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Flashcards in Chapter 21 Deck (25):
1

A nursing instructor is evaluating whether a student nurse knows the difference between evidence-based nursing practice (EBNP) and evidence-based practice (EBP). Which comment by the student would indicate that further teaching is needed? EBNP:
a. concerns nursing actions, not medical ones.
b. considers the patient’s needs and preferences based upon nursing theory and research.
c. utilizes nursing theory to determine process in nursing care.
d. targets medical decision making for the bulk of evidence-based care strategies.

D: Evidence-based practice (EBP) differs from evidence-based nursing practice (EBNP) in that EBP has a medical focus and EBNP is practice performed by nurses that considers the individual patient’s needs and preferences based upon nursing theory and research.
EVOLUTION OF EBP

2

The nurse educator explains to the nursing student that an evidence-based practice (EBP) guideline is:
a. a guideline for assessing practice.
b. a descriptive tool for identifying specified care in unique situations.
c. a standardized specification for care of a typical patient in the typical situation.
d. used in medical credentialing.

C: In evidence-based practice, guidelines are standardized tools or specifications of how care should be delivered, and they are used to guide practice treatment and intervention. EVOLUTION OF EBP

3

A nurse researcher understands that outcomes research:
a. is used in EBP.
b. studies mortality and end-of-life issues.
c. is a way of evaluating the goal or outcome of an educational program.
d. provides evidence concerning the continuum of disease processes.

A: Evidence-based practice (EBP) uses outcomes research to guide the development of specific strategies to deliver quality, cost-effective care. EVIDENCE-BASED PRACTICE

4

When giving a lecture regarding outcomes, the nurse educator explains that an important report issued by the ANA concerning outcomes is which of the following?
a. Crossing the Quality Chasm
b. To Err Is Human
c. Nursing Report Card for Acute Care Settings
d. Keeping Patients Safe

C: The American Nurses Association’s 1995 report entitled a “Nursing Report Card for Acute Care Settings” listed indicators for patient-centered outcomes, structures of care, and care processes. “Crossing the Quality Chasm,” “To Err Is Human,” and “Keeping Patients Safe” are all reports concerning patient safety and quality care from the Institute of Medicine (IOM). ROLE OF ANA

5

A nurse is exhibiting the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. The nurse’s actions are an example of which of the following?
a. Evidence-based models c. Evidence-based practice
b. Evidence-based practice guidelines d. Evidence-based nursing practice

C: Evidence-based practice (EBP) is a total process that makes a conscientious, judicious effort to utilize the most current and best evidence for clinical decision making regarding patient care. It uses evidence-based models and guidelines, and when it is applied to nursing practice, it is called evidence-based nursing practice. EVOLUTION OF EBP

6

The nursing instructor has just completed a lecture on evidence-based practice that included a discussion of the different phases. Which response by a nursing student who is identifying the phases would indicate to the nursing instructor that further clarification is needed?
a. Making the correct diagnosis
b. Locating the best practice
c. Clinical application of the best practice findings
d. Evaluation of the effectiveness of the care given

A: The steps involved in the total process of evidence-based practice are step 1, asking the correct clinical question(s), finding the best practice, and validating the findings to the particular care situation; step 2, clinical application of the best practice; and step 3, evaluation of the effectiveness of the care given and continual process improvement. The nursing instructor would need to clarify that making the correct diagnosis is always important, but it is not one of the steps in the process EVIDENCE-BASED PRACTICE

7

A student nurse has learned that traditionally, medicine has relied primarily upon biomedical parameters and measures such as laboratory and diagnostic tests to determine if a clinical intervention has been successful. The student nurse asks the nurse educator if this practice reflects current patient needs. Which of the following responses by the nurse educator would be correct?
a. Yes, because it has always been done this way, and it is a sound practice for patient care.
b. Yes, because these tests provide the clinical indicators necessary for accurate diagnosis.
c. No, because they may be false and thus not give enough information to make a sound diagnosis or intervention.
d. No, because these measures do not always address the multifaceted outcomes that patients care about most (quality of life).

