CHAPTER 22- Evidence-Based Practice Review for the Advanced Practice Nurse Flashcards Preview

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Flashcards in CHAPTER 22- Evidence-Based Practice Review for the Advanced Practice Nurse Deck (15)
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1

The scientific method is best used for:

  1. Generating new knowledge to the advanced nursing practice.
  2. Answering practice questions.
  3. Evaluating the quality and strength of evidence.
  4. Evaluating methodological rigor.

1. Generating new knowledge to the advanced nursing practice.

The scientific method is a formal, rigorous multi-step process designed to discover new knowledge or validate/refine existing knowledge. Researchers systematically identify a problem, review the literature, identify research questions, select a study design, describe study methods, collect data, analyze data, make conclusions that add to the existing knowledge base, and disseminate findings.

2

Research literacy is defined as which of the following?

  1. The ability to access, critically appraise, and interpret scientific literature
  2. The ability to translate research findings into practice
  3. The ability to carry out a research study
  4. The ability to use best current evidence in practice

1. The ability to access, critically appraise, and interpret scientific literature

The ability to translate research findings into practice is knowledge translation and is a critical step in the EBP process. The ability to carry out a research study is the job of researchers who have the appropriate formal training and education. The ability to use best current evidence in practice is a component of EBP.

3

What step would not be recommended when searching for evidence to answer a clinical question?

  1. Use controlled language of the database.
  2. Use keywords from a PICO question.
  3. Determine the level of evidence needed to answer the question.
  4. Search using multiple databases and keywords simultaneously.

4. Search using multiple databases and keywords simultaneously.

The clinician searches each database separately because the way in which each database organizes articles and the type of controlled language may be different. For example, MEDLINE and PubMed use MeSH, whereas CINAHL uses CINHAL headings.

4

What is the outcome in the following PICO question?: In hospitalized patients on telemetry, does a nurse-led noise reduction program compared to standard nursing care improve patient satisfaction?

  1. Patients on telemetry
  2. Nurse-led noise reduction program
  3. Standard nursing care
  4. Patient satisfaction

4. Patient satisfaction

The outcome is what the clinician wants to see happen after manipulating the independent variable. In this example, patients on telemetry is the population (P), nurse-led noise reduction program is the intervention (I), and standard nursing care is the comparison (C).

5

What is the intervention in the following PICO question?: In incarcerated females, does pedometer use plus portion control compared to pedometer use only decrease weight gain during the first 6 months?

  1. Incarcerated females
  2. Pedometer use plus portion control
  3. Pedometer use
  4. Weight gain

2. Pedometer use plus portion control

In the PICO mnemonic, examples of an intervention can be a treatment, procedure, or program. In this example, incarcerated females are the population (P), pedometer use is one of the two interventions being used (I), and weight gain is the outcome (O).

6

What is considered the highest level of evidence in an evidence hierarchy for intervention questions?

  1. Systematic review
  2. Meta-analysis
  3. Meta-synthesis
  4. Randomized control trial

2. Meta-analysis

A meta-analysis is a method of analyzing statistically quantitative findings from multiple studies on the same topic to create new knowledge or validate existing knowledge. A systematic review is a type of literature review where the authors develop a specific protocol to systematically search for, critically appraise, and synthesize evidence from several studies on the same topic (Milner, 2014). A meta-synthesis is a method of analyzing qualitative findings from multiple studies on the same topic. A randomized control trial is a type of quantitative study design where subjects are either randomly selected from a population for the study or they are randomly assigned to the study, experimental, or control group.

7

What is considered the highest level of evidence in an evidence hierarchy for prognosis questions?

  1. Systematic review of randomized control trials
  2. Meta-analysis of randomized control trials
  3. A single randomized control trial
  4. Systematic review of observational studies

4. Systematic review of observational studies

Prognostic questions are best answered using observational study designs because the researcher is evaluating the course of a disease or treatment outcome over time and this cannot be accomplished using an experimental study design like a randomized control trial. Systematic review of randomized control trials, meta-analysis of randomized control trials, and single randomized control trials are considered the highest level of evidence needed for treatment or diagnosis questions.

8

What is considered the highest level of evidence in an evidence hierarchy for meaning questions?

