NUR 220 - Exam 1

Evidence-Based Practice (EBP)

the conscientious use of current best evidence in making decisions about patient care

True or false: evidence-based practice does not translate research findings into practice

false

Why should we use EBP?

• higher-level of satisfaction

• reducing the escalating turnover rate in healthcare professions

• delivering high-quality, safe care

• saving healthcare dollars

What are the 5 steps of EBP?

1. Framing the important clinical question

2. Searching for relevant research-based evidence

3. critically appraising the evidence

4. Integrating evidence with other factors & translating into practice

5. Assessing effectiveness

True or false: due to the abundance of information available, finding the right information is like searching for a needle in a haystack

true

What is the best way to find the correct information?

Asking a searchable and answerable question

What does PICO stand for?

P - patient population of interest

I - intervention of interest

C -comparison

O - outcome

What does PICOT stand for?

P - patient population of interest

I - intervention of interest

C - comparison

O - outcome

T - time

Patient population

• age

• gender

• ethnicity

• populations with certain disorders (ex: diabetes)

Intervention

• Treatment

• Risk behavior

Comparison

• Second treatment

  • No treatment

  • Placebo

  • Typical care

• Absence of risk factor

Outcome of interest

• Risk of disease

• Improvement of symptoms

• Occurrence of adverse outcome

Time

• Time it takes for the intervention to achieve the outcome (over 6 months)

• Time in which the population is observed for an outcome (during chemo)

PICO question templates

• In ___ (P), how does ____ II) compared to _____ (C) affect (O) within ____ (T)?

• In ____ (P), how does ___ (I) compared to _____ (C) influence/predict _____ (O) over _____ (T)?

• In ___ (P) are/is ____ (I) compared with ___ (C) more accurate in diagnosing ____ (O)?

• Are ___ (P), who have __(I) compared with those without __ (C) at risk for/of _____ (O) over ___ (T)?

• How do ___ (P) with ____ (I) perceive ____ (O) during ____ (T)?

In the following scenario, what is the P?

Falling is a challenging problem with
serious consequences and morbidity among
older people. An older person who falls is
at risk for functional disability and
consequently, institutionalization.

You have heard that exercise can prevent
falls, and you are wondering whether you
should recommend an exercise program for
your older patients.

P - older adults

In the following scenario, what is the I?

Falling is a challenging problem with
serious consequences and morbidity among
older people. An older person who falls is
at risk for functional disability and
consequently, institutionalization.

You have heard that exercise can prevent
falls, and you are wondering whether you
should recommend an exercise program for
your older patients.

I -exercise

In the following scenario, what is the C?

Falling is a challenging problem with
serious consequences and morbidity among
older people. An older person who falls is
at risk for functional disability and
consequently, institutionalization.

You have heard that exercise can prevent
falls, and you are wondering whether you
should recommend an exercise program for
your older patients.

C - no exercise

In the following scenario, what is the O?

Falling is a challenging problem with
serious consequences and morbidity among
older people. An older person who falls is
at risk for functional disability and
consequently, institutionalization.

You have heard that exercise can prevent
falls, and you are wondering whether you
should recommend an exercise program for
your older patients.

O - falls

In the following scenario, what is the P?

A woman is brought to the ER with a 3-day
history of nausea, vomiting, and headache.
The only drug she is taking is
acetaminophen for her headache. The lab
results reveal that she has a hepatitis B
infection.

She has heard that acetaminophen can
cause liver problems, and she is wondering
whether she should continue taking the
drug for her headache, considering the
diagnosis.

P - women with hepatitis B

In the following scenario, what is the I?

A woman is brought to the ER with a 3-day
history of nausea, vomiting, and headache.
The only drug she is taking is
acetaminophen for her headache. The lab
results reveal that she has a hepatitis B
infection.

She has heard that acetaminophen can
cause liver problems, and she is wondering
whether she should continue taking the
drug for her headache, considering the
diagnosis.

I - acetaminophen

In the following scenario, what is the C?

A woman is brought to the ER with a 3-day
history of nausea, vomiting, and headache.
The only drug she is taking is
acetaminophen for her headache. The lab
results reveal that she has a hepatitis B
infection.

She has heard that acetaminophen can
cause liver problems, and she is wondering
whether she should continue taking the
drug for her headache, considering the
diagnosis.

C - no acetaminophen

In the following scenario, what is the O?

