NR 501: Theoretical Foundations for Nursing Practice and Scholarship

EVIDENCE-BASED PRACTICE/
UNDERSTANDING THEORY AND RESEARCH
FRAMEWORKS/ NURSING THEORY,
RESEARCH, AND EVIDENCE-BASED PRACTICE
QUESTIONS & ANSWERS GRADED A+
GUARANTEED PASS
Evidence-based medicine - ANSWER-the conscientious, explicit, and judicious
use of current best evidence in making decisions about the care of individual
clients.

Evidence-based public health - ANSWER-a public health endeavor in which there
is an informed, explicit, and judicious use of evidence that has been derived from
any of a variety of science and social science research and evaluation methods;
Brownson et al (2009) recently expanded the definition of evidence-based public
health to include "making decisions on the basis of the best available evidence,
using data and information systems, applying program planning frameworks,
engaging the community in decision making, conducting evaluations, and
disseminating what has been learned"

Evidence-based nursing - ANSWER--an integration of the best evidence available,
nursing expertise, and the values and preferences of the individuals, families, and
communities who are served.
-best evidence, expertise, values and preferences of the people who are served

Evidence-based practice: - ANSWER--includes the best available evidence from a
variety of sources, including research studies, evidence from nursing experience
and expertise, and evidence from community leaders.
-from variety of sources including research, experience and evidence of
community leaders

Mid to late 1970s - ANSWER--Growing consensus: scientific knowledge should
be used as a basis for nursing practice
-Division of Nursing began funding research utilization projects

,-Three Divisions of Nursing Projects: NCAST, WICHEN, CURN

1990s - ANSWER--Paradigm shift: change of old ways to new ways of doing
-Evidence-based practice term created to include all professions

Current literature - ANSWER-Focus is on applications in the acute and primary-
care setting

Three divisions of nursing projects - ANSWER--Nurse Child Assessment Satellite
Training Project (NCAST)
-Western Interstate Commission for Higher Education (WICHE) Regional
Program for Nursing Education (WICHEN)
-Conduct and Utilization of Research in Nursing Project (CURN)

Hierarchy of evidence - ANSWER--Randomized controlled trials: the highest level
of evidence
-Quasi-experimental, prospective, case-control, etc.
-Some include ways to judge that incorporate clinical experience, into professional
guidelines and practice

Factors to Implementation of EBP - ANSWER-Knowledge of research and current
evidence
Ability to interpret the evidence
Individual professional's characteristics
Time restraints
The hierarchy of the practice environment/level of support of managers/the ability
to engage in autonomous practice
Philosophy of the practice environment
Availability of resources
Practice characteristics
Links to outside supports
Political constraints
Lack of relevant and timely public health practice research

PICOT, - ANSWER-) population of interest,
the
(I)intervention or practice strategy in question,

,the population or intervention to be used for
(C)comparison,
the
(O)outcome desired, and
the
(T)time frame.

Step zero in EBP process - ANSWER-Curiosity about the interventions that are
being applied
1.PICOT question (population, intervention, comparison, outcome, and time
frame)
2.Literature search
3.Critical appraisal of the evidence
4.Found evidence integrated with clinical expertise and client values
5.Evaluation of outcomes of practice decisions and changes based on step 4
6.Disseminate outcomes

Systematic review: - ANSWER-a summary of the research evidence that relates to
a specific question and to the effects of an intervention.

Meta-analysis - ANSWER-a specific method of statistical synthesis used in some
systematic reviews, where the "results from several studies are quantitatively
combined and summarized."

Approaches to Finding Evidence - ANSWER--Guide to Community preventive
services
-Cochrane Public Health Group
-Center for Reviews and Dissemination
-Campbell Collaboration
-Meta-analysis: results of several studies
-Integrative review
-Narrative review

Evaluating Evidence - ANSWER--Sample selection: unbiased
-Randomization
-Blinding: not know who is or isn't receiving treatment
-Sample size: large enough to show an effect

, -Description of intervention in explicit detail
-Outcomes need to be measured accurately
-Length of follow-up to make sure was not just by chance
-Attrition: as few as possible drop out
-Confounding variables, if any should be accounted for
-Statistical analysis appropriate to determine outcome

Three domains for evaluation systems - ANSWER-Quality
Quantity
Consistency

The evidence is assigned a "grade" based on - ANSWER--Quality of the evidence
-Number of well-designed studies
-Presence of similar findings in all of the studies

Quality - ANSWER-extent to which bias is minimalized

Quantity - ANSWER-# of studies/sample size/amount of effect

Consistency - ANSWER-similar findings in other studies

Patient-oriented evidence that matters (POEM) - ANSWER-What are the results?
(Are they important?)
Are the results valid?
How can the results be applied to client care?

Approaches to Implementing EBP - ANSWER--Recognize current status of your
own practice
-Believe that EBP care will lead to improved client outcomes
-Nurses must practice in an environment that supports evidence-based care
-Public health nurses use the evidence to influence policies that will improve the
health of entire communities

Current Perspectives - ANSWER--Cost versus quality: reducing legal liability
-Individual differences may be needed if not sensitive to cultural issues, etc.
-Appropriate EBP methods for community-oriented nursing practice