EXAM 1 EBP

What is Evidence-Based Practice (EBP)?

A decision-making/problem-solving process that uses the best evidence, clinical experience, and patient preferences/values.

What is the main purpose of Evidence-Based Practice?

To close the gap between research and clinical practice

What are the 3 components of Evidence-Based Practice?

1. Best available evidence

2. Nurses’ clinical experience

3. Patient preferences & values

What is Research?

A systematic inquiry using disciplined methods to answer questions, solve problems, and develop new knowledge.

What is Nursing Research?

Systematic research focused on new knowledge about issues important to nurses and their patients

What is Clinical Nursing Research?

Systematic research focused on new knowledge carried out in the clinical setting

What is the role of nurses who use Evidence-Based Practice (EBP)?

They are CONSUMERS of research who use the EBP process to determine the best approaches to patient care

What are traditional sources of knowledge for nursing practice?

1. Clinical experience

2. trial and error

3. tradition

4. expert opinion

Why is learning about best-practice nursing an ongoing process?

Because evidence is constantly evolving → nurses must continue learning throughout their careers.

What is tradition as a source of nursing knowledge?

Untested customs or habits based on “unit culture.”

What is an expert as a source of nursing knowledge?

Someone with specialized knowledge

• BUT they can be wrong or outdated

What is clinical experience in EBP?

A source of knowledge and part of the EBP model.

Why is personal experience limited as evidence?

Too narrow + biased

What is trial and error?

Trying different alternatives until one works

What are the problems with trial and error?

Haphazard and idiosyncratic solutions

• Haphazard = random

• Idiosyncratic = individual

What is a paradigm?

A perspective or way of viewing the world.

What are the 2 major paradigms in nursing research?

1. Positivist

2. Constructivist

What is the Positivist paradigm?

• A straightforward approach that focuses on objective facts

• Linked to quantitative research.

What is the Constructivist paradigm?

• An approach that considers different perspectives and possible options

• Linked to qualitative research.

What is an assumption?

A principle that is believed to be true without verification.

What is empirical evidence?

Evidence based on objective reality, gathered through the senses rather than personal beliefs.

How is empirical evidence collected?

Through observation or experiments.

What are 2 key characteristics of empirical evidence?

1. Systematic

2. Repeatable

What does “systematic” mean in empirical evidence?

Information is collected in a planned, organized way.

What does “repeatable” mean in empirical evidence?

The process can be repeated to get consistent results.

What is generalizability?

The degree to which research findings can be applied to a broader population beyond the study participants.

What does generalizability allow researchers to do?

Generalize findings from a sample to the larger population.

When is a study more generalizable?

When the study is well-designed and representative of the population

What does higher generalizability mean?

The findings are more likely to be true for people beyond the study participants

What is the main difference between Positivist and Constructivist research?

• Positivist = quantitative, objective, and seeks generalizations.

• Constructivist = qualitative, subjective, and seeks in-depth understanding

How do Positivist and Constructivist research differ in their processes?

• Positivist = deductive → tests hypotheses.

• Constructivist = inductive → generates hypotheses

How do Positivist and Constructivist research designs differ?

• Positivist = fixed/prespecified design.

• Constructivist = flexible/emergent design.

How do Positivist and Constructivist samples and data differ?

• Positivist = large, representative samples + quantitative data.

• Constructivist = small, information-rich samples + narrative data.

How do Positivist and Constructivist researchers view context and the researcher’s role?

• Positivist = controls context; researcher is an outsider.

• Constructivist = context-bound; researcher is an insider

Positivist Paradigm (Quantitative Research):

• Deductive processes — hypothesis testing

• Emphasis on discrete, specific concepts

• Focus on the objective and quantifiable 

• Outsider knowledge — researcher is external, separate

• Fixed, prespecified research design 

• Controls over context 

• Large, representative samples

• Measured (quantitative) information 

• Statistical analysis

• Seeks generalizations

Constructivist paradigm (qualitative research):

• Inductive processes — hypothesis generation 

• Emphasis on the entirety of a phenomenon; holistic 

• Focus on the subjective and nonquantifiable 

• Insider knowledge — researcher is part of the process

• Flexible, emergent research design 

• Context-bound 

• Small, information-rich samples

• Narrative (unstructured) information 

• Qualitative analysis

• Seeks in-depth understanding

Why must primary research studies be critically appraised?

To determine if the evidence is rigorous enough to use in nursing practice.

Identification purposes of nursing research (Qual)

• What is this phenomenon?

• What is its name?

Description purposes of nursing research (Quan)

How prevalent is the phenomenon?

Description purposes of nursing research (Qual)

What are the dimensions or characteristics of the phenomenon?

Exploration purposes of nursing research (Quan)

What factors are related to the phenomenon?

Exploration purposes of nursing research (Qual)

What is the full nature of the phenomenon?

Prediction/control purposes of nursing research (Quan)

If phenomenon X occurs, will phenomenon Y follow? Can the phenomenon be prevented? (Quan)

Explanation purposes of nursing research (Quan)

What is the underlying cause of the phenomenon?

