Chapter 2

Question 1

What is EBP?

Answer 1

EBP uses research combined w/ clinical expertise, patient preferences, and local circumstances to augment nursing practice.

Question 2

What is research utilization? which more simple- EBP or Research utilization?

Answer 2

Research utilization is more simple than EBP; it uses research in a practical application – needs findings that are generalizable to a larger population to increase its ability to have practical application.

Question 3

EBP vs. Research Utilization (RU)- what questions do you ask?

Answer 3

EBP begins with a question that asks, “what does the evidence suggest is the best approach to solving a clinical problem?”

RU asks, “how research knowledge can be put to use in the clinical setting?”

Question 4

What is The Cochrane Collaboration founded on? What is an examples of this

Answer 4

The Cochrane Collaboration is founded on idea that research summaries need to be available for quick access. Systematic reviews are the best representation of this idea.

Question 5

3 barriers to implementing EBP

Answer 5

1. Quality and nature of the research
2. Characteristics of nurses
3. Organizational factors

Question 6

Tell me about the quality and nature of research barrier to implementing EBP

Answer 6

Repetition of procedure and results – it can be difficult to keep repeating similar enough studies in varying environments to provide sufficient evidence for an intervention to be adopted

Question 7

Tell me about the characteristics of nurses as a barrier to implementing EBP

Answer 7

• Are nurses taking the time to read journals?
• Some nurses may not readily adapt to change – they like their way of doing something, others may not value research or have access to research.

Question 8

Tell me about oranizational factors as a barrier to implementing EBP

Answer 8

• Some organizational barriers that exist (and may prevent evidence from being adopted into practice), include unit culture, inadequate leadership, or financial and staff limitations.
• Additionally, new interventions require time, training, and sometimes new equipment – if leadership doesn’t allocate the time/equipment needed, then the intervention will not be implemented effectively.

Question 9

What is the highest level of evidence on the evidence pyramid?

Answer 9

Systematic reviews are the highest level of evidence because they combine the results from lower studies on the pyramid.

Some systematic reviews will only incorporate the results from randomized controlled trials
(RCT), increasing the strength of the evidence.

Question 10

what are systemic reviews?

Answer 10

• a methodical, scholarly inquiry that combines the results of numerous research studies
  on a topic

Question 11

what is a meta analysis

Answer 11

• technique for integrating quantitative research findings statistically.
  § Quantitative
  § Analyzes data from multiple studies

Question 12

what is meta-synthesis?

Answer 12

Qualitative

§ Integrates and interprets findings from many qualitative studies

Question 13

what are clinical practice guidelines?

Answer 13

set of recommendations developed by a panel of experts; non-research-based evidence source
-often times mean utilizing Care Bundles

Question 14

what is AGREE and AGREE II

Answer 14

• Appraisal of Guidelines Research and Evaluation

- instruments used to appraise guidelines

Question 15

How a panel develop clinical practical guidelines

Answer 15

A panel of experts determines the recommendations – these recommendations are generated through the use of systematic review results

Question 16

Are clniical practice guidelines research or non research based?

Answer 16

Clinical practice guidelines are classified as a non-research-based evidence source because they do not perform a study or generate evidence, but rather provide a list of recommendations.

Question 17

What is PICO

Answer 17

a format for organizing EBP project

Question 18

what does pico stand for?

Answer 18

P: population or patients
○ I: Intervention, influence, or exposure
○ C: comparison or current practice
○ O: outcome

Question 19

What is the PICO question format?

Answer 19

In _____ (population), what is the effect of _____ (interventions), in comparison to ______(comparison), or ______ (outcome)?

Question 20

Evidence Appraisal: What to consider about evidence?

Answer 20

Evidence Quality
○ Magnitude of Effects
○ Precision of Estimates/Results
○ Peripheral Effects – evidence of other side effects of benefits?
○ Financial Costs – cost of applying the evidence?
○ Clinical Relevance – is the evidence relevant to my particular clinical situation?

Question 21

How do I, as a nurse, implement EBP?

Answer 21

Problem Identification
Assess Feasibility
Appraise the Evidence
Implement and Evaluate

Question 22

is Quality improvement research or non research based

Answer 22

non research based

Question 23

What is QI?

Answer 23

• a non-research-based means of improving a healthcare concern/problem w/o conducting a formal research study; an assessment of a patient care problem for the purpose of improving patient care through peer analysis, intervention, resolution of the problem, and follow-up. Results can be used to develop larger studied to test the interventions

Question 24

Tell me about some characteristics of QI

Answer 24

-Intervention changes or modifies as needed
○ Goal is to effect immediate improvement
○ Goal is to sustain an improvement
○ Necessary activity for a healthcare institution
○ Does not require a literature review
○ Internally funded

Question 25

``` Which of the following are important to incorporate evidence-based practice? (Select all that apply) A) clinical expertise B) patient preferences C) local circumstances D) authority ```

Answer 25

A, B, and C are all correct, clinical expertise, patient preferences, and local circumstances. The goal of EBP is to reduce the reliance on custom, authority, or ritual.

Question 26

``` Which evidence type is emphasized by the Cochrane Collaboration? A) systematic reviews B) randomized controlled trials C) quality improvement studies D) pilot studies ```

Answer 26

The answer is A, systematic reviews. The Cochrane Collaboration sought to make the findings from research easily accessible, and a systematic review combines the results of numerous studies together. Randomized controlled trials are rigorous study that can provide strong evidence but are still individual studies. Quality improvement studies are geared towards hospital improvement and are not required to be published or to generate knowledge for research. Pilot studies are small-scale studies to test an intervention before doing it on a larger scale and by themselves do not generate knowledge for research.

Question 27

``` What study type interprets and integrates the results of multiple qualitative studies? A) quality improvement project B) phenomenological study C) metasynthesis D) meta-analysis ```

Answer 27

The answer is C, metasynthesis. A meta-analysis analyzes the results of multiple quantitative studies. A phenomenological study is a type of qualitative study, and a quality improvement project is not a result of multiple qualitative studies.

Question 28

``` Which of the following is a part of the PICO process? A) Prevention B) Interpretation C) Collaboration D) Outcome ```

Answer 28

The answer is D, outcome. ``` P = patient or population I = intervention C = comparison or current practice O = outcome ```

Question 29

``` Which of the following is a component of appraising evidence? A) Sample size B) Magnitude of effects C) Strengths and limitations D) Ethical considerations ```

Answer 29

The answer is B, magnitude of effects. Other examples include evidence quality, precision of estimates, peripheral effects, financial costs, and clinical relevance. Sample size, strengths and limitations, and ethical considerations are all components of a research study, but are not used individually as evidence appraisal tools.