EBP Final Exam

Steps of EBP

1. ask a clinical question

2. collect evidence

3. evaluate evidence

4. Combine evidence with clinical expertise and patient preference

5. evaluate patient outcome

Full review

Necessary when vulnerable population are involved AND when risks are not minimal

Require ALL MEMBERS of the board to participate in review

expedited review

-used when there is minimal risk (aka "Everyday" risk)to human subjects

-Not all IRB members required to review the protocol

exempt review

used when there is no risk

justice

equity or fairness in the distribution of burdens and benefits, Individuals have the Right to fair treatment and privacy (confidentiality, anonymity)

beneficences

the principle of "Doing Good" for patients

autonomy

Individuals should be treated as autonomous, having the ability to make decisions about their health, lives, and bodies. This leads to voluntariness

informed consent

Ensure that participants:

- Have adequate information about the research

-Can comprehend that information

-Have free choice in deciding whether to participate in or withdraw from the study

problem statement

formally identifies what problem is being addressed in the study

purpose statement

indicates the aim of the study

research question

carefully formulated inquiry that guides the type of data to collect in a study. is specific, measurable, and focuses on a clinical issue or problem. PICO is a type of research question

PICO question types

-Intervention or therapy

-Etiology

-Diagnosis or diagnostic test

-Prognosis or prediction

-Meaning

Intervention or therapy PICO question

To determine which treatment leads to the best outcome

Etiology PICO question

To determine the greatest risk factors or causes of a condition

Diagnosis or diagnostic test PICO question

To determine which test is more accurate and precise in diagnosing a condition

Prognosis or prediction PICO question

To determine the clinical course over time

Meaning PICO question

To understand the meaning of an experience for a particular individual, group, or community

theory

A set of Concepts linked through Propositions to provide an explanation of a phenomenon

control

- Ability to manipulate, regulate, or statistically adjust for factors that can affect the dependent variable

- researcher taking steps to hold the conditions of the study uniform and avoid or decrease the effect of extraneous variable on the dependent variable or outcome

quantitative research

the investigation of phenomena using manipulation of numeric data with statistical analysis.

qualitative research

- explores subjective experiences and in-depth understandings through non-numerical data like interviews and observations (exploratory and descriptive)

- Useful in understanding human experiences such as pain, caring, powerlessness, and comfort

- do not plan to make group comparisons

-not true causality but pattern of data can reveal causal interpretations

key characteristics of experimental research

Manipulation, Randomization, Control

Case control

compares those with a disease and without, calculates odds ratio

cohort study

- A type of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease

- calculates relative risk

4 major qualitative designs

-Phenomenology

-Ethnography

-Grounded Theory

-Historical Research

Phenomenology

- type of qualitative design

-focuses on the discovery of the Meaning of People's Lived Experience

- Main data source: In-depth interview/conversations with participants

Ethnography

- type of qualitative design

-focus on culture

grounded theory

-type of qualitative design

-approach to the study of social life that attempts to generate a theory from the constant comparing of unfolding observations

historical research

- type of qualitative design

-focuses establishing facts about and relationships among past events

-analysis of non-numerical data, such as documents, artifacts, and oral histories

sampling methods used in qualitative research

-Purposive

-Convenience (volunteer)

-Snowball (network)

-Theoretical

purposive sampling method

-used in qualitative research

-Researchers deliberately choose the cases that will best contribute to the study

theoretical sampling method

-used in qualitative research

-Involves decisions about where to find data to develop an emerging theory optimally

convenience (volunteer) sampling method

-used in qualitative research

- participants readily available and willing to volunteer

snowball (network) sampling method

- used in qualitative research

-Early participants refer other participants who met criteria for the research study

common ways of collecting data for qualitative studies

-Fieldwork

-Interview

-Focus group discussion

-Diaries

-Photo voices

-Think-aloud method

-observation

data saturation

the point in qualitative research where further data collection and analysis yield no new insights, themes, or pattern