  1. Systematic review
  2. Meta-analysis
  3. Meta-synthesis
  4. Randomized control trial

3. Meta-synthesis

Meaning questions are best answered using qualitative methods. A meta-synthesis is the highest level of evidence needed for answering meaning questions because it is a method of analyzing qualitative findings from multiple studies on the same topic. Systematic review of randomized control trials, meta-analysis of randomized control trials, and single randomized control trials are considered the highest level of evidence needed for treatment or diagnosis questions.

9

The following is what type of clinical question?: For patients with a 75% blocked coronary artery, does medication therapy versus stent prevent occlusion?

  1. Intervention
  2. Etiology or harm
  3. Diagnostic
  4. Prognostic or prediction

4. Prognostic or prediction

This prediction question in PICO format will elicit a focused research for evidence that will aid in the treatment (medication versus stent) decision of a patient that has a 75% blockage in their coronary artery, with the goal of preventing a future outcome (occlusion).

10

National Guideline Clearinghouse is a free resource for accessing what type of evidence?

  1. Systematic reviews
  2. Meta-analysis
  3. Clinical trials
  4. Clinical practice guidelines

4. Clinical practice guidelines

To date, the National Guideline Clearinghouse is a free government-sponsored website where you will find clinical practice guidelines to guide practice. Systematic reviews can be found in PubMed or the Cochrane Database of Systematic Reviews. Epocrates online or the application provides free drug prescribing and safety information. Information on clinical trials can be found at https://www.clinicaltrials.gov/ct2/home.

11

Epocrates is a free resource for accessing what type of information?

  1. Systematic reviews
  2. Drug prescribing and safety information
  3. Clinical trials
  4. Clinical practice guidelines

2. Drug prescribing and safety information

Epocrates online or the application provides free drug prescribing and safety information. Systematic reviews can be found in PubMed or the Cochrane Database of Systematic Reviews. Information on clinical trials can be found at https://www.clinicaltrials.gov/ct2/home. The National Guideline Clearinghouse is a free government sponsored website where you will find clinical practice guidelines to guide practice.

12

Select the database where the advanced practice nurse would find evidence-based synopses.

  1. National Guideline Clearinghouse
  2. Turning Research into Practice Database
  3. Cochrane Database of Systematic Reviews
  4. Epocrates

2. Turning Research into Practice Database

The Turning Research into Practice (TRIP) database is a free meta-search engine where clinicians can find evidence-based synopses that are easy to understand and use in order to guide practice decisions. The National Guideline Clearinghouse is a free government-sponsored website where you will find clinical practice guidelines to guide practice. Systematic reviews can be found in the Cochrane Database of Systematic Reviews. Epocrates online or the application provides free drug prescribing and safety information.

13

Which of the following can be used to critically appraise a quality improvement study?

  1. CONSORT
  2. SQUIRE
  3. PRISMA
  4. STROBE

2. SQUIRE

CONSORT can be used to appraise single randomized control trials. PRISMA can be used to appraise systematic review and/or meta-analysis. STROBE can be used to appraise observational studies (e.g., cohort, cross-sectional, case-control).

14

Which of the following can be used to critically appraise a randomized control trial?

  1. CONSORT
  2. SQUIRE
  3. PRISMA
  4. STROBE

1. CONSORT

SQUIRE can be used to appraise a quality improvement study. PRISMA can be used to appraise systematic reviews and/or meta-analysis. STROBE can be used to appraise observational studies (e.g., cohort, cross-sectional, case-control).

15

Resources for patient and provider decision aids can be found at which of the following?

  1. Ottawa Hospital Research Institute website
  2. National Guidelines Clearinghouse website
  3. Center for Evidence-Based Medicine website
  4. International Patient Decision Aid Standards website

1. Ottawa Hospital Research Institute website

The Ottawa Hospital Research Institute website has excellent resources for patient and provider decision aids, including the decision aids developed under the guidance of the Agency for Healthcare Research and Quality (AHRQ). The National Guideline Clearinghouse website has clinical practice guidelines only. The Center for Evidence-Based Medicine website has resources to support the search and critical appraisal processes associated with EBP. The International Patient Decision Aid Standards website has tools for assessing the quality of patient decision aids.