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N458 exam 1
Terms in this set (58)
answers defined research questions by collecting and summarizing of all empirical evidence that fits pre-specified eligibility criteria
use of statistical methods to summarize the results of these studies
Randomized Controlled Trials (RCTs)
-A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions
-One of these interventions is the standard of comparison or control
-The control may be a standard practice, a placebo ("sugar pill"), or no intervention at all
-Someone who takes part in a randomized controlled trial (RCT) is called a participant or subject-
Non- Randomized Controlled Trials
-A clinical trial in which the participants are not assigned by chance to different treatment groups.
-Participants may choose which group they want to be in, or they may be assigned to the groups by the researchers.
Case Controlled Trials
-A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), & looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group, to determine the relationship between the risk factor and the disease
-These are observational, because no intervention is attempted, & no attempt is made to alter course of the disease
-Goal: Retrospectively determine the exposure to the risk factor of interest from each of the 2 groups of individuals: cases & controls.
-Designed to estimate odds
-A type of medical research used to investigate the causes of disease
-Establishes links between risk factors & health outcomes
-Usually forward looking- they are "prospective" studies, or planned in advance and carried out over a future period of time
"Any study that is not truly experimental"
-In human research, a descriptive study can provide info about the naturally occurring health status, behavior, attitudes, or other characteristics of a particular group
-Descriptive research methods are as they sound: they describe situations!
-They don't make accurate predictions & don't determine cause & effect
3 types of Descriptive Methods
Case- Study Methods
-Qualitative research is a generic term for investigative methodologies described as ethnographic, naturalistic, anthropological, field, or participant observer researc
-Emphasizes the importance of looking at variables in the natural setting in which they are found
-Interaction between variables is important.
-the lowest level of acceptable evidence but, in the absence of research evidence, may be the best guide available
-relatively informal technique
- may be used to assist in problem identification, in clarifying the issues relevant to a particular topic, and in the evaluation of products
-individual experts can be consulted, but usually better to bring groups of experts together so that a wide range of experience can be drawn on
Questions for Critiquing Evidence:
What is the question?
What is the purpose of the research?
Did the research design allow the question to be answered?
What were the results?
Were the researchers interpretations valid?
Are the results relevant and useable in practice?
What is a PICOT Question
A review question
- increases the chances that you can find the best evidence in a timely and efficient manner to guide your practice
What does PICOT stand for?
P= The population or problem you are interested in (client group, problem)
I=The intervention that you are interested in
C= The comparison or alternative intervention (if relevant) want to know if its better than what we have done before
O= The outcome or reason for using the intervention
T= The time frame
A general question relating to a clinical practice situation
evaluating literature and then that literature guiding and focusing your question (this is PICOT)
-Comes from a clinical question
-It is clear and specific to guide the search
A useful question consists of a problem, intervention and outcome and often takes the form of:
"What is the evidence for the effectiveness of X (intervention) for Y (outcome) in a client with Z (problem or diagnosis)"
Review Questions can be in relation to...
The cause of a condition
Diagnosis and assessments
Prevention of conditions
Prognosis of conditions
Intervention: In __________(P), how does __________(I) compared to __________(C) affect __________(O) within __________(T)?
Prognosis/Prediction: In __________(P) how does __________(I) compared to _________(C) influence/predict __________(O) over __________(T)?
Diagnosis or Diagnostic Test: In __________(P) are/is __________(I) compared with __________(C) more accurate in diagnosing __________(O)?
Etiology/Causation: Are __________(P) who have __________(I) compared with those without __________(C) at __________risk for/of __________(O) over __________(T)?
Meaning: How do __________(P) with __________(I) perceive __________(O) during __________(T)?
Barriers to using EPB on your practice units
Access and availability to information
Limited time of professionals, not getting paid, union wont allow
Lack of EBP skills
Confidence in the value of the evidence
Support from management
Conflict with client centered philosophy of Nursing
Can you over come barriers?
BARRIERS CAN ALWAYS BE OVERCOME
Break down doors as early as possible always questions about why and can we do something different
Using evidence in your practice-who is the best resource to use in the hospital setting
Who is the right practitioner to be implementing the evidence?