Coding Techniques

-bracketing

-using language that reflects participants

-memoing: the practice of writing reflective notes about the data

-identifying Categories/Themes: makes complex data understandable, shows patterns, links data to themes

bracketing

researchers setting aside their own ideas, ensures the research reflects the participants perspectives only

trustworthiness

Concerns the "truth value" of qualitative data and qualitative analysis, extent to which researcher's interpretation

actually represents participant's perspectives

4 criteria of qualitative research trustworthiness

-Credibility = Confidence in the 'truth' of the findings

-Dependability = stability of data over time and over conditions

-Confirmability =the objectivity of the data—the potential for congruence between two or more people about data accuracy, relevance, or meaning

-Transferability =The extent to which findings can be transferred to other settings or groups (generalizability)

techniques to create trustworthiness

-triangulation

-prolong engagement: investing sufficient time to have in-depth understanding

-member checking : Sharing study results (themes, codes) with participants and obtaining critical feedback

-debriefing

triangulation

the use of multiple research methods, sources, analysts, etc as a way of producing more reliable empirical data than are available from any single method

aspects of research planning

​​determine all key study elements including:

-type of data

- timing

-subjects

-methods

- personnel

- budget

-technology

Pilot Testing

a trial run used to identify unexpected problems, confirm study feasibility, allow for revisions

4 levels of measurement

-nominal

-ordinal

-interval

-ratio

Nominal Data

-"name"

-data of categories only. Data cannot be arranged in an order or rank (Gender, Race, Religion, state of residence)

ordinal data

-data exists in categories that are ordered but differences cannot be determined or they are meaningless.

-Unequal intervals between categories

- ex:BMI category, star ratings, 1st, 2nd, 3rd

interval data

- Categories are orderable

- Differences between values can be found, but there is no absolute 0

- differences between points on the scale

are equivalent.

-Ex- fahrenheit, IQ scores, time

ratio data

- Measure Continuous orderable data.

-there IS a true zero.

- Distances between numbers are equal

- Contains a true ratio between values

- Ex: Age in year, incomes in dollars, Length, Width, Weight, Distance

validity

-The extent to which an instrument measures the attributes of a concept ACCURATELY

- Does the Instrument Accurately Measure What It Is Supposed to Measure?

reliability

instruments are considered reliable when used it gives consistency in the results

types of instrument's reliability

-internal consistency

-interrater reliability

-stability

-equivalence

stability

a type of instrument reliablity

-Concerned with the consistency of repeated measures or test-retest reliability

equivalence

-type of instrument reliability

-Focused on comparing two versions of the same instrument (alternate forms reliability) or two observers (interrater reliability) measuring the same event

internal Consistency / (Homogeneity)

the extent to which items within an instrument measure various aspects of the same characteristic or construct

Population

A particular group of individuals or elements who are the focus of the research. May be

humans, medical records, specimens

Target population

An entire set of individuals or elements who meet the sampling criteria

Accessible population

portion of the target population to which the researcher has reasonable access.

Researchers will reach out to them and ask for research participation

research sample

a subset of a population that is selected to represent the larger group in a study

Characteristics of appropriate research samples

-representativeness

-adequate sample size

-randomness

-relevance to research question

probability sampling method

Involves random selection of elements/participants

non probability sampling method

Does not involve selection of elements/participants at random

simple random sampling

type of probability sampling method

each individual in the population of interest has an equal probability of selection

stratified random sampling

type of probability sampling method

mini- reproduction of the population

Before sampling, the population is divided into characteristics of importance for the research. Then the population is randomly sample within each category (probability)

quota sampling

non probability sampling method

researcher deliberately selects participants based on specific characteristics, ensuring they represent certain attributes in proportion to their prevalence in the population

cluster sampling

probability sampling method

obtained by dividing the sample into sections or clusters and then selecting one or more clusters at random and using all members in the cluster(s) as the members of the sample

Convenience Sampling

non probability sampling method

-Use of the most readily accessible persons or objects as subjects in a study, may have volunteers

- great risk of bias

5 S's of pyramid of evidence in order from lowest to highest

Studies(case, quantitative, qualitative)

