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NUR3300 > Appraising the Evidence > Flashcards

Appraising the Evidence Flashcards

1
Q

Best Practice…take into consideration:

A 
research evidence(clinically relevant)
expert opinion
organizational needs
patient preferences
situation
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2
Q

Decision making: uncertainty…

A

the degree to which a number of alternatives are perceived with respect to the occurrence of an event and the relative probability of these alternatives”

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3
Q

decision making

A

adopt or reject alternatives

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4
Q

pilot studies

A
  • To determine value for adoption
  • To reduce uncertainty
  • To increase assurance
  • To save costs
  • To enhance “buy-in”
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5
Q

rejection strategies

active

A

after pilot

active decision to not adopt change

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6
Q

rejection strategies

passive

A

non-decision

continue in status quo

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7
Q

appraisal strategies

A
  • Quality
  • Strength
  • Significance
  • Relevance
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8
Q

Five step approach

ask

A

is the research question well constructed to elicit a response or solution

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9
Q

five step approach

acquire

A

search the literature for pre-appraised evidence or research of highest quality available

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10
Q

five step approach

appriase

A

critical appraisal to determine validity and applicability

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11
Q

five step approach

apply

A

institute reasonable recommendations to practice

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12
Q

five step approach

assess

A

evaluate outcomes from a nursing practice framework

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13
Q

general appraisal of individual studies

review of the literature

A
  • Problem clear and concise
  • Sufficient background material
  • Significance evident
  • Purpose clear
  • Clear definitions
  • Assumptions clear
  • Question or hypotheses clear
  • Theory based?
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14
Q

individual studies continued:

review of the literature

A
  • Relevant
  • Adequate
  • Organized
  • Synthesized
  • Critical appraisal of major references
  • Summary
  • Implications
  • Adequately documented
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15
Q

individual studies continued

methods appropriate to question and purpose

A
  • Correct design
  • Human subjects
  • Clear and logical data collection process
  • Appropriate instruments
    * Reliable and valid
  • Sampling method appropriate
    * Population appropriate
    * Adequate sample
    * Attrition clarified
  • Controls for internal validity of design
  • Limitations of external validity of design
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16
Q

Individual studies continued

results

A
  • Clear data presentation
  • Demographics described
  • Analysis methods appropriate
  • Summarization in charts, tables, graphs
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17
Q

individual studies continued

discussion

A
  • Results based on the data
  • Sufficient evidence for conclusions
  • Consistent with problem, purpose, questions, design methods, and data analysis methods
  • Clear conclusions
  • Generalizations appropriate
  • Limitations admitted
  • Contribution to nursing knowledge
18
Q

appraisal of meta analyses

A
  • Do all studies fit the question
  • Inclusion of both published and unpublished evidence
    * lab notes, pilot studies
  • Systematic nature of selection
  • Adequate number
  • Merged statistical findings
19
Q

appraisal of randomized control trials

A
  • Examines treatment effects
    * The greater the treatment effect, the better the treatment
  • Large samples from multiple sites
  • Multiple control strategies
  • Examine for bias
  • Applicable results
20
Q

cohort studies

retrospective or prospective correlational designs

A
  • Comparison groups with similar risk factors
  • Determine past behavior related to the risk factors (retrospective) or how risk factor leads to outcome of interest (prospective)
21
Q

cohort studies

retrospective or prospective quasi experiemental design

A
  • Comparison groups with similar risk factors
  • Able to add an intervention or an intervention has been added in the past
  • Determine how previous intervention has affected occurrence of outcome of interest (retrospective) or occurrence of outcome of interest after intervention occurs (prospective)
22
Q

case control study

retrospective or prospective correlational design

A
  • Compare cases who have an outcome of interest

* Why they arrived at that outcome (retrospective study) or how the outcome progresses in the future (prospective study)

23
Q

case studies

descriptive

A
  • No IV and DV
  • No manipulation or randomization
  • Use descriptive statistics
  • Cross sectional or longitudinal
  • Correlations (looks for similarities)
  • Non-experimental designs (looks for differences)
24
Q

qualitative

appropriate methods

A
  • Design
  • Sample
  • Analysis
  • Results
25
Q

rapid critical appraisal
brief review
are the results of the study valid

A
  • Consider appropriateness of design selected
  • Consider randomization, control, bias, instrumentation, sampling issues
  • Consider threats to internal validity of design
26
Q

rapid critical appraisal
brief review
what were the results?

A
  • Consider appropriateness of statistics or qualitative methods
  • Consider magnitude of impact and/or strength of relationships
27
Q

rapid critical appraisal
brief review
will the results assist in caring for my patients?

A
  • Consider external validity of design issues
  • Consider relevance to organizational issues
  • Consider relevance to patient issues
  • Consider importance to outcomes
28
Q

Ranking Evidence
Many hierarchies of ranked evidence
Most have a medical model focusing on clinical significance:

A
  • Diagnosis
  • Therapeutic impact
  • Prognosis
  • Causation
29
Q

Synthesizing the evidence:

A

first, sythesize the amount and type of support for the recommendation

30
Q

determine the strength of your support:

A

another example for a new treatment intervention

31
Q

grading the evidence

A

evaluate teh quality of the evidence

32
Q

recommendation chart

A

determine your recomendation

33
Q

make the recommendation

A

•Based on amount, quality, and findings from the available evidence, make a recommendation.

34
Q

Clinical guidelines

A
  • “A unit of knowledge derived from the basis of a review of the current state of scientific evidence”
  • Based on current literature
  • Does not take into account specific situations or specific patient needs
    * General and not specific
  • AGREE-II form standardizes how guidelines are developed
35
Q

Agree-II format for guidelines

six domains

A 
scope and purpose of the guidelines
stakeholder involvement
rigor of development
clarity and presentation
applicabiltiy
editorial independence
36
Q

Agree-II format for guidelines
six domains
scope and practice of the guideline

A

purpose, aims, questions, population

37
Q

Agree-II format for guidelines
six domains
stakeholder involvement

A

meets the needs of the intended users

38
Q

Agree-II format for guidelines
six domains
rigor of development

A

gathering, sythesizing, and examination process

39
Q

Agree-II format for guidelines
six domains
clairity and presentation

A

clear format

40
Q

Agree-II format for guidelines
six domains
applicability

A

behavior, cost, and organizational consequences

41
Q

Agree-II format for guidelines
six domains
editorial independence

A

conflicts of interest

NUR3300 (20 decks)

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