What does the evidence say the "right" thing to do is?
What is the right way to implement the intervention?
What is the right place for the implementation?
What is the right time to implement?
You may need to change certain parts to fit the right place, time etc.
How To Search Databases
-Use an organized and systematic approach
Develop search strategies before you start, including:
-Databases you will use
-Key terms to search under
-Set limits of your search
When searching Databases, consider...
Is your focus medical or broader?
Is your focus Nursing specific?
Do you want literature from a particular country or area? (e.g. just the United states) other countries have really interesting research. Don't limit yourself to just the united states
Is there a specific research method you want to focus on? (e.g. systematic review)
Key Terms to use
-Pull out the key terms from your review question
-Generally the problem, intervention and outcome
-Consider alternative or related terms (e.g. Occupation and activity)
Limits to set for your search
Language of the article
Date of publication the ground breaking research may have been done 40 years ago so don't have to keep it within a certain time frame unless that is specific to your question.
Assess the value and trustworthiness of the evidence
Flaws in research
No research is without its flaws, need to ASK!:
"Do the flaws make me question the conclusion?"
-there will always be flaws, but its up to you to still rely or not rely on the conclusion
-Just because it was published doesn't't mean it was a good study or good research
3 Broad Areas to Analyze
The rigor of the research
Significance of the results
Impact upon your nursing practice
Definitions of SWOT
-The summary of your STRENGTH, WEAKNESSES, OPPORTUNITIES, THREATS (first two are internal, last two are external)
-a business or strategic planning technique used to summarise the key components of your strategic environments. That causes you to reflect on what you and other people are doing to not be caught off guard
-A study undertaken by an organization to identify its internal strengths and weaknesses, as well as its external opportunities and threats
-A strength is a core capability of your business where your business have an advantage over your competitor(s), which your customers value i.e. you passed the better than your competitors test.
-Found with completing internal analysis
-A weakness is a core capability of your business where your competitor(s) have an advantage over your business, which your customers value i.e. you failed the better than your competitors test.
-Found when completing internal analysis
An opportunity is an environmental condition in your macro or industry environments that can improve your organizations competitive position relative to that of your competitors.
Found with industry environment analysis and macro environment analysis
A threat is a forecast environmental condition that is out of your control and has the potential to harm your businesses profitability.
Found with industry environment analysis and macro environment analysis
Ex: Another unit has a better work environment and they are getting all the good nurses
-Internal Environment your own organization
-Macro Environment world in general
Sometimes the last two are combined and called your external environment
(Anything outside of your organization that can influence your industry in some way: election, natural disaster etc. new IV pump, new technology, vaccine)
Stage 1: Disciplined People (LEVEL 5 LEADERSHIP)
Level 5 leaders are ambitious first and foremost for:
- the organization
Dave the fierce resolve to do whatever it takes to make good on that ambition
-Displays a paradoxical blend of personal humility and professional will.
2. First Who ... Then What.
--Those who build great organizations make sure they have the right people on the bus, the wrong people off the bus, and the right people in the key seats before they figure out where to drive the bus. They always think first about "who" and then about what.
Stage 2: Disciplined Thought (THE STOCKDALE PARADOX)
Retain unwavering faith that you can and will prevail in the end, regardless of the difficulties, AND AT THE SAME TIME have the discipline to confront the most brutal facts of your current reality, whatever they might be.
Stage 2: Disciplined Thought (THE HEDGEHOG CONCEPT)
Greatness comes about by a series of good decisions consistent with a simple, coherent concept—a "Hedgehog Concept." The Hedgehog Concept is an operating model that reflects understanding of three intersecting circles: what you can be the best in the world at, what you are deeply passionate about, and what best drives your economic or resource engine.
-Focused on a single idea
-easily defends self as a single position in marketplace
Stage 3: Disciplined Action (CULTURE OF DISCIPLINE)
Disciplined people who engage in disciplined thought and who take disciplined action—operating with freedom within a framework of responsibilities—this is the cornerstone of a culture that creates greatness. In a culture of discipline, people do not have "jobs;" they have responsibilities.
