NURSING RESEARCH MODULE 1

Asking Clinical Questions

Guides the search, does not reflect a practice change.

PICOT format

A structured format for asking foreground questions that includes Patient population/disease, Intervention or issue of interest, Comparison of intervention or issue of interest, Outcome of interest, and Time needed for the intervention.

PEO format

A format distinguished from PICOT for formulating research questions.

SPIDER format

Another format distinguished from PICOT for formulating research questions.

Barriers to Finding the Right Information

Includes lack of access to information, low comfort level with library and search techniques, lack of access to electronic resources, and lack of time to search for and read the best evidence.

Background questions

Asks for general information about a clinical issue, usually has two components: the starting place of the question and the outcome of interest.

Foreground questions

Asks for specific scientific evidence about diagnosing, treating, or educating patients, focusing on specific knowledge.

Intervention questions

Ask what interventions most effectively lead to an outcome.

Prognosis/prediction questions

Ask what indicators are most predictive of an outcome.

Diagnosis questions

Ask what test most accurately diagnoses an outcome.

Etiology questions

Ask to what extent a factor, process, or condition is highly associated with an outcome.

Meaning questions

Ask how an experience influences either an outcome or the scope of a phenomenon or the influence of culture on behavior or healthcare.

Patient population/disease (P)

The specific group of patients or the disease being studied in a PICOT question.

Intervention or issue of interest (I)

The specific intervention or issue being examined in a PICOT question.

Comparison of intervention or issue of interest (C)

The alternative intervention or issue being compared in a PICOT question.

Outcome of interest (O)

The specific outcome that is being measured or evaluated in a PICOT question.

Time (T)

The duration needed for the intervention to achieve the outcome or the time in the course of the disease/symptom.

PICOT Format: Intervention Template

In ________________(P) how does___________(I) compared to __________(C) affect ___________(O) within (T)____________?

PICOT Format: Prognosis Template

In ________________(P), how does___________(I) compared to _____(C) influence/predict _______(O)?

PICOT Format: Diagnosis Template

In ________________(P) are/is ___________(I) compared to _____(C) more accurate in diagnosing (O) ____________?

PICOT Format: Etiology Template

Are ________________(P) who have _________(I), compared to those without _________________(C) at ______________ risk for/of ___________ (O) over ____________(T)?

PICOT Format: Meaning Template

How do ________________(P) with _________(I) perceive _________________(O) during ____________(T)?

What is Evidence-Based Practice (EBP)?

A systematic search for and critical appraisal of the most relevant and best research to answer a clinical question, incorporating clinical expertise and patient preferences.

What are the components of EBP?

External evidence from research, clinical expertise, patient assessment, internal evidence from practice, and patient/family-valued preferences.

What is the purpose of the IOM's Roundtable on Evidence-Based Medicine?

To accelerate progress toward a learning healthcare system where evidence is applied and developed as a product of patient care.

Which initiative focuses on generating evidence for effective healthcare strategies?

The IOM's Roundtable on Evidence-Based Medicine.

What is the difference between Quality Improvement (QI) and Evidence-Based Quality Improvement (EBQI)?

EBQI integrates evidence with clinical expertise and patient preferences to identify best practices.

What does the U.S. Preventive Services Task Force (USPSTF) do?

It is a federally funded initiative that influences evidence-based practice.

What is the role of the Patient-Centered Outcomes Research Institute (PCORI)?

To support research that helps patients and healthcare providers make informed decisions.

What are the key components of the Magnet Recognition Program?

Transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation, and empirical quality results.

What is the goal of the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare?

To prepare interprofessional EBP experts through immersive training and integrate EBP into nursing curricula.

What does the term 'external evidence' refer to in EBP?

Research findings from peer-reviewed studies that inform clinical practice.

What is the significance of patient/family-valued preferences in EBP?

They ensure that care is aligned with what patients and families value, enhancing patient-centered care.

How does EBP facilitate healthcare's quadruple aim?

By improving patient outcomes, enhancing patient experience, reducing costs, and improving clinician well-being.

What is the main focus of evidence-based decision making in healthcare?

To utilize the best available evidence to inform clinical decisions and improve patient care.

What is the Seven-Step Process of EBP?

A structured approach to integrating evidence into clinical practice, though the specific steps are not detailed in the notes.

What does 'translational research' refer to in the context of EBP?

Research that aims to translate findings from basic science into practical applications in healthcare.

What is the importance of public awareness regarding evidence in healthcare?

To improve understanding of evidence and its significance in making informed healthcare decisions.

What does outcomes management involve in the context of EBP?

The systematic tracking of patient outcomes to inform practice and improve care.

What is a key characteristic of a learning healthcare system?

Continuous learning and improvement through the application and development of evidence.

What is the role of empirical quality results in EBP?

To provide measurable evidence of the effectiveness of practices and interventions.

What is the significance of integrating EBP throughout nursing curricula?

To produce highly skilled graduates who can implement and sustain evidence-based practices.

What is meant by 'critical appraisal' in the context of EBP?

The evaluation of research studies to determine their validity, reliability, and applicability to clinical practice.

What is the expected outcome of implementing EBP in healthcare settings?

