hypothesis
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Clinical and research articles have a ___ section at the end
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summary section
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In a clinical article the author explains _______
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the clinical implications for the topic presented.
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In a research article, the author details ______
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the results of the study and explains whether a hypothesis is supported or how a research question is answered
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A research article includes a section that explains whether findings from the study have _________
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Clinical implications
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Analysis of Evidence Critiquing evidence involves ___
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evaluating it
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When critiquing evidence first ______
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evaluate the scientific merit and clinical applicability of the findings of each study
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Analysis of Evidence After evaluating the scientific merit and clinical applicability of the findings of each study you should
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Then using a group of studies and expert opinion, determine what findings have a strong enough basis for use in practice.
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What questions will you be able to answer after critiquing the evidence?
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Do the articles together offer evidence to explain or answer my *PICOT* question? Do the articles show *support* for the *reliability* and *validity* of the evidence? Can I use the evidence in *practice*?
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Integration of Evidence What should you consider when you decide to apply evidence?
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The setting Whether support is provided from staff and available resources
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What's the second thing you should do when integrating evidence?
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Evaluate the change
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What's the last thing you should do when integrating evidence?
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Share the information
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Evidence is integarted in a variety of ways through ______
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Teaching tools clinical practice guidelines policies and procedures new assessment or documentation tools
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What 2 things should you ask yourself after the change is implemented?
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How does the intervention work? How effective was the clinical decision for my patient or practice setting?
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When evaluating an EBP change what should you determine?
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Whether the change was effective If modifications in the change are needed If change needs to be discontinued
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When a practice change occurs on a nursing unit level, the first group to discuss the outcomes of the changes is often the ________
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Clinical staff on that unit
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True or false
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Clinicians enjoy and appreciate seeing the results of a practice change
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The practice change will more likely be sustainable and remain in place when
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staff are able to see the benefits of an EBP change
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Nursing Research The ______ supports the need for nursing research as a means of improving the health and welfare of people
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International Council of Nurses (ICN)
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Nursing Research Is a way to identify new _____
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Knowledge, improve professional education and practice, and use resources effectively
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The _____ supports nursing priorities for the nursing profession to guide research priorities for nursing profession and to guide research efforts of nurse scientists in those health care areas with the greatest need.
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International Council of Nursing
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Research is a _______ that asks and answers questions that generate knowledge, which provides a scientific basis for nursing practice.
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Systematic process
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Outcomes Management Research Designed to ____ the effectiveness of health care services and _____
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Assess and document Interventions
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Outcomes Management Research A response of the _________ to demands from ______ ________ and the ________
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Health care industry Policy makers, insurers, and the public
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Outcomes Management Research Outcomes must be _________ or ________
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Observable or measurable
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Care delivery outcomes are the ____ or _______ effects of some _____ or action
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Observable or measurable Intervention
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Although important outcomes to understand, commonly measured outcomes such as _______ do not always measure the true effect of a specific nursing intervention on care delivery.
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mortality
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What is the first step of the research process?
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Identify the problem
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Scientific method Is the ______ of research
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Foundation
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Scientific method The most ______ and _______ means of acquiring and conducting research and gaining knowledge.
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reliable and objective
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A step-by-step process to ensure that findings from a study are ______
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valid, reliable, and generalizable to a similar group of subjects
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The _______ is used in all professional areas.
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scientific method
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The scientific method _____ the chance that _____ by a researcher will influence the results of research and thus the knowledge gained
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minimizes bias or opinion
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Researchers try to control ________ that are _____ but can influence a relationship between the phenomena they are studying.
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external factors not being studied
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Researchers gather _______ through the use of ______ and ______ and use the data to discover new knowledge.
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empirical data observations and assessments
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Nursing and the Scientific Approach Nursing research provides a way for nursing questions and problems to be studied in _____ context
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broader
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Nursing research contains what 2 types of methods?
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Quantitative and qualitative
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Nursing and the Scientific Approach Quantitative types include:
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historical, exploratory, evaluation, descriptive, experimental, correlational
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Nursing and the Scientific Approach Quantitative approaches offer ________
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precise measurement p 58
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Nursing and the Scientific Approach ______ is the study of phenomena that are difficult to *quantify* or *categorize*; information is obtained from ______ or _______
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Qualitative research written transcripts or interviews
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Nursing and the Scientific Approach Qualitative research involves ________ to develop generalizations or theories from specific observations or interviews
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inductive reasoning
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The ______ is an orderly series of steps that allows a researcher to find the answer to a question
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Nursing and the Scientific Approach
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Research Process The research process consists of how many steps?
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5
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What are the 5 steps of the research process?
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Identify problem. Design study. Conduct study. Analyze data. Use the findings.
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Research is a ________ that asks and answers questions that generate knowledge, which provides a ______ for nursing practice.
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systematic process scientific basis
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Before research can be conducted, a number of issues must be explored. All subjects must have provided ______. Their responses must ______ and ______
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informed consent remain anonymous confidential.
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Human Research Terminology Informed consent means
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Participants receive *full and complete* information They can *understand* the information They have *free choice* to participate They *understand* how their *confidentiality* will be kept
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Human Research Terminology Confidentiality ______
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guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team
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Before conducting any study with ______, the researcher obtains approvals from the agency's human subjects committee or ______. An ____ includes scientists and laypersons who review all studies conducted at the institution to ensure that ______, including the ___ of human subjects, are followed.
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human subjects institutional review board IRB ethical principles rights
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Quality and performance improvement Every health care organization gathers data on health outcome measures as a way to gauge _______
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the quality of care.
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Quality and performance improvement A thorough analysis of QI data leads clinicians to understand _______ and the need to ______
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work processes change practice
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The ______ defines _______ as an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others.
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Joint Commission quality improvement
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In _________, an organization analyzes and evaluates current performance, using the results to develop focused improvement actions. Remember that _________ and __________ go hand in hand. Combined, they provide the foundation for patient care and outcomes.
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performance improvement evidence-based practice quality improvement
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The PDSA cycle or approach is a type of _____ program
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QI
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What does the P of PDSA stand for?
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Plan—Review available data to understand existing practice conditions or problems to identify the need for change.
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What does the D of PDSA stand for?
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Do—Select an intervention on the basis of the data reviewed and implement the change.
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What does the S of PDSA stand for?
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Study—Study (evaluate) the results of the change.
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What does the A of PDSA stand for?
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Act—If the process change is successful with positive outcomes, act on these practices by incorporating them into daily unit performance
