Chapter 06: Evidence-Informed Practice

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Chapter 06: Evidence-Informed Practice

Potter et al: Canadian Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

• The extent to which the findings of a qualitative study are thought to be meaningful and

applicable to similar cases or other situations is known as which of the following?

• Credibility.
• Transferability.
• Validity.
• Reliability.

ANS: B

Transferability refers to the extent to which the findings of a qualitative study are thought to be meaningful and applicable to similar cases or other situations. Credibility concerns whether the research and results are trustworthy. Validity refers to whether the study measured what it intended to. Reliability concerns whether the study results are repeatable.

DIF: Understand REF: 83 OBJ: Define the key terms listed.TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

• In caring for patients, it is important for the nurse to realize that evidence-informed decision

making is which of the following?

• The only valid source of knowledge that should be used.
• Secondary to traditional or standard care knowledge.
• Dependent on patient values and expectations.
• Not related to quality improvement studies

ANS: C

Even when the best evidence available is used, application and outcomes will differ according to patients’ values, preferences, concerns, and expectations. Nurses often care for patients on the basis of tradition or convenience, as in the standard “It has always been done this way.” Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence-informed decision making is closely related to quality improvement.

DIF: Understand REF: 76| 77 (Box 6-1)

OBJ: Explain the need for evidence to inform nurses’ decision making.

TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

• The first step in evidence-informed practice is to ask a clinical question. In doing so, what

does the nurse need to realize with regard to researching interventions?

• The question is more important than its format.
• The question will lead the researcher to hundreds of articles that must be read.
• The question may be easier if it is in PICOT format.
• The question may be more useful the more general it is.

ANS: C

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The PICOT format enables the nurse to ask questions that are intervention focused.Inappropriately formulated questions will probably lead to irrelevant sources of information.It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. The more focused the question asked is, the easier it will become to search for evidence in the scientific literature.

DIF: Understand REF: 77 OBJ: Discuss the steps of the research process.TOP: Evaluate MSC: NCLEX: Safe and Effective Care Environment

• When the best evidence is collected, what is the “gold standard” for research?
• The randomized controlled trial (RCT).
• The peer-reviewed article.
• Qualitative research.
• The opinion of expert committees.

ANS: A

Individual RCTs are the “gold standard” for research. A peer-reviewed article is one that has been reviewed by a panel of experts; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT.Expert opinion is on the bottom of the hierarchical pyramid of evidence.

DIF: Knowledge REF: 83 OBJ: Discuss methods for developing new nursing knowledge. TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse is writing a research article on a patient care topic. Which section will get the reader

to read the article because of the value of the topic for the reader?

• Abstract.
• Introduction.
• Literature review or background.
• Results.

ANS: B

The introduction contains information about its purpose and the importance of the topic to the readers of the article. The abstract is a brief summary of the article. The literature review or background offers a detailed background of the level of science or clinical information that is available about the topic of the article. The results section is the summary section of the article.

DIF: Understand REF: 78 OBJ: Discuss the steps of the research process.TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse is caring for a patient with chronic low back pain. In providing care for this patient,

the nurse wonders whether there is literature on nursing interventions for chronic low back pain. What are the best-known databases for nursing literature?

• MEDLINE and CINAHL.
• EMBASE and PsycInfo.
• PsycINFO and CINAHL.
• MEDLINE and EMBASE.

ANS: A

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The best-known databases for nursing literature are MEDLINE and CINAHL. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines.

DIF: Understand REF: 78 OBJ: Discuss methods for developing new nursing knowledge. TOP: Implementation MSC: NCLEX: Health Promotion and Maintenance

• The nurse is developing a PICOT question related to sucrose administration before

phlebotomy in infants: “Is the pain score lower in infants who are administered sucrose one minute before phlebotomy than in infants who do not receive sucrose at all?” With a PICOT question, P is the population of interest, I is the intervention of interest, C is the comparison of interest, O is the outcome, and T is the time; is this a true PICOT question?

• Yes, because the outcome always comes before the intervention.
• Yes, regardless of placement of elements.
• No, because the comparison comes after the intervention.
• No, because the outcome comes after the population.

ANS: B

A well-designed PICOT question does not have to follow the sequence of P, I, C, O, and T.The aim is to ask a question that contains as many of the PICOT elements as possible.

DIF: Understand REF: 77 OBJ: Discuss methods for developing new nursing knowledge. TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment

• In a review of literature for an evidence-informed practice study, what is the most reliable

level of evidence?

• Systematic review and meta-analysis.
• Randomized control trial (RCT).
• Case-control study.
• Control trial without randomization.

ANS: A

In a systematic review or meta-analysis, an independent researcher reviews all the RCTs conducted on the same clinical question and reports whether the evidence is conclusive or whether further study is needed. A single RCT is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted. Case-control studies also have room for bias.

DIF: Analyze REF: 83 OBJ: Discuss methods for developing new nursing knowledge. TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• Why is qualitative nursing research valuable?
• It excludes all bias.
• It entails the use of randomization in structure.
• It helps determine associations between variables and conditions.
• It entails the study of phenomena that are difficult to quantify.

ANS: D

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Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness. No study can totally exclude bias.However, randomization, such as that used in randomized control studies, helps, but in qualitative nursing research, randomization is not usually used. Control studies determine whether there is an association between one or more predictor variables and the condition.

DIF: Knowledge REF: 83 OBJ: Define the key terms listed.TOP: Assessment MSC: NCLEX: Safe and Effective Care Environment

• The nurse has used her PICOT question to develop an evidence-informed change in protocol

for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurse’s best option?

• Drop the idea of making the change at this time.
• Insist that management hire the needed staff to facilitate the change.
• Seek employment in another institution that may have the staff needed.
• Conduct a pilot study to develop evidence to support the change.

ANS: D

When evidence is not strong enough to apply in practice, or if resources are limited, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution probably would not be the answer because most institutions operate under similar established guidelines.

DIF: Apply REF: 79 OBJ: Discuss methods for developing new nursing knowledge. TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment

• According to hospital policy, when starting an intravenous (IV) catheter, the nurse must first

prepare the potential IV site with alcohol and dress it with a gauze dressing. The nurse has done a literature review and believes that evidence-informed practice dictates the use of a transparent dressing to prevent catheter dislodgement. What should the nurse do?

• Begin to use transparent dressing instead of gauze dressings.
• Bring findings to the policy and procedure committee.
• Use transparent dressings on half of her IV starts and gauze on the other.
• Continue following hospital policy without saying anything.

ANS: B

As a result of her finding, the nurse should meet with the policy and procedure committee to recommend routine use of transparent dressings. However, until the policy is changed, or until the nurse receives approval to conduct a pilot study, the nurse is obligated to follow hospital procedure. If the nurse has information that can lead to better patient care, he or she has an obligation (moral and professional) to bring it to the attention of policymakers.

DIF: Apply REF: 79 OBJ: Discuss the steps of evidence-informed decision making. TOP: Implementation MSC: NCLEX: Safe and Effective Care Environment

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Canadian Fundamentals of Nursing 6th Edition Potter Test Bank This study source was downloaded by 100000841743851 from CourseHero.com on 01-23-2023 02:21:42 GMT -06:00

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