Chapter 18: Evidence-Based Practice

When providing care to patients, nurses use evidence-based practice whenever they:

a. advise patients with musculoskeletal back pain to continue normal daily activities within limits of their pain tolerance

b. advise patients with musculoskeletal back pain to remain on bedrest until pain has been relieved by prescribed back exercise.

c. advise patients that early premature activity with musculoskeletal pain may lead to permanent disability.

d. advise patients that continued normal activity after a musculoskeletal back injury

may result in delayed return to work.

a. advise patients with musculoskeletal back pain to continue normal daily activities within limits of their pain tolerance

Research has demonstrated that with early ambulation, even patients with back pain recover more quickly without complications. Research has disproved the previous understandings about early ambulation noted in options B, C, and D.

When providing care to postoperative patients, nurses use evidence-based practice whenever

they

a. continue bedrest after surgery until the pain level is 1 on a scale of 1 to 10.

b. continue bedrest after surgery until the pain level is 2 on a scale of 1 to 10.

c. ambulate patients as soon as possible after surgery

d. ambulate patients as soon as they are awake from anesthesia.

c. ambulate patients as soon as possible after surgery

Research supports the use of early ambulation in surgical patients. According to the research, ambulation is not based on pain level. Option D could possibly be an unsafe practice. The patient needs to be fully awake and responsive after anesthesia prior to attempts to ambulate.

When providing care to patients, nurses understand that evidence-based practice supports the concept that:

a. to avoid atelectasis and pneumonia, use of an incentive spirometer has an outcome equal to coughing for a patient following surgery.

b. to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery.

c. to avoid atelectasis and pneumonia, use of an incentive spirometer has a worse outcome than coughing for a patient following surgery.

d. neither coughing nor use of an incentive spirometer will avoid atelectasis or pneumonia in postoperative patients.

b. to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery.

Research supports the use of the incentive spirometer to avoid postoperative atelectasis. Evidence supports the use of the incentive spirometer to prevent atelectasis postoperatively.

When providing care to a child requiring temperature measurement, nurses use evidence-based practice whenever they:

a. understand that a rectal temperature is the most accurate method in a child.

b. understand that a rectal temperature is the least accurate method in a child.

c. understand that an axillary temperature is the most accurate method in a child.

d. understand that adding 1C to an axillary temperature in a child is as accurate as a rectal temperature.

a. understand that a rectal temperature is the most accurate method in a child.

Research demonstrates the accuracy of taking rectal temperatures in children versus the axillary mode. Research supports the use of rectal temperature as the most accurate method to use in children.

When providing care to patients at risk for ARDS, nurses use evidence-based practice whenever they:

a. suction a patient at high risk for developing ARDS every 2 hours.

b. suction a patient at high risk for developing ARDS whenever crackles are

auscultated.

c. turn a patient at risk for developing ARDS every 2 hours.

d. turn a patient at risk for developing ARDS every 5 minutes.

d. turn a patient at risk for developing ARDS every 5 minutes.

Research has shown that turning a patient at risk for developing ARDS every 5 minutes reduces that risk. There are hospital beds now designed to provide that care. There is no evidence to support options A, B, and C as measures to reduce the risk for patients to develop ARDS.

When providing care to patients, nurses use evidence-based practice to avoid urinary tract infections whenever the insertion of a urinary catheter is performed by

a. a UAP.

b. an RN.

c. an LPN.

d. a senior nursing student.

b. an RN.

Research supports the use of only RNs to insert urinary catheters to avoid urinary tract infections. There is no evidence to support the use of the staff members in options A, C, and D in inserting urinary catheters to avoid urinary tract infections.

When collecting data for research purposes on patient safety methods, the nurse would use

a. maximum census of patients on a specific unit over the course of admissions for 1 year.

b. maximum census of the entire hospital over the course of admissions for 1 year.

c. information obtained in other, similar research projects.

d. appropriate research design.

b. maximum census of the entire hospital over the course of admissions for 1 year.

Reliable research results are usually supported by the study of larger samples. Option A may be too small of a sample to produce valid or reliable data. Other studies may not provide data appropriate to the specific question to be researched and the studies must be validated before they are relied on. Research design cannot be the essential factor to confirm validity.

