Evidence Based Practice exam 4

What is evidence-based practice (EBP)?

A problem-solving approach to clinical practice that combines the best available evidence, clinical expertise, patient preferences and values, and healthcare resources to make patient-care decisions.

What are the three main components of EBP?

Best available evidence, clinical expertise and available resources, and patient values, preferences, and circumstances.

Why is EBP important in nursing?

Practice can lag behind new evidence, and familiar routines or a single article may not fit every patient. EBP supports informed decisions and evaluation of results.

What is a spirit of inquiry?

Continuously questioning current practices and looking for evidence to improve care.

What is the nurse's responsibility when their knowledge or clinical expertise is limited?

Recognize their limitations and seek appropriate evidence, guidance, or expertise before deciding whether to deviate from evidence-based best practices.

How does EBP improve patient care?

It helps nurses make informed care decisions, evaluate practice changes, and determine whether those changes improve patient outcomes.

A nurse has always performed a procedure one way, but new evidence suggests a better approach. What should the nurse do?

Question the current practice, investigate the evidence, assess its quality, and determine whether the change is appropriate for the patient and setting.

What are the steps of the EBP process, including step 0?

0. Cultivate curiosity about current practice.

1. Ask a focused question.

2. Search for relevant evidence.

3. Appraise and synthesize findings.

4. Apply evidence with the patient and team. 5. Evaluate outcomes.

6. Communicate outcomes.

What is a problem-focused trigger for EBP?

A clinical problem that raises a question, such as an increase in patient falls on a unit.

What is a knowledge-focused trigger for EBP?

New information or a guideline that challenges a familiar practice.

Why should nurses describe the clinical concern before selecting an intervention?

To identify the actual problem and guide the search for an appropriate evidence-based solution.

A unit notices an increase in patient falls. Which type of trigger is this, and what should happen next?

A problem-focused trigger. The nurse should define the concern and develop a focused clinical question before selecting an intervention.

A nurse reads a new guideline that challenges the unit's usual procedure. Which type of trigger is this?

A knowledge-focused trigger.

What does PICOT stand for?

P = Patient or population; I = Intervention; C = Comparison, when relevant; O = Outcome that can be observed or measured; T = Timeframe, when relevant.

What is the purpose of a PICOT question?

To create a focused, searchable clinical question that guides the search for evidence.

Which PICOT component identifies what will be measured to determine whether an intervention works?

o=outcome

Where should nurses begin when looking for trustworthy evidence?

Current clinical practice guidelines and systematic reviews.

Which databases are listed for searching primary studies?

CINAHL and PubMed/MEDLINE.

Which types of evidence may help answer intervention questions?

Systematic reviews and well-designed trials.

Which type of research may help answer questions about experiences and preferences?

Qualitative research.

Which types of evidence may help answer questions about prevalence?

Descriptive studies and local data.

What questions should a nurse ask when appraising evidence?

Was the study designed and conducted well? How large and precise was the effect? Does it matter clinically? Were harms, burden, and costs described? Does it apply to this patient and setting?

What is the difference between statistical findings and clinical importance in EBP?

the nurse must consider not only the reported effect but also whether it matters in actual patient care.

Why are study limitations important?

They affect how confidently the findings can be interpreted and whether they apply to other patients or settings.

What should a nurse examine before recommending a practice change based on a study reporting fewer falls?

The comparison group, baseline differences, adherence to the intervention, and unintended effects.

A study shows fewer falls after hourly rounding, but the patients in the intervention group were healthier at baseline. What should the nurse consider?

The baseline differences could affect the results, so the nurse should evaluate the study design and other evidence before recommending the change.

A study reports a positive result, but the intervention is costly and increases staff workload. What should the nurse assess?

The clinical importance of the result, the intervention's costs and burden, potential harms, and whether the benefits justify the change.

What does synthesizing multiple studies involve?

