Chapter 5: Evidence-Informed Practice in Community Health Nursing

Question 1

1. What aotion by a nurse leader would best implement evidence-informed practice at a
   community nursing centre that serves a large Cuban immigrant population?
   a. Having university experts with cultural competency expertise review the centre’s
   policies
   b. Having weekly staff meetings for the purpose of determining which methods seem
   to work best when helping immigrants
   c. Including Cuban immigrants from the community on the centre’s advisory board
   d. Sending centre staff to conferences and seminars that focus on providing health
   care to immigrants from Spanish-speaking countries

Answer 1

ANS: C
Although all of the proposed options are good, in order to determine whether the centre’s
practice is serving the needs of the population, the nurse executive will need to consult
members of the population being served. This means that evidence would be applied to
practice with input from the community. For example, decisions related to the services to be
offered in a community health nurse (CHN)-managed clinic would be made with input from
the clinic’s advisory board, which should include community leaders and consumers of the
clinic’s services. The needs of Cuban immigrants may not be the same as those of immigrants
from other Spanish-speaking countries, such as Mexico or Spain

Question 2

2. Which activity to determine the best way to address an outbreak of a new infectious disease
   exemplifies evidence-informed practice?
   a. Reviews policies and procedures
   b. Reviews outcomes of clinical trials
   c. Reviews several nursing textbooks
   d. Gets information from the Internet

Answer 2

ANS: B
Evidence-informed practice is defined as combining the best evidence derived from research
with clinical practice, knowledge, expertise, and unique client expectations, preferences, or
choices when making clinical decisions. Getting ideas from the Internet is helpful only if
evidence-informed practice sites are accessed; however, most Internet sites do not offer
information grounded in evidence-informed practice

Question 3

3. What is the biggest challenge for CHNs who are familiar with evidence-informed practice and
   want to implement it in their care of clients?
   a. Interpreting vast amounts of evidence and integrating it into practice
   b. Advocating for change and convincing others that it is beneficial
   c. Distinguishing evidence-informed practice from practice based on old standards
   d. Showing clients that evidence-informed practice will improve their health
   outcomes

Answer 3

ANS: A
The challenge for the CHN is accessing the evidence, interpreting it, and integrating it into
practice, thus moving beyond practice based solely on experience, tradition, or ritual.

Question 4

4. A CHN plans to use evidence-informed practice to guide the development of health education
   programs that are most likely to increase retention of information in elementary school
   children. What represents the best way to use evidence-informed practice in this situation?
   a. Asking other CHNs about what they included in their own education programs
   b. Comparing and contrasting findings from randomized clinical trials related to
   learning in elementary school children
   c. Developing a series of games to accompany the programs developed to promote
   health
   d. Seeking out and examining information on the Internet on health education
   programs for elementary school children

Answer 4

ANS: B
Randomized clinical trials are the gold standard for evidence gathering in evidence-informed
practice.

Question 5

5. A health care provider is concerned about the high number of clients with type 2 diabetes who
   have poor glucose control. In order to implement evidence-informed practice to manage this
   problem, what would be the best reference for the health care provider to use?
   a. Published protocols
   b. Current research findings
   c. Opinions of colleagues
   d. Media reports

Answer 5

ANS: B
Evidence-informed practice in community health nursing challenges CHNs to integrate the
best evidence into their clinical practice. Current research findings will explicate the evidence
of the most successful interventions. (Randomized clinical trials are the gold standard of
research for evidence-informed practice.) Protocols and opinions often reflect tradition rather
than the most current scientific evidence. Although many media reports seek expert opinion,
many are not research based or focused on scientific evidence.

Question 6

6. A CHN implemented an education program that incorporated computer games to reinforce
   learning in a community of older adults. Although earlier research had demonstrated evidence
   of improved retention of information by using this method, the CHN found exactly the
   opposite effect in this group of clients. What would be the most likely cause of the poor
   outcome in the education program?
   a. Failure to consider client and contextual differences
   b. Inadequate incorporation of evidence into practice
   c. Inferior quality of the available research evidence
   d. The CHN’s lack of skills in evaluating the evidence

Answer 6

ANS: A
Evidence-informed practice cannot be applied as a universal remedy without attention to
client differences. When evidence-informed practice is applied at the community level, best
evidence may point to a solution that is not sensitive to cultural issues and distinctions and
thus may not be acceptable to that particular community. For example, computer games may
be an excellent choice for younger groups but is often not suitable for older adults, who may
face challenges with learning new technology.

Question 7

7. A nursing administrator aims to develop a work environment conducive to the implementation
   of evidence-informed practice. What is the best approach to achieve this goal?
   a. Conducting market research to determine customer satisfaction with evidenceinformed practice
   b. Eliciting opinions from CHNs on how evidence-informed practice will affect
   workload
   c. Increasing access of nursing research sources, including nursing research journals,
   in the libraries of health care institutions
   d. Sending staff to conferences related to incorporation of evidence-informed practice
   into practice

Answer 7

ANS: C
Inadequacy of nursing research sources, including nursing research journals, in the libraries of
health care institutions can create a barrier to the implementation of evidence-informed
practice in community-based nursing agencies. Increased nursing research holdings can help
CHNs to quickly access current evidence-informed findings and recommendations.

Question 8

8. How can a CHN best facilitate incorporation of evidence-informed practice in the clinical
   setting?
   a. Elimination of all protocols and standards that are not evidence based
   b. Group reflection on the ideals and expectations of nursing care
   c. Incorporation of more client/practice-oriented research into decision making
   d. Revision of mission statements and organizational philosophies

Answer 8

ANS: C
Evidence-informed practice demands changes. It requires the incorporation of more practiceoriented research and more collaboration between clinicians and researchers. Emphasis should
be on decision making using the various sources of evidence. When CHNs access scientific
knowledge of all types, they need to choose the most relevant information for each client’s
clinical situation.

Question 9

9. What best represents the first step to take when using evidence-informed practice in the
   clinical setting?
   a. Eliminating all protocols and standards that are not evidence based
   b. Gathering data on the clinical problem
   c. Formulating the clinical question
   d. Revising mission statements and organizational philosophies

Answer 9

ANS: C
The first step in the evidence-informed practice process is formulating the question, which
includes defining and refining the question. To answer the client clinical question that has
been formulated, the sources of evidence-informed practice related to community health
nursing include the best available evidence.