Explanation purposes of nursing research (Qual)

What does the phenomenon mean?

What is a systematic review?

A methodical process that summarizes and evaluates evidence from multiple studies.

How is a systematic review different from a literature review?

It evaluates current evidence, rather than simply summarizing literature.

What is a meta-analysis?

Combines results from multiple quantitative studies using statistics.

What is a metasynthesis?

Combines and interprets findings from multiple qualitative studies.

What is meta-aggregation?

Combines findings from qualitative studies without mainly interpreting them.

What is a mixed studies review?

Combines both quantitative and qualitative studies.

What is Level 1 of the Polit–Beck Evidence Hierarchy? (Top)

Systematic review / meta-analysis

• Secondary

What is Level 2 of the Polit–Beck Evidence Hierarchy?

Randomized controlled trial (RCT)

• Primary

What is Level 3 of the Polit–Beck Evidence Hierarchy?

Nonrandomized trial (quasi-experiment)

What is Level 4 of the Polit–Beck Evidence Hierarchy?

Systematic review of non-experimental (observational) studies

What is Level 5 of the Polit–Beck Evidence Hierarchy?

Non-experimental / observational study

What is Level 6 of the Polit–Beck Evidence Hierarchy?

Systematic review / metasynthesis of qualitative studies

What is Level 7 of the Polit–Beck Evidence Hierarchy?

Qualitative / descriptive study

What is Level 8 of the Polit–Beck Evidence Hierarchy?

Nonresearch source, such as internal evidence or expert opinion

Which level of the Polit–Beck Evidence Hierarchy is considered the best and least biased?

Level 1 - Systematic review / meta-analysis

What does PICO stand for?

• P — Population 

• I — Intervention 

• C — Comparison 

• O — Outcome

5 step process of EBP

1. Formulating your clinical (bedside) question

   1. Letting patients inform you 

2. Searching for evidences

3. Appraising (critique) evidence

4. Applying evidence to practice

5. Evaluating evidence use

What is a concept?

A general, abstract idea or thought that may mean different things to different people.

Why are concepts important in research?

They are the building blocks of research.

What is a construct?

A concept that has been clearly defined by identifying its parts and how they can be measured.

When does a concept become a construct?

When its parts are defined and can be measured.

What is the difference between a concept and a construct?

• Concept - broad and unclear

• Construct - more specific and measurable.

What do you initially use in research: concept or contruct?

Concept

What are people called in qualitative research?

Participants

What are people called in quantitative research?

Subjects

What is an operational definition?

A specific explanation of how researchers will measure a concept and collect the needed information.

What does “measurable” mean for an operational definition?

It explains exactly what researchers need to do to measure the concept

What is an independent variable?

The thing that is changed or can change.

What letter is the independent variable in PICO?

I

Can the independent variable be manipulated?

Yes

What is a dependent variable?

The outcome of a change.

What letter is the dependent variable in PICO?

O

What is the difference between independent and dependent variables?

• Independent = what changes

• Dependent = the outcome of the change

What is a relationship in research?

A connection between phenomena.

How can a relationship between variables be expressed?

If there is more of Variable X, there is more or less of Variable Y.

What is an example of a relationship between variables?

More frequent turning of bedridden patients → fewer pressure ulcers

How are relationships often expressed in quantitative research?

In terms of more than or less than

What is cause and effect in quantitative research?

A relationship where one variable (the cause) determines the other variable (the effect).

What type of research can demonstrate cause and effect?

Experimental studies

• Especially randomized controlled studies (RCTs).

What is an experimental study?

A QUANTITATIVE study where the researcher gives a treatment and changes a variable.

What can an experimental study show?

• Cause and effect

• Relationships

What is a nonexperimental study?

• A QUANTITATIVE study with no treatment or manipulation

• The researcher observes variables.

What does a researcher do in a nonexperimental study?

Observes variables without changing them

What is a predictor variable?

A variable used to predict another variable in a nonexperimental study.

What can a nonexperimental study show?

Correlation, or a relationship between variables

• NO CAUSE AND EFFECT

What is the main difference between experimental and nonexperimental studies?

• Experimental = researcher changes a variable.

• Nonexperimental = researcher observes without changing variables.

What are the 3 major qualitative research traditions?

1. Phenomenology

2. Grounded theory

3. Ethnography

What does phenomenology study?

Lived experiences and their meaning

What is the main focus of phenomenology?

One phenomenon only.

• Example - Studying what it is like for patients to live with chronic pain

What does ethnography study?

Cultures

• Studying the culture and practices of nurses in an ICU

What does grounded theory study?

Processes and theory development

What is the goal of grounded theory?

To develop a theory about a process

• Example - Studying the process of how new nurses adjust to their first year of practice

What are the 5 major steps in quantitative research?

1. Conceptual

2. Design

3. Empirical

4. Analytic

5. Dissemination

What happens during the conceptual phase?

1. Identify the problem

2. Develop the question

3. Review the literature

4. Choose a framework

5. Develop a hypothesis

What happens during the design phase?

• Choose the sample and variables

• Get IRB approval