D: Traditionally, health care providers have relied solely upon biochemical parameters and diagnostic tests to determine if an intervention is needed or if a treatment was effective. However, in today’s society, there are other outcomes of care that matter most to patients such as quality of life, family, work, and overall level of functioning, which are not reflected in these types of tests or procedures. EVIDENCE-BASED PRACTICE

8

A student nurse has heard of something called the IHI 100,000 Lives campaign. When the student nurse asks a nurse educator about it, the nurse educator explains that the primary goal of the campaign is:
a. saving lives through improvements in safety and effectiveness of care.
b. delivering reliable evidence-based care for acute myocardial infarctions.
c. the evaluation of the effects of actions in relation to phenomena.
d. preventing adverse drug-related events by medication reconciliation.

A: The primary goal of the 100,000 Lives Campaign, launched in 2004 by the Institute of Healthcare Improvement (IHI), is to save 100,000 lives among hospitalized patients through improvements in safety and effectiveness of care. Delivering reliable EB care for acute myocardial infarctions and preventing adverse drug events through medication reconciliation are two of the targeted intervention identified, but they are not the primary goals themselves. The evaluation of the effects of actions in relation to phenomena is one of the defining characteristics of nursing from the 1980 ANA Social Policy Statement. EVIDENCE-BASED PRACTICE

9

A nurse suggests that deploying rapid response teams and preventing central line infections are important ideas to implement. These ideas were identified in which publication/campaign?
a. Joint Commission Patient Safety Goals c. IHI’s 100,000 Lives Campaign
b. IOM’s “To Err Is Human” d. IOM’s “Crossing the Quality Chasm”

C: Deploying rapid response teams and preventing central line infections are two of six areas for evidence-based interventions identified by the Institute of Healthcare Improvement’s 100,000 Lives Campaign. EVIDENCE-BASED PRACTICE

10

When comparing the applicability of the University of Colorado Hospital Model and Model for Improvement, the nurse manager realizes that they both have which of the following in common?
a. They have nothing in common.
b. They are the same model, only one is for Colorado and the other is for California.
c. They are used in EBP.
d. They are used in PARETO.

C: The University of Colorado Hospital Model and Model for Improvement are both multidisciplinary practice models used in evidence-based practice. They present frameworks for thinking about the use of specific sources of information to support or change one’s practice. EVIDENCE-BASED MULTIDISCIPLINARY PRACTICE MODELS

11

A nurse researcher decides to employ the University of Colorado Model, which categorizes information according to several sources of evidence that are linked to a research core. Which source of evidence does not necessarily belong?
a. Patient preference c. Cost-effective analysis
b. Clinical expertise d. Comparison analysis data

D: The nine sources of evidence (information) linked to a central core of valid and current research in the University of Colorado Hospital Model are patient preference; clinical expertise; cost-effective analysis; infection control data (not comparison analysis data); benchmarking data; pathophysiology; retrospective or concurrent chart review; quality improvement and risk data; and international, national, and local standards. THE UNIVERSITY OF COLORADO HOSPITAL MODEL

12

A student nurse read an article that mentioned PDSA. When the student nurse asks the nurse educator what PDSA is, the nurse educator responds that PDSA is:
a. a national quality improvement campaign.
b. process, demonstrate, supervise, and analyze.
c. an acronym for an EBP model.
d. a type of quality improvement outcome that is part of the 100,000 Lives Campaign.

C: The Model for Improvement, an evidence-based practice (EBP) model, uses the plan-do-study-act (PDSA) format as the basis for its process. THE MODEL FOR IMPROVEMENT

13

A nurse manager wishes to implement the Model for Improvement with the rest of the team. The nurse manager knows that the Model for Improvement begins with three questions. Which of the following is not necessarily one of the three questions?
a. What are we trying to accomplish?
b. What change is needed for improvement?
c. What change can we make that will result in improvement?
d. How will we know that a change is an improvement?

