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Yoost Chapter 13: Evidence-Based Practice and Nursing Research (Questions)

Terms in this set (20)

A nursing student is taking care of a patient with possible appendicitis and is curious about the best method of diagnosing this disorder. What does the nursing student have to consider in formulating a question using the PICO format (patient, population, or problem; intervention; comparison intervention; outcomes) to determine evidence-based practice?
a. Problem: appendicitis; interventions: ultrasound versus CT scan; outcome: diagnosis of appendicitis
b. Problem: pain; interventions: meperidine versus morphine; outcome: pain free
c. Problem: fever; interventions: cooling measures versus antipyretics; outcome: normal temperature
d. Problem: appendicitis; Interventions: complete blood count versus chemistry panel tests; outcome: painless
Answer: A
The PICO format asks for the patient's problem, the two possible interventions for comparison (i.e., diagnostics), and the desired outcome from the interventions.
The nurse decides to access a systematic review database to determine evidence-based practice related to the patient's treatment plan for a diagnosis of otitis media (i.e., ear infection). What database can provide that type of resource?
a. Cumulative Index of Nursing and Allied Health Literature (CINAHL)
b. Cochrane
c. PubMed
d. MD Consult
Answer: b
The Cochrane database provides systematic reviews of the literature. CINAHL and PubMed provide primary research articles, and MD Consult provides background information.
The nurse researcher provides participants with informed consent so that what ethical principle is upheld?
a. Respect for persons
b. Beneficence
c. Justice
d. Ethics
Answer: a
Informed consent abides by the principle of respect for persons. The beneficence principle reminds researchers to minimize harms and maximize benefits. The principle of justice requires researchers to treat people fairly and to design research to select subjects equitably and avoid exploitation of vulnerable populations. Ethics is a general concept, not a specific principle.
The nurse feels that the results of a recent literature search and analysis about handwashing should be implemented in the entire hospital system. With whom would the nurse be required to collaborate?
a. Colleagues caring for patients in her unit
b. Colleagues in the community
c. Administrators at the hospital
d. Others in her department
Answer: c
Implementation would require collaboration with hospital administrators to influence the larger practice environment of the entire hospital. Collaboration with colleagues in the community would have no effect on the hospital system. Collaboration with the department or colleagues in the unit would not allow for hospital-wide implementation.
Knowledge gained from research in the 1970s about placing infants on their backs to prevent sudden infant death syndrome was not recommended to parents until the 1990s. This is an example of what barrier to evidence-based practice?
a. Proliferation of research
b. Implementation delay
c. Information needs not being met
d. Lack of readily available resources
Answer: b
There is an implementation delay of approximately 17 years from clinical research to integration into practice. Proliferation of research is the large amount of research that is conducted. Lack of resources refers to a reduced number of databases that provide the information being sought, and information needs not being met refer to the inability to readily find the answers to questions.
A patient is on the way to the hospital in an ambulance and is asked to participate in a research protocol for a new treatment for myocardial infarction. What is this an example of? (Select all that apply.)
a. Standard practice
b. An ethical dilemma
c. A violation of informed consent
d. A patient who is in a vulnerable population category
e. Compliance with important ethical issues of justice and autonomy
Answers: c, d
Because the patient does not have time to consider the option, this is a violation of informed consent. Because the patient is in an emergency situation, the patient is in a vulnerable population category. It is neither standard practice nor an ethical dilemma, because research protocols clearly indicate when a person is to be approached for participation in research studies. Asking a patient to participate in research in an emergency situation is a violation of the ethical issues of justice and autonomy.
Patients are participating in a study to identify genetic disorders. What is a potential concern? (Select all that apply.)
a. Violation of confidentiality if a disorder is revealed
b. Possible adverse consequences related to employment
c. Possible adverse consequences related to reputation
d. Possible adverse consequences to insurability
e. Inability to prevent the progression of genetic disorders
Answers: a, e
Potential concerns include violation of confidentiality and the inability to prevent progression of genetic disorders. Employment, reputation, and insurability would not be of concern as a result of participating in the study.
Which entity or document specifically addresses the role of the nurse in research? (Select all that apply.)
a. American Nurses Association standards of practice
b. Institutional review board
c. Hospital Magnet status
d. Joint Commission
e. MD Consult
Answers: a, c
The American Nurses Association (ANA) standards of professional performance support the nurse's role in research, and hospital Magnet status includes the nurse using evidence to improve quality of care. The Joint Commission does not address nursing research, institutional review boards approve all research involving human subjects if it is funded by the federal government, and MD Consult is a background resource for research. None of these three entities specifically address the role of the nurse in research.
Which of the following factors contributes to the nurse having difficulty keeping up with the latest patient care information? (Select all that apply.)
a. Implementation delays
b. Proliferation of research
c. Volume of health care literature
d. Hours spent in direct patient care
e. The need to read 3 articles every day of the week
Answers: b, c, d
The proliferation of research has led to huge volume of literature, which would require the nurse to read approximately 17 articles every day to remain current. Hours spent in direct patient care make it nearly impossible to keep up with current practices. Implementation delays affect putting alternative interventions into practice, not a nurse's ability to keep up with research findings.