The nurse explains the PICO acronym to colleagues in which of the following ways?

a. PICO represents the questions to ask regarding application of the research to the specific setting.

b. PICO represents the trigger for initiating the research.

c. PICO represents the benchmarking website used in research.

d. PICO represents the regulatory guidelines established for practitioners.

a. PICO represents the questions to ask regarding application of the research to the specific setting.

PICO is the acronym used in formulating research questions and stands for P = patient or population, I = intervention, C = comparison or alternative intervention used, and O = outcomes. Options B, C, and D do not represent the purpose or focus of the acronym PICO.

When making clinical practice changes, nurses should make permanent changes based on:

a. reviewing other unit practices

b. reviewing case reports.

c. obtaining expert opinions.

d. implementing piloting changes.

d. implementing piloting changes.

Piloted changes should be implemented first because there are data to support them. Options A, B, and C are not supported by research.

When integrating evidence-based research into practice, the nurse understands that the type of research is important to the application of a particular nursing unit. Which of the following factors is most important in determining the usefulness of the research to the needs of the practice?

a. Randomized clinical trials

b. Case studies

c. Anecdotal information

d. Single correctional studies

a. Randomized clinical trials

Randomized trials are clinically the most reliable because of the randomization of the group studied. The other options are not a good method for establishing reliability in research.

A novice nurse observes change differences in practice from what was taught in nursing school and expresses confusion to the nurse manager. The nurse manager suggests which of the following methods as the best resource to determine best practice in the clinical setting?

a. Ask a former faculty member.

b. Review the textbook used during nursing school.

c. Research electronic databases such as CINAHL.

d. Attend professional conferences.

d. Attend professional conferences.

Professional conferences usually present current research. Research electronic databases such as CINAHL will provide only current published research. Sometimes the time between the actual research and its publication may be lengthy and cause it to be irrelevant. Options A and B may not provide current research information.

Harm to patients from medication errors is a component to initiation of research in which of the following ways?

a. Establishing a question

b. Establishing a solution

c. Establishing a population sample

d. Establishing a cost benefit

a. Establishing a question

Establishing the questions is a major first step to initiating research. In the case, the question is WHY? The other options are not part of the initial steps for establishing reasons for research.

Which responses by nurses incorporate reasons for resistance to research utilization?

a. "I want to see the outcomes for the patients."

b. "I believe that patients will not benefit from this change."

c. "I've grown tired of doing it the same way."

d. "I'm ready for a change."

b. "I believe that patients will not benefit from this change."

Some people are resistant to change because they have a belief that it will not be beneficial to the patient or themselves. Statement A shows interest in the possible change and not resistance. Statement C shows interest in the possible change and not resistance. Statement D shows interest in the possible change and not resistance.

A student nurse is conducting a research project for school. Although this is a new assignment, she understands that the quickest and most dependable source of information is the Internet. Which resources require intervention by the instructor?

a. Wikipedia

b. CINAHL

c. MEDLINE

d. Online nursing journals

a. Wikipedia

This is not a reliable source for research purposes and would require intervention by the instructor. The other options are legitimate sources for research and do not require intervention.

A nurse involved in evaluating the validity of research prior to implementation should consider which of the following as the most important hierarchical evidence for effectiveness?

a. Opinions from experts

b. Single observational studies

c. Randomized controlled versus nonrandomized trials

d. Systematic review study

c. Randomized controlled versus nonrandomized trials

Randomized controlled studies are most important for determining the effectiveness of the study. The other options are less important for determining the importance of the study.

Of the steps to implementation, research is not complete until which of the following steps is accomplished?

a. Synthesizing relevant research

b. Determining the sufficiency of the sample

c. Instituting the change

d. Monitoring the outcome

d. Monitoring the outcome

Monitoring the outcome is the final step in determining whether to continue with the new practice. The other options are a step to implementation but is not the final step.

