Module 1

Question 1

Most EBP definitions include…
What is EBP?

Answer 1

research-based information, clinical expertise, and patient preferences
EBP is a process involving the examination and application of research findings or other reliable evidence that has been integrated with scientific theories.

Question 2

Before EBP, nursing was involved with research utilization, which is…

Answer 2

Changing practice based on the results of a single research study
- Many nursing questions cannot be answered by a single study, and human conditions are not always amenable to clinical trials.
- Also, the research utilization process does not place value on the importance of clinical decision making, nor is it noted for being patient focused.

Question 3

EBP models usually include…

Answer 3

Each one begins with a question or need for the identification of acquiring knowledge about a question. All involve appraisal of evidence and making a decision about how to use evidence. These models conclude by closing the loop through evaluation to determine that the practice change is actually meeting the expected outcomes.

Question 4

Tradition as a source of information

Answer 4

Nurses can be so entrenched in practice traditions that they fail to ask questions that could lead to changes based on evidence. Consistent use of tradition as a basis for practice limits effective problem solving and fails to consider individual needs and preferences.

Question 5

Authority as a source of information

Answer 5

Various sources of authority, such as books, articles, web pages, and individuals and groups, are perceived as being meaningful sources of reliable information; yet, in reality, the information provided may be based on personal experience or tradition rather than scientific evidence. Authority has a place in nursing practice as long as nurses ascertain the legitimacy of the information provided.

Question 6

Trial and error as a source of information

Answer 6

Because trial and error is not based on a systematic scientific approach, patient outcomes may not be a direct result of the intervention.
For example, in long-term care the treatment of decubitus ulcers is often based on this haphazard approach. Nurses frequently try a variety of approaches to heal ulcers. After some time, they settle on one approach that is more often than not effective.
This approach can lead to reduced critical thinking and wasted time and resources.

Question 7

Personal experiences/intuition as a source of information

Answer 7

Although previous experience can help to build confidence and hone skills, experiences are biased by perceptions and values that are frequently influenced by tradition, authority, and trial and error.
Intuition is not one of the most advantageous sources of evidence for driving patient care decisions because nurses are expected to use logical reasoning as critical thinkers and clinical decision makers.

Question 8

__________ can be useful because it fills gaps that exist in nursing science and provides a basis on which to build new evidence; it can be a stronger type of evidence than are sources not based on theory and science.

Answer 8

Borrowed evidence

Question 9

To have an EBP, whenever possible nurses must emphasize the use of research-based information based on ____ over the use of evidence obtained through tradition, authority, trial and error, personal experience, and intuition. _____ provides the best source for evidence for making decisions about patient care.

Answer 9

theory
Scientific research

Question 10

Individual barriers include…
Strategies?

Answer 10

Lack of time
Lack of value placed on research in practice
Lack of knowledge about EBP and research
Lack of technological skills to find evidence
Lack of ability to read research
Resistance to change
Strategies need to be aimed at instilling an appreciation for EBP, increasing knowledge, developing necessary skills, and changing behaviors

Question 11

Organizational barriers include…
Strategies?

Answer 11

Factors can include organizational management failing to embrace EBP and lack of institutional support, such as financial or release time
- Resistance to change
- Lack of resources to access evidence
- Lack of resources
Strategies to overcome organizational barriers must be directed toward creating and maintaining an environment where EBP can flourish

Question 12

Research-related barriers include..
Strategies?

Answer 12

Research-related factors can include the communication gap between researcher and clinician, the technical writing associated with research reports, and lack of dissemination of research findings
Research-related barriers can be overcome by writing user-friendly research reports and using technology to disseminate research findings.

Question 13

The model of diffusion of innovations
Early adopters
Laggards

Answer 13

To overcome barriers to using research findings in practice, it can be helpful to use a model to assist in understanding how new ideas come to be accepted practice.
The model includes four major concepts: innovation, communication, time, and social system. Diffusion is “the process by which (1) an innovation (2) is communicated through certain channels (3) over time (4) among the members of a social system”
Initially, only a minimal number of individuals, known as early adopters, embrace the innovation.
Those individuals who are slow or who fail to adopt the innovation are known as laggards.