After reading various research articles and reviews on a subject, the nurse designs a practice change based on the literature. What stage of evidence-based practice is this?
a. Maintaining the change
b. Implementing the change
c. Evaluating and critically appraising
d. Synthesizing the evidence and developing a plan
Answer: b
This stage requires the nurse to synthesize all of the information found and develop a plan for a practice change.
The nurse found a research article and decided to implement the research findings in her practice on the unit. This is an example of
a. evidence-based practice.
b. research.
c. research utilization.
d. critical appraisal.
ANS: C
This is an example of research utilization as it is based on one piece of research. Evidence-based practice requires a more systematic review of the literature and critical appraisal of all of the literature found to then make a clinical decision based on an individual patient. Research refers to just conducting research.
How would you differentiate basic research from clinical research?
a. Basic research is the application of theories in different populations, whereas clinical research is the testing of theories for effectiveness of interventions.
b. Basic research is the generation of theories, whereas clinical research is the application of theories in different populations.
c. Basic research is the generation of theories, whereas clinical research is the testing of theories for effectiveness of interventions.
d. Basic research is the generation of knowledge, whereas clinical research is the generation of theories.
ANS: C
Basic research is the generation of theories and clinical research is the testing of theories for the effectiveness of interventions.
How would you differentiate correlational research from experimental research?
a. Correlational research examines a relationship between two variables, and experimental research examines a causal relationship between variables.
b. Correlational research examines a relationship between two variables, and experimental research describes data and characteristics about a population.
c. Correlational research examines a causal relationship between two variables, and experimental research examines relationship variables.
d. Correlational research describes data and characteristics about a population, and experimental research examines a relationship between two variables.
ANS: A
Correlational research examines the relationship between two variables, while experimental research examines a causal relationship between variables.
How would the nurse differentiate between quantitative research and qualitative research?
a. Quantitative research is inductive, and qualitative research is deductive.
b. Quantitative research is observable and measurable, and qualitative research focuses on values and beliefs.
c. Quantitative research is knowledge gained through understanding of meaning of the process, and qualitative research is knowledge gained through scientific research.
d. Qualitative research is based on post-positivist philosophy, and quantitative research utilizes a constructivist philosophy.
ANS: B
Quantitative research is observable, measurable, deductive, based on a post-positivist philosophy, and the knowledge is gained through the scientific process. Qualitative research focuses on values and beliefs, is inductive, based on a constructivist philosophy, and knowledge is gained through an understanding of the meaning of the process.
How does ethnography differ from grounded theory?
a. Ethnography is the lived experience of a group of people, and grounded theory studies historical documents.
b. Ethnography derives a theory from research data, and grounded theory is described as field notes.
c. Ethnography is described as field notes, and grounded theory derives a theory from the research data.
d. Ethnography studies historical documents, and grounded theory is the lived experience of a group of people.
ANS: C
Ethnography is described as field notes, and grounded theory derives a theory from the research data. Historical research studies historical documents. Phenomenology is the lived experience of a group of people.
The nurse has identified an article that is appropriate for the question and needs to interpret the information that is related to the patient the nurse is caring for. What step in the process of EBP is the nurse at?
a. Synthesize the evidence and develop a plan.
b. Formulate a question.
c. Search for information and evaluate and critically appraise the information.
d. Implement the plan.
ANS: C
The third phase of the process requires searching the database and evaluating the articles found by critically appraising them. Formulating the question is in the first phase, followed by searching for evidence, evaluating, and critically appraising the information. Then the nurse would synthesize the evidence and develop a plan.
The nurse has found a review of a specific EBP related to infection control that would be appropriate for all nurses in the ICU. To implement this research, the nurse must collaborate with
a. one other nurse.
b. the other nurses on the day shift.
c. the hospital administration in charge of the entire facility.
d. all the colleagues in the unit (the clinical microsystem).
ANS: D
If the nurse only wants the infection control practice to be implemented in the ICU, the nurse would need to collaborate with all of the nurses in the unit. If the nurse wanted to have this be implemented in the entire hospital, the nurse would collaborate with the administration for the entire hospital. Collaborating with only one nurse or only nurses on the day shift would not allow for implementation.
The IRB is a review committee that has regulations that avoid exploitation of vulnerable populations. This is inherent in which ethical principle?
a. Beneficence
b. Justice
c. Respect for persons
d. Informed consent
ANS: B
Justice requires researchers to treat people fairly and design research to select subjects equitably and to avoid exploitation of vulnerable populations.
A researcher is studying the effect of exercise on heart rate. Which type of variable is heart rate?
a. Quantitative
b. Qualitative
c. Dependent
d. Independent
ANS: C
The variable that is being affected is the dependent variable. Exercise is the independent variable. Quantitative and qualitative are types of research.
The nurse has found an article discussing insulin use in the diabetic patient. Which of the following would contribute to the belief that it is a valid study? (Select all that apply.)
a. A small sample size
b. Random assignment of patients to control and treatment groups
c. No discussion of IRB approval
d. Patient is kept blind as to which treatment is being used
ANS: B, D
A number of points need to be addressed to critically appraise a study. In experimental research, the use of random assignment to control and treatment groups and keeping the patients blind to which treatment they are receiving are two signs of a valid study. Other examples include a large sample size and approval by an IRB committee to assure the ethical treatment of patients.
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