Chapter 3 Understanding Evidence-Based Practice

Question 1

ACP Journal Club

Answer 1

The ACP (American College of Physicians) Journal Club summarizes and interprets the best evidence of one recent study or review article from traditional journals, based on the criteria provided by the practitioner.

Question 2

Agency for Healthcare Research and Quality (AHRQ)

Answer 2

The AHRQ has promoted EBP through the establishment of 12 Evidence-Based Practice Centers (EPCs).

Question 3

Background questions

Answer 3

1. Questions focusing on basic or general knowledge about a condition and/or disorder.
2. Components are only a question (who, what, where, how, why) and a verb.
3. Examples: What causes migraines?; What is the best diagnostic test for a kidney stone?; How often should women over the age of 40 have mammograms?

Question 4

Cochrane Database of Systematic Reviews

Answer 4

One of the most popular databases is The Cochrane Library, which reviews and summarizes individual clinical trials and systematic reviews from more than 100 medical journals.

Question 5

Evidence-based medicine (EBM)

Answer 5

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Question 6

Evidence-based nursing (EBN)

Answer 6

The conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and in consideration of individual needs and preferences.

Question 7

Foreground questions

Answer 7

1. Questions focusing on specific knowledge to inform clinical decisions or actions.
2. Components are from the PICOT model (patient/population/problem; intervention; comparison; outcome; timeline).
3. Examples: How should you treat acute bronchitis in children under the age of two?; Should patients with whiplash injury wear a cervical collar?

Question 8

InfoPOEMS

Answer 8

Info-POEMS (Patient-Oriented Evidence that Matters) is a database similar to the ACP Journal Club; it reviews and provides commentary on recent articles.

Question 9

Knowledge-focused triggers

Answer 9

1. Ideas that emerge from staff when they read, listen to research presentations, or encounter EBP guidelines by federal agencies or specialty organizations.
2. Examples: Pain management, prevention of skin breakdown, assessment of nasogastric tube placement, and patency of arterial lines.
3. Reading a study in a specialty journal; hearing and reading a lot about evidence-based practice; knowing you should be using research findings in practice.

Question 10

MD Consult

Answer 10

A database that provides full-text access to textbooks, journal articles, practice guidelines, patient education handouts, and drug awareness.

Question 11

Meta-analysis

Answer 11

1. A statistical method (not a research design) that takes the results of many studies in a specific area and synthesizes their findings to draw conclusions regarding the state of the science in the area of focus.
2. Sometimes referred to as a quantitative synthesis - creates a large sample size that has the ability to detect differences whereas before, individual studies may have been underpowered and experienced Type II errors.

Question 12

National Guideline Clearinghouse

Answer 12

This Clearinghouse provides a collection of evidence-based clinical practice guidelines.

Question 13

PICOT model

Answer 13

Five components that provide structure when writing *clinical questions*:
P—Patient/Population/Problem; 
I—Intervention (treatment, etc.); 
C—Comparison; 
O—Outcome;
T—Timeline.

Question 14

Problem-focused triggers (practice-based triggers)

Answer 14

1. Ideas that emerge from staff in the context of clinical practice by examining quality improvement data, risk surveillance data, benchmarking data, or a recurrence of a clinical problem.
2. Examples: Increased incidence of deep vein thrombosis and pulmonary emboli.
3. Outcomes are not what they should be; a sense that something just is not working right; you’ve heard about a better way of doing something.

Question 15

Research utilization

Answer 15

1. The process by which knowledge generated from research becomes incorporated into clinical practice.
2. Emphasizes translating empirically derived knowledge into real-world applications, with a focus on improving patient outcomes.

Question 16

Reasons for the delay in using research findings in nursing practice (research-practice gap)

Answer 16

1. Nurses in practice do not know about research findings, or lack the skills to locate and read research reports.
2. Nurses in practice do not usually associate with those individuals who produce knowledge. There is often a lack of dialogue between researchers and clinicians.
3. Research is often reported in the language of statistics instead of being reported in clinically meaningful terms.

Question 17

Limitations associated with EBP

Answer 17

1. A need for developing skills in researching and appraising the research.
2. The limited amount of time in practice to master such skills.
3. Scarce resources to access the evidence.

Question 18

Evidence-based practice was derived from the principle that _

Answer 18

Health-care professionals should not center their practice on tradition or experience, but rather on scientific research findings.

Question 19

Three important characteristics of EBP

Answer 19

1. EBP is a problem-solving approach that considers the context of the nurse’s current clinical experience.
2. EBP brings together the best available research evidence by combining research with knowledge and theory.
3. EBP allows patient values, preferences, expectations, and concerns to be heard and integrated into clinical decisions.

Question 20

EBP vs. research utilization

Answer 20

1. Research utilization is a subset of EBP focusing on application of research findings.
2. EBP is a broader term that not only includes the definition of research utilization, but also integrates clinical expertise with the best available evidence from systematic research. It is clinical expertise that decides whether the evidence applies to the individual patient and how it is integrated into a clinical decision.

Question 21

_ have become the “gold standard” for judging the strength and quality of research evidence.

Answer 21

Randomized control trial (RCTs).

Question 22

Four major categories associated with EBP

Answer 22

1. Therapy.
2. Treatment.
3. Diagnostic tests.
4. Prognosis.

Question 23

Steps associated with EBP

Answer 23

Derived from the Iowa Model of Evidence-Based Practice to Promote Quality Care:

1. Selecting a topic and formulating a question.
2. Forming a team.
3. Tracking down the best possible evidence.
4. Appraising the evidence critically.

Question 24

Hierarchy of research evidence

Answer 24

(Strongest to weakest)

1. Meta-analysis of randomized clinical trials.
2. Individual randomized clinical trials.
3. Individual cohort study.
4. Outcomes research.
5. Individual case-control study.
6. Case studies.
7. Expert opinion.

Question 25

Presenting EBP to patients

Answer 25

Research findings and research evidence should be shared with patients and their families as part of the decision-making process; the nurse is free to express their own informed views about the meaning of research findings.

Question 26

Which of the following are limitations to evidence-based practice? (absence of research that explains practice; time, money, and clinical resources; attending conferences where research is presented that are outside your institution; establishing linkages between academics and practice)

Answer 26

Time, money, and clinical resources.

Question 27

The EBP movement is heavily dependent on pre-appraised evidence sources such as _

Answer 27

Systematic reviews.

Question 28

Using the PICOT model is synonymous with _

Answer 28

Asking foreground questions.

Question 29

Critical appraisal of research evidence is important; by one estimate only about _ of studies are of high quality and clinically relevant.

Answer 29

6.8%.

Question 30

James Lind

Answer 30

In 1747, conducted the *first randomized control trial (RCT)* on the relationship between scurvy and vitamin C.

Question 31

Literature review vs. systematic review

Answer 31

1. Reviews of the literature summarize, critique, and synthesize articles while *not* using a systematic methodology - search is usually limited, not based on any standard process. 2. Systematic reviews adhere to *explicit and rigorous methods* to identify, critically appraise, and synthesize relevant primary/original studies - search is exhaustive, uses a quality appraisal filter.

Question 32

Characteristics of a systematic review

Answer 32

1. Identifies gap between what we know and what we need to know. 2. Concise and transparent. 3. Identifies contradictory findings. 4. Provides a narrative summary or pooled statistical analysis (called a meta-analysis). 5. Sets forth a research agenda based on identified gaps.

Question 33

_ are the foundation of systematic reviews, which are used to create _

Answer 33

Randomized control trials (RCT); practice guidelines.