Question 14

Steps of the Research Process

Answer 14

Research: Systematic study that leads to new knowledge and/or solutions to problems or questions
1. Identify the research question.
2. Conduct a review of the literature.
3. Identify a theoretical framework.
4. Select a research design.
5. Implement the study.
6. Analyze data.
7. Draw conclusions.
8. Disseminate findings.

Question 15

Replication studies

Answer 15

Repeated studies to obtain similar results

Question 16

Descriptive research

Answer 16

A category of research that is concerned with providing accurate descriptions of phenomena

Question 17

Explanatory research

Answer 17

Research concerned with identifying relationships among phenomena

Question 18

Predictive research

Answer 18

Research that forecasts precise relationships between dimensions of phenomena or differences between groups

Question 19

Basic research

Answer 19

Research to gain knowledge for the sake of gaining knowledge; bench research

Question 20

Applied research

Answer 20

Research to discover knowledge that will solve a clinical problem

Question 21

Empirical evidence

Answer 21

Evidence that is verifiable by experience through the five senses or experiment
Focus for quantitative research

Question 22

Deductive reasoning

Answer 22

Thinking that moves from the general to the particular
Primarily linked with quantitative research

Question 23

Inductive reasoning

Answer 23

Thinking that moves from the particular to the general
Associated with qualitative research

Question 24

Research article
Abstract

Answer 24

The first section of a research article, usually limited to 100 to 150 words.
The purpose of the abstract is to provide an overview of the study, but the presence of an abstract does not necessarily mean that an article is a research study.

Question 25

Research article
Introduction

Answer 25

Follows the abstract, contains a statement of the problem and a purpose statement.
The problem statement identifies the problem in a broad and general way.
Authors usually provide background information and statistics about the problem to convince readers that the problem is significant.
The background information provided should set the stage for the purpose statement, which describes what was examined in the study.

Question 26

Research Article
Review of Literature

Answer 26

The third section
An unbiased, comprehensive, synthesized description of relevant, previously published studies should be presented.
For each study included in the review, the purpose, sample, design, and significant findings are discussed. The review should focus on the most recent work in the field but may include older citations if they are considered to be landmark studies.
Concludes with a summary of what is known about the problem and identifies gaps in the knowledge base to show readers how the study adds to existing knowledge.

Question 27

Research Article
Theoretical Framework

Answer 27

The structure of a study that links the theory concepts to the study variables; a section of a research article that describes the theory used
Authors frequently use a model or diagram to explain their theoretical framework.

Question 28

Research Article
Methods section

Answer 28

Major portion of a research article that describes the study design, sample, and data collection
In this section, it is important for the authors to describe the target population and explain how the sample was obtained.
Procedures for collecting data, including the types of measures used, should also be outlined.
Throughout this section, authors provide a rationale for decisions made regarding how the study was implemented.

Question 29

Research Article
Results section

Answer 29

Component of a research article that reports the methods used to analyze data and characteristics of the sample
In quantitative studies, data tables are frequently included for interpretation, and authors indicate which findings were significant and which were not. In qualitative studies, authors present themes that are supported by quotes from participants.

Question 30

Research Article
Discussion Section

Answer 30

Portion of a research article where interpretation of the results and how the findings extend the body of knowledge are discussed
Results should be linked to the review of the literature and theoretical framework.
The authors discuss the limitations of the study design and sometimes suggest possible solutions to address them in future studies.
Implications for practice, research, and education are proposed.