Stage 3: Disciplined Action (THE FLYWHEEL)
In building greatness, there is no single defining action, no grand program, no one killer innovation, no solitary lucky break, no miracle moment. Rather, the process resembles relentlessly pushing a giant heavy flywheel in one direction, turn upon turn, building momentum until a point of breakthrough, and beyond.
STAGE 4: BUILDING GREATNESS TO LAST
5 factor analysis of:
Neuroticism- Emotional Stability
Openness to Experience
Relates to interpersonal behavior
Extent to which individuals prefer to be alone or with others
Ability to experience positive emotions
Surgency: ability to be vigorous and energetic
Optimistic fun loving
Relates to interpersonal behavior
Characteristic responses of other people to an individual
Liked by others, nice, warm, courteous
Relates to way in which individual performs tasks
Careful, hardworking, neat, organized
Relates to person's emotional life
Measures psychological adjustment and emotional stability
Prone to experience negative emotions
Openness to Experience
Assesses seeking and appreciation of experience for its own sake
Toleration for and exploration of the unfamiliar
Jungian psychology , mother daughter duo in world war II
1. Extroversion vs introversion
2. Sensing - intuition
3. Thinking - feeling
4. Judging - perceiving
Extroversion - Introversion
The first criterion defines the source and direction of energy expression for a person.
The extrovert (E) has a source and direction of energy expression mainly in the external world while the introvert (I) has a source of energy mainly in the internal world
Interdisciplinary team care-planning and staffing
Interaction with patients and families
Interaction with community
In-service training with staff
Sensing - Intuition
The second criterion defines the method of information perception by a person.
"Sensing" (S) means that a person believes mainly information he or she receives directly from the external world. "Intuition" (N) means that a person believes mainly information he or she receives from the internal or imaginative world.
Assessing patients and families
Understanding staff perception of Nursing Role
Thinking - Feeling
he third criterion defines how the person processes information.
"Thinking" (T) means that a person makes a decision mainly through logic. "Feeling" (F) means that, as a rule, he or she makes a decision based on emotion.
Death and dying issues - helping clients cope while you are coping
Objectivity vs becoming numb
Questioning agency's policies and practices
Judging - Perceiving [added by isabel briggs myers]
The fourth criterion defines how a person implements the information he or she has processed.
"Judging" (J) means that a person organizes all his or her life events and acts strictly according to this plan. "Perceiving" (P) means that he or she is inclined to improvise and seek alternatives.
Handling interruptions and emergencies
"Thinking on your feet" versus planning ahead
Dealing with change and the unknown
Uses of Big 5
Self rating items
Cannot use for beliefs, goals and values
Uses of Myer Briggs
Whatever the circumstances of your life, the understanding of type can make your perceptions clearer, your judgments sounder and your life closer to your heart's desire
NO predictive of behavior because everyone has choice no matter how much there are preferences
Mental health counseling;
Helping assess one's preferences & how those can impact or help explain direction in career, performance as a team member, & behavior in his or her personal life, etc.
Organizational Development consultation in team building or in analyzing productivity or morale in an agency.
Job interviews: may create bias, does not predict behavior or competence
TRAIT THEORIES (1950s)
There are inherent attributes that some people are born with that make them great leaders.
Born to be leader with certain traits ( however studies ignored power and position)
BEHAVIORAL THEORIES (1960s)
Great leadership is based on what someone does
1. Situational Theory
Situational Theory (characteristics)
Autocratic leads group towards leaders goal
use of coercion
direct with commands
communication flows downhill
difference in status is huge
criticism is punitive
Situational Theory ( results )
Well defined group action
Results are predictable = reduce frustration in work group
Productivity is usually high
Creativity, self-motivation and autonomy are low
Common in large bureaucratic systems
moves the group towards its goal
Economic and ego awards are used to motivate
Direction through suggestions and guidance
Communication flows both ways
Decision are made with input from others
"we" not "I"
Criticism is constructive
Promotes autonomy and growth of individual
Less efficient more voices being head
Laissez faire: (characteristics)
Motivation by support when requested
Communication up and down
Decision making dispersed throughout group
It is all about the group
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