Improved patient outcomes and enhanced quality of care.

What is the quadruple aim in healthcare related to evidence-based practice?

To advance and sustain evidence-based care.

What organization conducts national webinars on evidence-based practice?

Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare.

What is the purpose of the implementation toolkit based on the ARCC model?

To assist in the implementation of evidence-based practice.

True or False: Organizational culture and context are necessary for evidence-based practice to be implemented and sustained.

False.

True or False: According to Melnyk & Fineout-Overholt, there are six steps to the evidence-based practice process.

True.

What are some examples of barriers to evidence-based practice?

Lack of EBP knowledge and skills, cultures steeped in tradition, negative attitudes about research, lack of belief in EBP outcomes, information overload, lack of time and resources.

What facilitates the uptake of evidence-based practice in healthcare organizations?

A culture that makes EBP the standard, support from leadership, alignment of stakeholders, time for appraisal, clear research reports, and EBP mentors.

What strategies can be employed to eliminate barriers to using evidence-based practice?

Assess barriers and facilitators, conduct surveys or focus groups, document EBP status, expose non-buyers to real-case scenarios, and correct misperceptions.

In the provided scenario, what is identified as a barrier to evidence-based practice?

The timing and stipulations for attendance of the unit-based journal clubs.

What is the role of EBP mentors in healthcare organizations?

To provide excellent EBP skills and knowledge, as well as proficiency in individual and organizational change strategies.

What should practitioners learn to do regarding barriers and facilitators of EBP?

Overcome barriers and leverage facilitators to implement EBP.

What is a common misconception about evidence-based practice among practitioners?

That EBP will not result in more positive outcomes than traditional care.

How can organizations assess their readiness for implementing evidence-based practice?

By assessing organizational barriers, facilitators, culture, and readiness for system-wide implementation.

What is the significance of conducting surveys or focus groups with clinicians regarding EBP?

To assess baseline knowledge, beliefs, and behaviors regarding evidence-based practice.

What is one of the goals of the strategic plan mentioned in the scenario?

To ensure all policies are supported by evidence within 3 years.

What is the purpose of hosting unit-based journal clubs in the scenario?

To teach advanced critical appraisal skills.

What factor can limit staff attendance at unit-based journal clubs?

Census and staffing ratios.

What does EBP stand for?

Evidence-Based Practice.

What is the role of leadership in fostering an EBP culture?

To provide support and encouragement that fosters expectations for EBP.

What is one challenge faced by practitioners regarding the volume of information in professional journals?

The lack of time and resources to search for and critically appraise evidence.

What is the importance of clearly written research reports in EBP?

They facilitate understanding and implementation of findings.

What does the acronym ARCC stand for in the context of evidence-based practice?

Advancing Research and Clinical Practice through close Collaboration.

What does the PICOT question define in a research project?

The PICOT question defines the project focus and guides the search for relevant evidence.

What are the strengths of keyword searching in databases?

Keyword searching provides a quick snapshot of database relevance and allows for refinement using subject headings.

What are the weaknesses of keyword searching?

Keyword searching can be ambiguous and may not capture major topics in the article.

What should you do after identifying keywords from your PICOT question?

Start your search by determining the most likely sources to contain the best evidence.

Name one source of external evidence for clinical research.

Cochrane Database of Systematic Reviews (CDSR) is an example.

What types of content can be found in bibliographic databases?

Bibliographic databases contain records, full text articles, videos, and references to articles.

What fundamental question should you ask about the evidence in a database?

Is the evidence current and how frequently is the database updated?

What is the recommended strategy for searching synonyms in databases?

Conduct individual searches for each keyword, synonym, and subject heading to track the number of hits.

What are subject headings in the context of database searching?

Standardized terms used to locate material on a specific topic, helping to find information regardless of the author's terminology.

What is the purpose of using Boolean connectors in search strategies?

Boolean connectors like OR and AND help expand or restrict search results based on the presence of terms.

What are limit functions in database searches?

Filters that restrict search results based on criteria such as study design, language, or publication year.

Why is saving search histories important?

It allows for repeating searches in other databases or rerunning the search strategy later without retyping.

What is one method for managing citations in research?

Using reference management software (RMS) like EndNote to organize citations.

What is the ancestry method in advanced searching strategies?

Scanning references of articles to find additional relevant articles.

What is the purpose of handsearching in research?

To find articles that have not yet been indexed in databases.

What is the advantage of subject headings searching compared to keyword searching?

Subject headings may yield fewer hits but are more likely to be relevant to the clinical question.

What is truncation in the context of database searching?

A technique used to search for variations of a word by using a root word followed by a wildcard.

What is adjacency/proximity searching?

A search strategy that looks for terms that are close to each other in the text.

What is the purpose of database alerts or RSS feeds?

To notify users of new articles or updates related to their search topics.

What is a major weakness of searching titles for relevant articles?

It may miss studies that do not contain the keywords in the title.

Which databases are examples of bibliographic databases?

CINAHL and MEDLINE are examples of bibliographic databases.

What is the significance of using filters in database searches?

Filters help narrow down search results to more relevant articles based on specific criteria.

What should be done with citations of interest found in databases?

They should be printed, saved, emailed, or managed using citation management tools.