A woman is brought to the ER with a 3-day
history of nausea, vomiting, and headache.
The only drug she is taking is
acetaminophen for her headache. The lab
results reveal that she has a hepatitis B
infection.

She has heard that acetaminophen can
cause liver problems, and she is wondering
whether she should continue taking the
drug for her headache, considering the
diagnosis.

O - liver problems

In the following scenario, what is P?

Pressure ulcers are extremely prevalent in
older nursing home residents. Inadequate
hydration impedes pressure ulcer healing.

Nurses are interested in finding out whether
fluid treatment to older nursing home
residents with pressure ulcers enhances
pressure ulcer healing.

P - older nursing home residents with pressure ulcers

In the following scenario, what is I?

Pressure ulcers are extremely prevalent in
older nursing home residents. Inadequate
hydration impedes pressure ulcer healing.

Nurses are interested in finding out whether
fluid treatment to older nursing home
residents with pressure ulcers enhances
pressure ulcer healing.

I - fluid treatment

In the following scenario, what is C?

Pressure ulcers are extremely prevalent in
older nursing home residents. Inadequate
hydration impedes pressure ulcer healing.

Nurses are interested in finding out whether
fluid treatment to older nursing home
residents with pressure ulcers enhances
pressure ulcer healing.

C -no fluid treatment

In the following scenario, what is O?

Pressure ulcers are extremely prevalent in
older nursing home residents. Inadequate
hydration impedes pressure ulcer healing.

Nurses are interested in finding out whether
fluid treatment to older nursing home
residents with pressure ulcers enhances
pressure ulcer healing.

O - pressure ulcer healing

When do we use time in a PICO question search?

to further narrow the research available. if thousands of articles appear in response to your original PICO question, then add T to narrow the amount avaliable

Research Variables

concepts at various levels of abstraction that are measured or manipulated in a study

What are variables characterized by?

degrees, amounts, & differences within a study

What is the variable of the example:

How many days you had taken off from work in the previous year?

days off

What is the variable of the example:

Which option best describes your preference?

1). work alone

2). group work

work preferences

What is the variable of the example:

apples, bananas, oranges, grapes

fruit

True or false: the outcome of the PICO question will always be a variable

true

How many variables do most PICO questions have?

2 variables (I/C & O) - sometimes 3 if C is separate

experimental research

researchers actively introduce an intervention or treatment

• researchers manipulate or change something in the research

nonexperimental research

researchers collect data without intervening or introducing treatments

True or false: independent & dependent variables are nonexperimental research types

false - experimental research

Independent variable

variable manipulated by the researcher

• treatment variable

• experimental variable

• stimulus

Dependent variable

outcome variable

• response or effect to the manipulation of independent variable

Research

a systematic inquiry using disciplined methods to solve problems

Why do we conduct research?

to develop knowledge about issues of importance to the profession

Nursing Research

systematic inquiry to develop knowledge about issues of importance to the nursing profession

What does nursing research typically focus on?

• health promotion

• illness prevention

• assessment, diagnosis, & management of chronic illnesses

What are the 5 phases of a research study?

1. conceptual phase

2. design & planning phase

3. empirical phase

4. analytic phase

5. dissemination phase

Conceptual phase

• phase 1

• research problem & purpose

• literature review

• study framework

• objectives, research questions, hypothesis

Design & planning phase

• phase 2

• research design

• population & sample

• methods of measurement

• protection of human/animal rights in study

Empirical phase

• phase 3

• data collection

Analytic phase

• phase 4

• data analysis

• interpretation of research outcomes

Dissemination phase

• phase 5

• communicating the findings in a research report

• utilizing findings in practice

Peer Review (Refereed)

utilized to protect, maintain, & raise the quality of scholarly publications

• critical evaluation of research findings by peers of author

• revisions may be required

• acceptance for publication implies that the research is reliable

What is the #1 nursing database?

CINAHL

Database

collection of journals & articles are what you use to inform research

True or false: research journal articles are the secondary method of disseminating research evidence

FALSE - research journal articles are the primary method

What is the general layout of a research journal article?