B: The three primary questions that the Model for Improvement begins with are “What are we trying to accomplish?”, “How will we know that a change is an improvement?” (not “What change is needed for improvement?”), and “What change can we make that will result in improvement?” These three questions begin the PDSA cycle for improvement for this model. THE MODEL FOR IMPROVEMENT

14

A nurse has been assigned to care for a trauma patient with bilateral femoral spiral fractures and a torn spleen, which was removed 2 days before. The patient confides to the nurse that she agreed to an advance directive when she entered the hospital but now is not so sure that is what she wants. The patient asks if this is normal for her to feel this way. Which element of the University of Colorado Hospital Model should the nurse consider first in this situation?
a. Clinical expertise c. Patient preferences
b. Benchmarking data d. Quality improvement and risk data

C: Of the nine possible elements in the University of Colorado Hospital Model, patient preferences would be the most appropriate in this situation because it includes discussion, documentation, and implementation of the patient’s wishes regarding advanced directives, pain management, etc. Even though consulting the patient’s health practitioner (clinical expertise) is also indicated, the primary need for this patient is to have her questions answered and some discussion of her concern. TABLE 21-2 PRACTICE APPLICATIONS TO ELEMENTS OF THE UNIVERSITY OF COLORADO HOSPITAL MODEL

15

A patient has been complaining of unrelieved pain. The nurse is aware that unrelieved pain:
a. is unnecessary.
b. can be easily accommodated through drugs and patient positioning.
c. is a major health problem.
d. is one of the interventions in the 100,000 Lives Campaign.

C: Unrelieved pain continues to remain a major health problem. In 2006, pain management standards were added to the Joint Commission’s Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). PAIN AND COMFORT

16

A nurse is giving a presentation to the rest of the team regarding the elements of the Joint Commission's pain management standards. Which of the following does not necessarily belong among those elements?
a. Respect for patient values and beliefs
b. Pain assessment for all patients
c. Reassessment after an allotted time frame to monitor the effectiveness of pain management treatments
d. Patient rights to pain management.

C: Pain management standards as set forth in the 2006 Joint Commission’s Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH) include respect for patient values, beliefs, preferences and dignity; pain assessment in all patients; data collection to monitor effectiveness of pain management; and patient rights to pain management. Reassessment may be used as one of the means of gathering data to evaluate the effectiveness of care, but it should be postponed according to specified time frames for medication administration. PAIN AND COMFORT

17

A student nurse wishes to know which model provides a way for the nurse to organize information needed not only to care for the patient but also to evaluate the care provided. The nurse educator explains that this is which of the following models?
a. Model for Improvement c. Mayo Clinic
b. University of Colorado Hospital d. Samaritan Hospital Quality Practice

B: The University of Colorado Hospital Model provides a framework that nurses can use to organize data/information needed to not only care for individual patients but also to evaluate the care rendered. The Model for Improvement utilizes a plan-do-check-act or plan-do-study-act format. THE UNIVERSITY OF COLORADO HOSPITAL MODEL

18

During a presentation to the rest of the team, a nurse explains that reducing the prevalence of pressure ulcers is a major goal of:
a. the Model for Improvement. c. Joint Commission Core Measures.
b. 100,000 Lives campaign. d. Healthy People 2020.

D: One of the primary goals of the Healthy People 2020 initiative for national health (U.S. Department of Health and Human Services, 2000) is to reduce the prevalence of pressure ulcers. PRESSURE ULCER MANAGEMENT

19

A nurse is reviewing the guidelines developed by the Agency for Healthcare Research and Quality (AHRQ) for the identification and treatment of pressure ulcers. The nurse notes that the guidelines include several categories of care. Which of the following is not necessarily one of those categories?
a. Skin care c. Mechanical loading
b. Early treatment d. Nutritional assessment

D: The Agency for Healthcare Research and Quality (AHRQ) developed evidence-based guidelines for the prevention and treatment of pressure ulcers. These guidelines categorized preventive care into three areas: 1) skin care and early treatment, 2) mechanical loading and support surfaces, and 3) education. PRESSURE ULCER MANAGEMENT

20

When reviewing some of the primary aspects of effective local wound management, a nurse would see all of the following, except:
a. maintain a moist environment. c. promote epithelialization.
b. ongoing debridement. d. increase comfort.

