Scientific Basis Exam 1

evidence-based practice (EBP)

the act of basing practice on best evidence to make patient care decision to improve outcomes and being cost effective

-latest research + clinical skills + patient wants

1. individual clinical expertise

2. best available clinical evidence

3. patient's values and expectations

what is the triad of EBP to improve patient outcomes?

not

EBP is _____ research

research

-systematic and planned investigation

-specification of a problem to be investigated

-statement of predetermined outcomes

-contributes to understanding of the world

evidence-based practice (EBP)

-systematic research for, and appraisal of, best evidence to help answer a clinical question

-use of evidence for making clinical decisions, the evidence is often being produced by research

-account taken of individual needs of the client, we well as research-based evidence

-brings about changes in practice

-nurses need to apply up-to-date research in their daily practice to ensure high-quality care

-healthcare providers should know how to find, analyze, and use relevant evidence to their practice

-nurses should avoid anecdotal treatments

why is EBP important?

1. The Affordable Care Act (ACA)

2. Changes in Nursing Education

3. The Future of Nursing Report

what are the 3 major developments of EBP in healthcare and nursing?

1. Evaluate clinical practice to generate questions to improve nursing care.

2. Evaluate appropriateness and strength of the evidence.

3. Use best evidence in practice.

4. Participate in the implementation of a practice change to improve nursing care.

5. Participate in the evaluation of outcomes and their implications for practice.

6. Explain the rationale for ethical research guidelines, including Institutional Review Board (IRB) guidelines.

7. Demonstrate ethical behaviors in scholarly projects including quality improvement and EBP initiatives.

8. Advocate for the protection of participants in the conduct of scholarly initiatives.

9. Recognize the impact of equity issues in research.

what are 9 AACN BSN competencies related to evidence and EBP?

-Testable idea must be formulated and refined

-Research team must be assembled

-Preliminary data gathered

-Permissions must be obtained

-Regulatory requirements must be met

-Support must be obtained, including personnel, supplies, and funding

-Subjects must be enrolled

-Interventions must be delivered

-Data must be collected

-Analyses performed

-Dissemination (sharing) of data through presentations and publications

-Then, and maybe then, practitioners and/or facilities investigate embedding this into practice

-Assessment must be completed to see if these changes are working/not working

-And so on...

what is the timeline of evidence into clinical practice?

1. Tradition and authority/"experts"

2. Clinical expertise

3. Disciplined research

what are the 3 sources of evidence for current clinical practice?

multifaceted

research in nursing is _____________

best

If a nursing intervention is not based on the best research evidence, there is no way to determine if that intervention is the _______ one

evidence

a collection of facts believed to be accurate and true

external evidence

comes from outside your clinical setting

-generated through rigorous research

-intended to be generalized to other settings and clinical practices

internal evidence

comes from within your organization

-typically generated through practice initiatives such as program evaluations, quality improvement projects, and outcomes management

-often use internal data within an organization to make improvements

scientific evidence

produced from scientific research

-Uses a systematic and objective method to gather data

-Based on empirical data gathered in an unbiased approach

-Used to support or refute scientific theories or hypotheses

1. Objectivity

2. Reliability

3. Reproducibility

what are the 3 ways scientific evidence is characterized by?

1. Identify a problem or phenomenon that needs to be studied

2. Ask a question

3. Formulate a hypothesis or testable explanation

4. Designing an experiment to test the hypothesis

5. Analyze the data and make conclusions

6. Communicate the results

What are the 6 steps of the scientific method?

1. exploration

2. description

3. explanation

4. prediction

5. control

6. evaluation

7. development

what are the 7 types of research purposes and inquires?

exploration research

research that investigates a new area where little information exists

description research

research that describes characteristics or functions of a particular phenomenon or population

explanation research

research that explains why and how something happens, identifying causes and effects

prediction research

research that predicts future occurrences based on existing data and trends

control research

research that finds ways to influence or manage outcomes or variables

evaluation research

research that assesses the effectiveness of programs, interventions, or policies

development research

research that contributes to the creation of new theories, practices, or technologies

1. therapy/intervention

2. diagnosis/assessment

3. prognosis

4. etiology (causation/prevention of harm)

5. meaning and process

what are the 5 common types of research questions?

therapy/intervention research question

research question that learns more about specific treatments, interventions, actions, products, or processes

diagnosis/assessment research question

research question that looks at methods and instruments used to help diagnose or screen for a condition or assess a clinical outcome

prognosis research question

research question that understands the eventual outcome or consequences of diseases, conditions, or health problems

etiology (causation)/prevention of harm research question

research question that:

-understands the cause or determinant of what results in a health problem

-determines factors and exposures that lead to, cause, or affect various illnesses, mortality, or morbidity

meaning and process research question

research question that gains insight into clients' perspectives on how they perceive their treatments, diagnoses, etc.

evidence-based practice

the intentional application of current best evidence, clinician expertise, and patient values to make decisions that will result in best practice outcomes

-purpose = to improve patient outcomes and advance the discipline of nursing

research

experiments to examine a topic; uses processes to sample populations so the best representation of a population is present

-purpose = to discover new knowledge and advance the discipline of nursing

research utilization

applying research knowledge into clinical practice; used before evidence-based practice

-purpose = to improve patient outcomes and advance the discipline of nursing

quality improvement projects

projects implemented and the results are studied; is site specific so the results may not be the same at another facility

-purpose = to improve patient outcomes

framework

every study has a foundational _____________ to guide their research

theoretical framework

-based on various theories and concepts

-broader scope, applies beyond the research problem

-formulated with theories with research questions

-used in quantitative research

conceptual framework

-shows relationships between variables

-narrow scope, specific to the research problem

-developed using concepts and variables

-used in both qualitative and quantitative research

1. Ask

2. Access

3. Appraise

4. Apply

5. Assess

what are the 5 steps of the EBP process?

Ask

step of EBP process

-formulate an answerable clinical question

Access

step of EBP process

-track down the best evidence

Appraise

step of EBP process

-Appraise the evidence for its validity and usefulness

Apply

step of EBP process

-integrate the results with your clinical expertise and your patient values/local conditions

Assess

step of EBP process

-evaluate the effectiveness of the process

problem

every study starts with a __________ the researcher wants to solver

1. clinical practice

2. patient experiences

2. gaps identified in current, existing literature

what are 3 ways a clinical research question often arises?

1. specific

2. relevant

3. has potential to improve patient outcomes

the problem of a clinical research question needs to be what 3 things?

something that can be studied by collecting and analyzing data

what makes a problem able to be researchable?

1. problem identification

2. background

3. scope of the problem

4. consequences of the problem

5. knowledge gaps

6. proposed solution

most problem statements have what 6 of the following components?

1. problem-focused

2. knowledge-focused

what are 2 sources of clinical problems?

problem-focused clinical problem

sources of evidence:

-Financial concerns

-Evidence for current practice questions

-Quality-concern (efficiency, effectiveness, timeliness, equity, person-centeredness)

-Safety or risk management concerns

-Unsatisfactory patient, staff, or organizational outcomes

-Variations in practice compared with external organizations (e.g. facility policies)

-Variations in practice within the setting

knowledge-focused clinical problem

sources of evidence:

-New sources of evidence

-Changes in standards or guidelines

-New philosophies of care

-New information provided by organizational standards committees

1. beneficence

2. nonmaleficence

3. autonomy

4. justice

what are 4 ethical considerations in formulating a research problem?

1. ask - ask a clear, specific, focused, and relevant clinical question

2. acquire - search for high-quality evidence from reputable sources

3. appraise - critically evaluating the quality, credibility, and applicability of the research

4. apply = implementing the evidence-based intervention in a clinical setting while considering preferences, available resources, and institutional policies

5. analyze/adjust - ensures continuous improvement in practice

what are the 5 steps of the EBP process?

1. Is there evidence that the current treatment works?

2. Does the current practice help the patient?

3. Why are we doing the current practice?

4. Should we be doing the current practice this way?

5. Is there a way to do this current practice more efficiently?

6. Is there a more cost-effective method to do this practice?

what are 6 examples of compelling questions to ask for the first step of the EBP process?

PICO(T) statement

what format is a research/clinical question often asked in?

1. Patient, population, or problem

2. intervention

3. comparison

4. outcome

5. time

what does a PICO(T) statement stand for?

Patient, population, or problem

describe the patient or the relevant group of people

intervention

identify the intervention such as a test, drug, or factor that might affect a health income

comparison

identify an alternative strategy if you want to compare one intervention to another

outcome

state the clinical outcome - usually what you and the patient are most concerned about

1. Therapy/intervention/treatment

2. diagnosis/assessment

3. prognosis

4. etiology/harm

5. description (prevalence/incidence)

6. meaning or process

what are 6 types of PICO(T) questions?

therapy/intervention/treatment PICO question

To learn more about specific treatments, interventions, actions, products, or processes

template for therapy/intervention/treatment PICO question

In _________ (Population), what is the effect of ___________ (Intervention) in comparison to ___________(Comparison) on __________ (Outcome)?