• abstract

• introduction

• methodology

• results

• discussion/conclusions

True or false: PICO question is only relevant to articles if BOTH the intervention & comparison match

True

Abstract

brief description of major features of a study stated at the beginning of a journal article

• single paragraph (between 100-350 words)

• sometimes has specific headings

• does not give enough info

  • info provided is not in-depth

Introduction

describes the central phenomena, concepts, or variables of the study

• study significance (need for it)

• review of literature

• study purpose, research questions, hypotheses

• theoretical/conceptual framework is how the 2 variables are compared

Methods

describes the research design

• samples: sampling plan & eligibility criteria of study participants

• setting

• methods of operationalizing variables & collecting data

• study procedures (protection of participants)

• analytic methods

Results - Quantitative studies

• descriptive information (description of subjects)

• results of statistical analyses

  • names of statistical tests

  • value of calculated statistics

• level of statistical significance

• precision & magnitude of effects (sometimes)

Results - Qualitative studies

findings often organized according to major themes, processes, or categories identified in the analysis

• almost always includes raw data: quotes directly from study participants

discussion

describes the interpretation of the results

• study strengths & limitations

• implications for nursing practice & further research

What are the two types of research evidence?

1. primary research

2. summative research

Primary research articles

the research articles that are produced by the researchers or scientists that conducted the experiment

• explains exactly what the researcher did

• results or findings are frequently released in primary

summative research article

• systematic review

• meta-analysis

• meta-synthesis

Systematic review

synthesizes past research by drawing overall conclusions from many individual studies that are believed to address a similar research question

Meta-Analysis

research technique that synthesizes & analyzes quantitative scientific evidence

• uses statistical procedures to pool results from independent primary studies

• usually includes experimental/quasi-experimental

Meta-Synthesis

research techniques that synthesizes & analyzes qualitative scientific evidence

• identification of key concepts

• interprets & translates findings

• only qualitative studies

What type of data does quantitative researchers collect?

numeric data

What type of data do qualitative researchers collect?

narrative data

What is quantitative research used to do?

• describe new situations, events, or concepts

• examine relationship among variables

• determine the effectiveness of treatments

What is qualitative research used to do?

• understand & explore

• focus on subjective experience of individuals

• identify themes & patterns

Setting

the specific location where information is gathered

True or false: quantitative researchers often work in uncontrolled settings

false - they work in controlled settings (intervention occurs)

True or false: qualitative studies take place in naturalistic settings by researchers who engage in fieldwork

true

Paradigm

a general perspective on the complexities of the real world, with certain assumptions about reality (a world view).

Positivist paradigm

reality exists; there is a real world driven by natural causes

Naturalistic paradigm

reality is multiple & subjective, constructed by individuals

What are the two key paradigms for nursing research?

positivist & naturalistic paradigm

True or false: qualitative research is conducted through prolonged contact with participants in their environment

true - generates descriptive data (helps w full understanding)

Purpose statement vocab that indicates a qualitative study

• understand

• explore

• identify

What are some major qualitative designs?

• phenomenology

• grounded theory

• ethnography

• historical research

• critical theory: aim is social change for the better

• Feminist research: aim is to reveal gender bias & suggest change for better

Confounding (extraneous) variable

a variable that impacts the dependent variable. If not controlled, then this variable causes trouble when attempting to determine causality.

What are the purposes of literature review?

• a persuasive argument that the current study is necessary

• review of what we know & what we don’t know about a topic

• demonstrates “gap” in literature that the study will address

Secondary source

a document or recording that relates or discusses information originally presented elsewhere

what are the disadvantages of secondary sources?

• you never know if primary sources are accurately interpreted

• may omit essential parts of primary source

What are the advantages of secondary sources?

• efficiency

• aid in understanding of primary sources

Problem statement

a statement articulating the research problem and indicating the need for a study.

Statement of purpose

the researcher’s summary of the overall study goal

• found in introduction & abstract section

What does the statement purpose identify?

• key study variables

• population of interest

• the nature of the inquiry (describe, evaluate, etc)

research questions

the specific queries the researcher wants to answer in addressing the research problem

True or false: research questions are sometimes direct rewordings of statements of purpose

true

Hypotheses

the researcher’s predictions about relationships among variables

• must always involve at least two variables

• contains terms indicating a relationship

Directional hypothesis

predicts the direction of the relationship (more than, higher than)

Nondirectional hypothesis

predicts the existence of a relationship but not its direction

Research hypothesis

states what researcher thinks is true (actual prediction of relationship)

Null hypothesis

states no difference or relationship exists (absence of relationship)

True or false: the type of hypothesis used alters which is tested

false - the type of hypothesis used does not alter that the null hypothesis is always tested

True or false: the purpose of the study suggests the design of the study

true

What describes the research design?

method

What reports the findings from analyses?

results