B: The treatment of local wounds includes several components for effective therapy. Some of these measures are maintaining a moist environment, aiding debridement (not ongoing debridement), promoting epithelialization, increasing comfort, controlling exudate and odor, minimizing the frequency of dressing changes, and removing dressings without trauma. PRESSURE ULCER MANAGEMENT

21

In an effort to provide evidence-based care, the nurse manager of the unit informs the staff that they will be benchmarking their wound care practices with that of the major medical center in the area. The staff recognizes that they will be doing which of the following?
a. Measuring their wound care practices against one of their hospital’s toughest competitors, a recognized leading hospital in the area
b. Competing with another hospital to determine who provides the better care
c. Comparing the number of cases of wound care in their hospital with the number of cases in the other hospital
d. Working harder for longer hours each shift

A: Benchmarking is defined as the continuous process of measuring products, services, and practices against the toughest competitors or those customers recognized as industry leaders (The Joint Commission, 2009; Camp, 1994). The purpose of benchmarking is not to compare number of cases, compete with the other hospital, or for the staff to work harder.THE UNIVERSITY OF COLORADO HOSPITAL MODEL

22

The nurses on your unit are using the University of Colorado Hospital Model to care for patients with pressure ulcers and to evaluate the care given. One of the steps in this model is to identify patient preferences. During this step of the model, the nurses would do which of the following?
a. Review pathophysiology and etiology of pain and pressure ulcer progression for the palliative care patient
b. Compare the patient’s comfort, palliative care, and wound care measures against institutional and national benchmarks. Review evidence-based literature
c. Discuss, document, and implement patient’s wishes regarding advanced directives and comfort care measures
d. Consult Acute Care Nurse Practitioner (ACNP) and other practitioners for pressure relief, wound care, pain management, and comfort and palliative care measures

C: To identify patient preferences, you would discuss, document, and implement patient’s wishes regarding advanced directives and comfort care measures. None of the other options directly address patient references. TABLE 21-2 PRACTICE APPLICATIONS TO ELEMENTS OF THE UNIVERSITY OF COLORADO HOSPITAL MODEL

23

One of your patients is not responding to curative treatment. Implementing which of the following would be most appropriate at this time?
a. Hospice care c. Terminal care
b. Palliative care d. Respite care

B: You would most likely begin to implement palliative care. Palliative care has been defined by the World Health Organization as the active, total care of patients whose disease is not responsive to curative treatment. Palliative care is directed at preventing, reducing, and relieving symptoms of disease or disorders rather than interventions to cure. THE PALLIATIVE CARE PATIENT

24

According to Kobala, comfort is the immediate state of being strengthened by having which of the following needs met?
a. Food, shelter, clothing c. Relief from pain, shelter, work ease
b. Food, hygiene, pain d. Relief, ease, transcendence

D: Kobala defined comfort as the immediate state of being strengthened by having the needs of relief, ease, and transcendence met. PAIN AND COMFORT CARE

25

You are providing wound care for a patient. The order is for Tagaderm once a day. Tagaderm is used to do which of the following?
a. Treat local signs of infection c. Stop bleeding
b. Autolytically debride devitalized tissue d. Mechanically debride necrotic tissue

B: Tagaderm is used to autolytically debride devitalized tissue. A topical antimicrobial would be used to treat local signs of infection. A hemostatic such as Surgicel would be used to stop bleeding, and wet-to-dry dressings would be used to mechanically debride necrotic tissue. FIGURE 21-6 WOUND AND SKIN CARE PRODUCTS WITH INSTRUCTIONS