Syntheses

Synopses

Summaries

Systems (EHRs)

ex of syntheses

-systematic reviews

-Literature reviews (articles)

-Integrative reviews (Scholarly paper synthesizing published studies)

-meta analysis

-PRISMA

ex of synopses

Abstracts obtained through databases

Medical and medication updates and alerts to mobile apps

literature or narrative review

Literature (or narrative) reviews an article based on common or uncommon elements. Little or no concern for research methods, design, reporting

PURPOSE: Summarize existing knowledge on a topic, Identify gaps in the research

systematic review

rigorous and synthesis of research findings about a clinical problem

PURPOSE: Answer a specific research question, Collect, evaluate, and synthesize all available evidence

descriptive statistics

-Summarize and describe numerical data

-Describe the sample

- May be used to draw conclusions

-Types: Frequency Distribution, mean, median, mode, standard deviation

inferential statistics

-used to test hypotheses, making inferences from a sample to population.

Two main types: Parametric Tests and Nonparametric Tests

Frequency Distribution

-type of descriptive statistic

-organization of raw data in a table - uses classes and frequencies

Measures of central tendency

type of descriptive statistic

mean, median, mode, standard deviation.

Distribution of data

type of descriptive statistic

Normal distribution vs others (e.g., Bimodal, Skewed, Multimodal)

bimodal data

a distribution that has two distinct peaks or modes

skewed data

a dataset where the distribution of values is not symmetrical, --> results in a curve that appears distorted or stretched towards one side, either the left or right, of the distribution

pearson R values

R value -1 = a negative aka perfect inverse relationship

R value +1=perfect positive correlation

R value 0= no relationship

R value between -0.3-+0.3 = weak linear relationship

R value between -0.5 to -0.3 or +0.3 to +0.5= moderate linear relationship

R value <-0.5 or >+0.5 =strong linear relationship

pearson R value -1

perfect inverse or negative relationship

Pearson R value +1

perfect positive correlation

Pearson R value 0

no relationship

pearson R value between -0.3-+0.3

weak linear relationship

pearson R value between -0.5 to -0.3 or +0.3 to +0.5

moderate linear relationship

pearson R value <-0.5 or >+0.5

strong linear relationship

Parametric Tests

type of inferential statistic

-t-test (t)

-ANOVA (f)

- Person's r (correlation)

-Regression

Nonparametric tests

type of inferential statistic

- Chi square

T test

type of Parametric Tests

statistically tests whether two group means are different

ANOVA

type of Parametric Tests

Analysis of Variance- statistically tests whether three or more group means are different, utilizes f test

pearson's R

type of Parametric Tests

- tests correlation:used to determine the strength and direction of the relationship between two variable

regression

type of parametric test

used to predict outcome relationships such as how does x effect y

Chi Square

type of nonparametric test

Used when data are at the Nominal level and the researcher wants to determine whether groups are different regarding the outcomes.

Ex: Is there any difference between the proportion of males and the proportion of females who ever use e-cig

evidence levels ranked highest to lowest

1. systematic reviews, meta analysis, EBP guidelines

2. randomized control trials

3. quasi experiment

4. cohort or case control studies

5. evidence from systematic reviews of descriptive/qualitative studies

6. evidence from single descriptive/qualitative studies

7. evidence from opinion of authority/reports of expert committees

clincal practice guideline

allow best practices, research and EBP based, guiding the care in specialty areas with specific clinical issues- Statement describing recommended practice

adoption

integrating innovation into their regular routines or systems during the trial phase.

shows that the innovation is not just being tested but is gaining acceptance and traction with its intended users.

rejection

Try it and decided not to adopt ( Active rejection) or never considered using innovation (passive rejection)

stakeholder's importance in change

they influence, support, and are affected by the change. These can include nurses, patients, physicians, administrators, and even policymakers.

nurse roles in EBP

Identify Clinical Questions

Search and Appraise Evidence

Apply Evidence to Practice

Evaluate Outcomes

ways EBP is used in EHR

Risk Assessment Alerts

Embedded Protocols

documentation prompts

tracking outcomes