Question 31

Research Article
List of References

Answer 31

Publication information for each article cited in a research report
Although styles vary, many journals adhere to the guidelines provided in the Publication Manual of the American Psychological Association (2020)

Question 32

How research and EBP differ

Answer 32

1. Research generates new knowledge, while EBP applies new knowledge to point of care
2. Research fills gap in literature, while EBP is based on evidence in literature
3. Research: Research question; EBP: Clinical question
4. Research: Participants; EBP: Patients
5. Research: Designed to describe a phenomenon, find a relationship, or test an intervention. EBP: Designed to change practice in clinical setting
6. Research AND EBP: Analysis of data
7. Research: Evaluates findings in light of research question; EBP: Evaluates practice change by measuring patient outcomes

Question 33

The Seven Steps of EBP

Answer 33

Step 0: Cultivate a spirit of inquiry along with an EBP culture and environment.
Step 1: Ask the PICO(T) question.
Step 2: Conduct a literature search to collect relevant evidence.
Step 3: Critically appraise the evidence.
Step 4: Integrate the evidence with clinical expertise and patient preferences to make the best clinical decision.
Step 5: Evaluate the outcomes of the EBP change.
Step 6: Disseminate the outcomes.

Question 34

The impetus for changing nursing practice comes from

Answer 34

new knowledge, safety concerns, healthcare outcomes, healthcare costs, and societal need for professional nursing.

Question 35

Impetus for Change
New Knowledge

Answer 35

New knowledge comes from research. Research is defined as “an activity designed to test a hypothesis, permit conclusions to be drawn, and thereby to develop or contribute to generalizable knowledge (expressed, for example, in theories, principles, and statements of relationships)
Nurses can learn new knowledge from a number of sources, including reading journals, participating in a journal club, listening to a webinar, attending a conference, discussing issues with a colleague from another setting, or hearing something on the news.

Question 36

Impetus for Change
Safety Concerns
Sentinel event

Answer 36

Nursing practice involves interactions that can make patients, as well as nurses, susceptible to harm or injury. A sentinel event is a “patient safety event that results in death, permanent harm, or severe temporary harm”
These types of events are typically reviewed and scrutinized by organizations during morbidity/mortality or root cause analysis meetings. The objective of these meetings is to identify the sources for error, which can be the impetus for change.

Question 37

Impetus for Change
Healthcare outcomes
Indicators
Structural, process, outcome measures

Answer 37

Hospitals routinely use patient outcomes, including mortality, hospital-acquired conditions, complication rates, avoidance of adverse events, condition-specific parameters, and patient satisfaction and engagement, as indicators for evaluating nursing care.
Indicators are quantitative criteria used to measure outcomes (also referred to as measures)
Structural measures evaluate how care is organized
Process measures are used to evaluate activities that were performed with respect to patient care.
Outcome measures are the consequences of the health care provided.

Question 38

The _________ for nursing practice, developed by the ANA with endorsement from the National Quality Forum (NQF), identify linkages between nurse staffing and patient outcomes. The ________ allows nurses to compare organizational patient outcomes with state, regional, and national norms for similar facilities down to the unit level. The original mission was “to aid the nurse in patient safety and quality improvement efforts by providing research-based, national, comparative data on nursing care and the relationship of this care to patient outcomes”

Answer 38

Nursing Quality Indicators
National Database of Nursing Quality Indicators (NDNQI)

Question 39

Structure measures examples

Answer 39

Nurse turnover
RN education/specialty certification
RN survey options

Question 40

Outcome measures examples

Answer 40

Patient falls
Catheter-associated bloodstream infections (CABSIs)
Ventilator-associated pneumonia (VAP)
Pediatric peripheral intravenous infiltrations
Pressure injuries
Assaults by psychiatric patients
Catheter-associated urinary tract infections (CAUTIs)

Question 41

Process measures examples

Answer 41

Patient falls
Pressure injuries
RN survey options

Question 42

Impetus for Change
Healthcare Costs

Answer 42

When hospitals and other healthcare organizations lose money, change is necessary for them to remain in business. When patient outcomes do not meet expected goals, hospitals may not receive reimbursement for their expenses. For example, the Centers for Medicare and Medicaid Services (CMS) will not reimburse for hospital-acquired conditions, such as stage III and IV pressure ulcers, foreign bodies retained after surgical procedures, and infections due to catheters.
Practices may also change when financial incentives are offered. For example, the CMS initiated a values-based program to ensure better care for individuals, improve the health of populations, and lower costs.