Which of the following would be considered a sentinel event?

a. Patient who has developed a fatal mediastinal infection 7 days after cardiac

surgery

b. Patient who experiences a CVA during a cardiac catheterization

c. Patient who receives a double dose of a medication in error

d. Wrong patient scheduled for a chest radiograph

a. Patient who has developed a fatal mediastinal infection 7 days after cardiac surgery

The unexpected death of a patient is a sentinel event and would require investigation by the appropriate hospital committee. The other options do not qualify as a sentinel event.

Which of the following would most likely present the most difficult step in research utilization?

a. Monitoring outcomes

b. Determining the research question

c. Instituting the change

d. Piloting the project

c. Instituting the change

Buy-in by the staff may be the most difficult step because people are usually very resistant to change. The others are a step in research utilization but is not the hardest to implement.

When providing care to patients, nurses make patient care decisions based on which of the following? (Select all that apply.)

a. Resource availability

b. Nurse practice act

c. Shared governance

d. Managerial leadership style

e. Tradition

f. Clinical circumstances

b. Nurse practice act

e. Tradition

f. Clinical circumstances

Options B, E, and F are components relied on in making patient care decisions in nursing. Options A, C, and D are not part of the nurse's decision-making process.

n determining the applicability of a research study, the nurse must look at many factors. Which factors can be used to determine appropriateness of the research to the individual

setting? (Select all that apply.)

a. Sample size

b. Credentials of authors

c. Time element

d. Context

e. Intervention used

a. Sample size

d. Context

e. Intervention used

Research to be used in clinical practice should have appropriate sample size. Research to be used in clinical practice should have context to current question to be researched. Research to be used in clinical practice should have appropriateness of intervention. Options B and C are not factors used to support validity or applicability.

Based on the Iowa model for evidence-based practice, research is initiated because of either problem- or knowledge-based triggers. The nurse understands that these triggers may arise as a result of (Select all that apply.)

a. staff complaints.

b. an increase in surgical infection rates.

c. an increase in chronic renal failure following use of dye during radiographic

procedures in diabetic patients.

d. medicare reimbursement changes.

e. a new nurse manager.

b. an increase in surgical infection rates.

c. an increase in chronic renal failure following use of dye during radiographic

procedures in diabetic patients.

d. medicare reimbursement changes

Options B, C, and D are a possible trigger of problems or knowledge that leads to research according to the Iowa model for evidence-based practice. Options A and E are usually the basis to support research.

After piloting changes based on evidence-based research, the nurse understands that they will be instituted as a result of the effects on which of the following? (Select all that apply.)

a. Staff

b. Number of UAPs available

c. Cost

d. Patient

e. Census

a. Staff

c. Cost

d. Patient

Changes based on research will ultimately be instituted based on the effects of these factors. Options B and E do not generally affect the institution of the research.

After piloting an evidence-based clinical practice change, the nurse would (Select all that apply.)

a. institute the change.

b. pilot the project until the desired outcome is achieved.

c. determine applicability for use

d. incorporate changes into practice.

e. pilot the project until consensus is achieved.

a. institute the change.

c. determine applicability for use

d. incorporate changes into practice.

Following the appropriate piloting of a project, the changes should be implemented after determining applicability. Options B and E are counterproductive to legitimate research.

Maintaining currency in a profession is achieved through (Select all that apply.)

a. academic inquiry.

b. continuous participation in professional organizations.

c. asking questions of other professionals.

d. observing your role model's practice.

e. participation in evidence based projects.

a. academic inquiry.

b. continuous participation in professional organizations.

e. participation in evidence based projects.

Options A, B, and E are a method by which the professional nurse would keep current. Options C and D are an incorrect method for maintaining professional currency because it does not ensure accuracy or currency.

The questions that nurse researchers should ask before beginning their study include which of the following? (Select all that apply.)

a. Why are we doing it this way?

b. Where is the evidence to support this practice?

c. How much will it cost to change?

d. Can we as nurses lose our jobs if we implement this?

e. What is a better way of doing this?

a. Why are we doing it this way?

b. Where is the evidence to support this practice?

e. What is a better way of doing this?

Questions should be asked about why we practice the way we currently do and why we should want to change that practice before beginning any research. The other questions should not be relevant to practice change.