Or

Does _________ (Intervention) compared to __________ (Comparison) decrease/increase ______________ (Outcome) in ____________ (Population)?

example of therapy/intervention/treatment PICO question

Does a smoking cessation program increase the number of adult patients over the age of 18 who quit smoking?

diagnosis/assessment PICO question

Concerned with methods and instruments utilized to help diagnose or screen a condition or to assess a clinical outcome

template for diagnosis/assessment PICO question

For _________ (Population), does __________ (Identifying tool/procedure) yield more accurate or more appropriate diagnostic/assessment information than __________ (Comparative tool/procedure) about __________ (Outcome)?

example of diagnosis/assessment PICO question

Smith and colleagues developed and rigorously evaluated the Checklist for Postoperative Total Hip Replacement Discharge using data from 1,445 patients in two hospitals. The checklist was designed to assess whether discharge checklists were helping to optimize function and follow-up.

prognosis PICO question

Concerned with understanding the eventual outcomes or consequences of diseases, conditions, or health problems

template for prognosis PICO question

For ______ (Population), does _______ (Exposure to disease or condition), relative to _______ (Comparative disease or condition) increase the risk of ________ (Outcome)?

example of prognosis PICO question

This study investigated the rate of obesity amongst individuals with limited access to fresh produce.

etiology/harm PICO question

Understanding the cause or determinant of what results in a health problem. Determining factors and exposures that lead to, cause, or affect various illnesses, mortality, or morbidity is the focus of this type of inquiry.

template for etiology/harm PICO question

Does (Influence, exposure, or characteristic) increase the risk of ________ (Outcome) compared to ________ (Comparative influence, exposure, or condition) in ________ (Population)?

example of etiology/harm PICO question

This study identified factors associated with the risk of fatalities among smokers infected with the coronavirus.

template for description (prevalence/incidence) PICO question

These questions vary from the typical PICO in that explicit comparisons are not typical (except to compare population).

In ______ (Population), how prevalent is ________ (Outcome)?

meaning or process PICO question

To gain insight into our clients' perspectives. There is no intervention or measurement being done, but simply a study to investigate how clients perceive their treatments, diagnosis, etc., to better understand how we can motivate compliance with treatment and design appealing interventions.

template for meaning or process PICO question

Explicit comparisons are not typical in these types of questions. These are qualitative questions and are used to elicit narrative, subjective responses.

What is it like for ________ (Population) to experience _________ (situation, condition, circumstance)?

example of meaning or process PICO question

This study explored the experiences and journey through diabetes of women in the U.S.

statements of purpose

-outlines intent of the research, its scope, and what it aims to achieve

-summarized the study's overarching goal

-may also be referred to as a research purpose, aim, or goal

-it is not the same as a hypothesis or research/clinical question

hypothesis

predicts the outcome

research question

guides the EBP

ethical considerations in crafting a purpose statement

-need to make sure study aims are scientifically sound and ethically responsible

-consider potential risks to participants, fairness of the research design, and broader implications of the study's findings

hypothesis

a statement of predicted outcome

-developed prior to conducting research

-not always cause and effect; may be associated or correlation

-in a PICO(T), think of the "I" as the IV, and the "O" as the DV

independent variable

a measure that can be manipulated by the researcher

-"I" in a PICO statement

dependent variable

the rest of the independent variable

-"O" in a PICO statement

1. null

2. alternative

3. directional

4. non-directional

5. complex

6. simple

what are 6 types of hypotheses?

null hypothesis

states there is no effect, relationship, or difference between variables

alternative hypothesis

there is an effect, relationship, or difference between variables

directional hypothesis

specifies the direction of the expected relationship or difference between variables

non-directional hypothesis

predicts a relationship or difference between variables but does not specify the direction

complex hypothesis

predicts the relationship between multiple independent and/or dependent variables

simple hypothesis

predicts the relationship between a single independent variable and a single dependent variable

1. clarity

2. testability

3. specificity

4. grounded in existing literature or theory

5. free from harm, bias, or exploitation

what are 5 ways to craft a strong hypothesis

research

once a hypothesis is developed, it must be tested through ___________

Boolean Operators

AND narrows, OR broadens, and NOT excludes terms from a search.

AND

which Boolean word narrows the search?

OR

which Boolean word broadens the search

NOT

which Broolean word excludes terms from a search?

Database

A structured, searchable collection of research articles and resources