Question 43

Impetus for Change
Societal Need for Professional Nursing

Answer 43

Impetus for change can come from policy-making bodies that consider the needs of society when determining the role of nursing.
An example of this is the work of the Institute of Medicine (IOM) with the Robert Wood Johnson Foundation (RWJF). The National Academy of Medicine (formerly known as the IOM) is one of three academies in the National Academies of Science, Engineering, and Medicine, which are private, nonprofit institutions working outside of the federal government to provide objective advice about matters of science, technology, and health.
The expert committee will make recommendations for continuation of the vision of nursing through 2030 by considering a variety of aspects related to nursing

Question 44

Change associated with transitioning evidence into practice can seem challenging, but nurses do not have to go it alone. Conferring with others

Answer 44

Research librarians can assist with searches to ensure that appropriate databases are searched and the most accurate search terms are used.
Nurse educators and APNs, such as nurse practitioners, clinical nurse specialists, and nurse midwives, can provide valuable information based on clinical expertise. Many healthcare organizations employ nurses who specialize in wound, ostomy, diabetic, and other types of nursing care.

Question 45

Administrators and clinical leaders can promote improvements in patient care by motivating staff to adopt EBP and removing barriers: ____________
________ are also important to successful implementation of EBP because they can mediate between the EBP project-related responsibilities and day-to-day activities.

Answer 45

One way to overcome barriers is to identify and secure appropriate resources needed for EBP. Another strategy for successful EBP is connecting individuals who are impacted by the change and ensuring that well-suited people are involved in the project. Communicating expectations for implementation of EBP is an important responsibility of administrators, because they set the tone of the organizational culture.
Middle managers

Question 46

Overcoming barriers
Organizations can promote a “culture of safety” in which ________

Answer 46

in which reporting of errors, adverse events, and injuries is encouraged by consistent and helpful responses without fear of punishment or embarrassment. This promotes open communication and enables learning from mistakes, which can be an impetus for practice changes.

Question 47

All stakeholders should be identified and considered when planning change. These are…

Answer 47

Stakeholders are individuals who may be internal or external to the organization and have an interest in the outcome. Stakeholders might include policy makers, administrators, researchers, interprofessional healthcare providers, and patients

Question 48

Care bundles

Answer 48

Better patient outcomes can result when several changes are initiated together.
Care bundles are three to five interventions that are implemented together to improve patient outcomes

Question 49

__________ is necessary for EBP. Collaborative practice is encouraged based on a belief that “purposeful collaboration among clinicians, healthcare administration, and finance leaders is key to delivering high-value health care”

Answer 49

Interprofessional collaboration

Question 50

Research-related barriers to EBP can be addressed by ensuring that researchers disseminate findings to practitioners. This can be accomplished by…

Answer 50

This can be accomplished by writing articles in user-friendly styles. Researchers can display posters in high-traffic areas, such as cafeterias or hallways. Research findings can be presented at nursing grand rounds or in organizational newsletters. Another way to overcome research-related barriers is to include staff nurses in the research process. Nurses at the bedside are experts at identifying clinical problems. Furthermore, engaging nurses in the research process can generate enthusiasm for future practice changes.