Comparing participants, interventions, settings, and outcomes; looking for agreement; explaining conflicting findings; weighing study quality and applicability; and identifying uncertainty.

What should nurses consider before applying evidence to a patient's care?

Patient options and preferences, clinical judgment, contraindications, organizational policy, and available resources.

What must be considered when implementing an EBP change on a unit?

Staff education, workflow, resources, organizational policy, and evaluation of the result.

What is the purpose of a pilot study when introducing a practice change?

To determine whether the change can be implemented easily before wider implementation.

How can evidence be integrated into routine nursing practice?

Through care plans, teaching tools, clinical practice guidelines, policies and procedures, and new assessment tools.

A research-supported intervention conflicts with a patient's preferences. What should the nurse do?

Discuss the options with the patient and consider their values and preferences alongside the evidence and clinical judgment.

A unit wants to introduce a new procedure across the entire facility. What is a sensible first step before large-scale implementation?

Plan the change, educate staff, assess resources and workflow, and consider a pilot study.

What should be done before implementing a practice change to evaluate its effects?

Choose outcome measures, record baseline data, and plan how to track implementation and patient outcomes.

What is an outcome measure?

A measure of the result of care, such as patient falls per 1,000 patient days.

What is a process measure?

A measure of whether the intervention or planned process was carried out, such as the proportion of scheduled rounds completed.

What is a balancing measure?

A measure used to identify unintended effects of a change, such as increased staff workload or interrupted care.

Why should nurses track implementation as well as patient outcomes?

To determine whether the intervention was actually carried out and whether the results can reasonably be interpreted.

What questions should nurses ask when evaluating a practice change?

Was the change effective? Are modifications needed? Should the change be discontinued?

Why must EBP changes always be evaluated?

Unexpected results may occur, and evaluation determines whether the change should continue, be modified, or be discontinued.

Who should receive the results of an EBP practice change?

Clinical staff on the unit, nursing practice councils, EBP councils, research councils, and other relevant clinicians.

Where else may EBP results be communicated?

Clinical grand rounds, professional conferences, and meetings.

What should be included when communicating EBP findings?

The methods, results, and limitations.

How can a successful EBP change be sustained?

Update orientation and procedures, incorporate the change into the practice environment, use targeted strategies, and continue monitoring.

What leadership approach is mentioned in the PowerPoint for sustaining EBP?

Transformational leadership.

What is the difference between EBP, research, and quality improvement (QI)?

EBP applies existing evidence to care decisions; research systematically generates knowledge; QI tests changes to improve a local process.

What is the purpose of nursing research?

To answer questions, solve problems, and contribute to generalizable knowledge through systematic inquiry. It may or may not directly improve patient care.

What is the purpose of quality improvement (QI)?

To improve local work processes, patient outcomes, and healthcare system efficiency. Results are usually not generalizable.

A nurse uses published research and patient preferences to choose the best intervention for a patient. Is this EBP, research, or QI?

EBP

A nurse conducts a systematic study to generate new knowledge that may apply beyond one unit. Is this EBP, research, or QI?

research

A hospital tests a new handoff checklist to improve its own unit's workflow. Is this EBP, research, or QI?

QI

Can EBP, research, and QI overlap?

Yes. They are related but answer different questions and serve different purposes.

What are the basic steps of scientific inquiry in nursing?

Observe a problem and form a clear question; select methods suited to the question; collect and analyze data systematically; and interpret findings while considering limitations.

What does PDSA stand for?

Plan, Do, Study, Act.

What happens during the Plan stage of PDSA?

Define a local problem and plan a small test of change.

What happens during the Do stage of PDSA?

Try the change and document observations.

What happens during the Study stage of PDSA?

Compare the results with the prediction.

What happens during the Act stage of PDSA?

Adapt, adopt, or abandon the change based on the results.

During the Study stage, the results do not match the prediction. What should happen next?

during Act, the team decides whether to adapt, adopt, or abandon the change based on the findings.