chapter 1 Flashcards
(19 cards)
what is quadruple aim in healthcare?
the use of evidence based practice that enhances
1) healthcare quality
2) improves patient outcomes
3) reduce costs
4) empowers clinicians
where is quadruple aim more implemented and how effective is it?
mostly implemented in the states but unfortunately Americans continue to struggle with quality due to multiple med errors
why does quadruple aim not work in the world although theoretically sound?
becase “this is the way we do it here” continues to thrive instead of the quadruple aim
what are 3 components of evidence based practice?
basically the definition is broad and varies but it always integrates 3 concepts
1) Research aka external evidence (search for and critical appraisal of the best current available information)
2) clinical expertise aka internal evidence (quality improvement projects and outcomes management)
3) patient preferences and values
what are 2 types of evidence used in evidence based practice?
1) external - generated through research ex: randomized trials, case studies etc…
- it is generalized and used in setting where research didn’t occur
2) internal - generated through practice initiatives/experiences
- not meant to be generalized and used in the facilities they’re developed in
what is the difference between EBP and QI?
EBP - rigorous critical appraisal + synthesis and recommendations for practice backed by peer-reviewed evidence with clinician expertise + client preferences to guide patient care
QI - improves the process or outcome of a specific population ONCE a problem has been IDENTIFIED. For example: if randomly the number of patients on ventilators having pneumonia increases and when data is collected and evaluated shows oral care protocol was no implemented then we can implement quality improvement to address this
What are the 3 types of research utilization?
1) instrumental research utilization - application in ones practice : DOES change practice
2) conceptual research utilization - changes ones thinking about practice : does NOT change practice
3) symbolic research utilization - Legitimatizes one position in a discussion…ex: “According to the evidence ….”
what does the author say about research utilization?
the use of only one study
Finding a quasi-experimental study in a peer-reviewed
nursing journal article that tests a protocol for the
frequency of turning for immobile patients is an example of
external evidence.
TRUE
A clinical nurse specialist plans some education sessions to
decrease fall rates on a unit. They talk about what could be
done, provide some education, and monitor the fall rates
using the data collected by the organization (e.g., minimum
data set) for the next 6 months. What is this an example
of?
A. Evidence Based Practice
B. Quality Improvement
B. Quality Improvement
GH reads a systematic review on how to treat pressure
ulcers and begins talk about these findings in meetings
to sway their colleagues. What is this an example of?
A. Instrumental research use
B. Conceptual research use
C. Symbolic research use
Question
B
what are the origins of evidence based practice?
Dr. Archie Cochrane published a report in 1972 for the
Nuffield Provincial Hospitals Trust
* Demonstrated how slow the medical profession
was in using published evidence to change
practice
why is research important?
about 20 - 30% of patients receive care they dont need or is deemed potentially harmful
only 55% receive recommend appropriate care
what are the 6 steps of EBP?
0.Cultivate a spirit of inquiry within the environment
1.Ask the burning clinical question in PICOT format
2.Search for and collect the most relevant best evidence
3.Critically appraise the evidence (i.e., rapid critical
appraisal, evaluation, and synthesis, validity and reliability )
- Integrate the best evidence with one’s clinical expertise
and patient preferences and values in making a practice
decision or change
5.Evaluate outcomes of the change
6.Disseminate the outcomes of the evidence-based change
what are the 2 best scientific research styles?
level 1 - systematic review or meta analyses of RCTs
level 2 - single RCTs
what is the least reliable scientific research style?
opinion of authorities and report of expert committees
A single randomized controlled trial (RCT) constitutes the
highest level of evidence and is the most reliable guide to
nursing practice
true or false
false
it says single not meta
what is the formula to determine CONFIDENCE in the research you collected?
Level of Evidence (hierarchy) + Quality of evidence (validity, reliability, applicability) = strength of evidence (confidence)