Question 51

Nurses must remain curious and think critically about practice issues. Competencies practicing nurses need for efficiently moving evidence to practice include:

Answer 51

1. Questioning clinical practices to improve the quality of patient care
2. Describing clinical problems using evidence from the organization, such as quality improvement and patient outcomes
3. Formulating clinical questions using the PICOT format
4. Searching for evidence to answer PICOT questions
5. Critically appraising preappraised evidence, such as clinical practice guidelines
6. Critically appraising published research studies for strength, quality, and applicability to clinical practice
7. Evaluating and synthesizing evidence to determine its strength, quality, and applicability to clinical practice
8. Systematically collecting data about patient outcomes as internal evidence for clinical decision making in the care of individuals, groups, and populations
9. Integrating external and internal evidence to plan EBP changes
10. Implementing practice changes based on evidence, clinical expertise, and patient preferences to improve care processes and patient outcomes
11. Evaluating outcomes of evidence-based decisions and practice changes to determine best practices
12. Disseminating information about best practices supported by evidence
13. Participating in approaches to sustain an EBP culture

Question 52

Knowledge transition

Answer 52

A mutually collaborative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve nursing practice and patient outcomes

Question 53

Six attributes of knowledge translation: collaboration, action, receptivity, process, translation, and improved healthcare outcomes.
Describe each

Answer 53

• Collaboration occurs between the researcher and the users of the research findings, who can be nurses, other healthcare professionals, or patients.
• Action occurs when knowledge is moved from the lab (“bench”) into practice (“the bedside”)
• Receptivity refers to the willingness of the healthcare professionals involved to use the knowledge
• Translation research is a process because it takes place over time, (1) the initial analysis and publication of results, (2) when clinical recommendations are made, and (3) when clinical recommendations are used in routine clinical practice.
• When knowledge translation is successful, nurses observe improved healthcare outcomes

Question 54

Lewin’s Change Theory

Answer 54

Unfreeze–change–refreeze model.
1. The unfreeze stage requires prior learning to be rejected because individuals begin to recognize that their ways of doing things are not productive.
2. In the change stage, the process of change begins.
3. During the final stage, refreeze, the change is sustained and made part of the organizational culture, celebrate successes

Question 55

Transtheoretical Model
Includes six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination

Answer 55

Six stages of change
1) Precontemplation: an individual has no intention of changing and is unaware of any need to change the status quo.
2) Contemplation: the individual is aware that a problem exists and thinks seriously about making change but is still in the decision-making phase, weighing the pros and cons of acting.
3) Preparation: In this stage, the individual is committed to acting and is making a plan to change.
4) Action: the individual actually makes changes in behavior.
5) Maintenance: Once an individual has sustained the change for 6 months
6) Termination: happens when the individual is not tempted to resume previous behaviors

Question 56

Kotter’s eight stages of change model

Answer 56

The first stages of the model involve organizing and planning.
1) Establish a sense of urgency about the need to achieve change
2) Create a coalition: assemble a key group of individuals
3) Develop a vision: desirable change vision
4) Communicate the vision: to the staff
5) Empower action: involve staff in change efforts
6) Generate short-term wins: celebrate progress
7) Consolidate gains/produce more: leaders do this and create more change
8) Anchor approaches: new approaches anchored in culture

Question 57

_________ outlines ethical conduct regarding nursing practice. Although not explicitly stated, it is apparent that EBP is relevant to the provisions in the code. For example, provision 7 in the code indicates that nurses are charged with ensuring that the nursing profession advances through research and the development of professional standards, which should be based on evidence.

Answer 57

The Code of Ethics for Nurses, originated by the ANA

Question 58

One ethical consideration when transitioning evidence to patient care involves _________
Another ethical concern when implementing an EBP change is _______.
Ethical care demands that nurses provide information to patients and their family members so that questions are answered, misinformation is clarified, and both risks of harm and benefits are considered.
During the EBP process, it is ethical to ________

Answer 58

• consideration of patients’ opinions about their care and respecting their decisions.
• to avoid harm. Benefits of care should be maximized and risks minimized
• give credit to sources.

Question 59

When innovations are being tested or pilots are being conducted, only a small sample of patients may have the opportunity to have access to the treatment. This raises ethical concerns about justice. Once an EBP change becomes a standard of care, nurses must ensure that _______

Answer 59

all patients have access to the treatment without prejudice.