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EBP > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Common Barriers to EBP

A

Individual and System level

  • Knowledge/Education
  • Low prioritization
  • Time
  • Resources
  • Culture
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2
Q

What is Evidence Based Practice?

A

“Integration of best research evidence with clinical expertise and patient values”

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3
Q

EBP consists of 3 factors

A

Evidence
Patient Preferences
Clinician Expertise

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4
Q

How do we integrate best research evidence into patient care?

What do we need to know? (3)

A

1) Your clinical question
2) How to search for evidence to address clinical question
3) How to appraise evidence for quality

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5
Q

What is research evidence”?

A

Systemic inquiry to identify “truth”

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6
Q

What is “Best” Research Evidence?

A

Has a High level of incidence -> when performed well, certain study designs are inherently stronger than others

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7
Q

Characteristics of high quality research evidence

A 
Study results are credible 
Not due to random chance or 
Non-random error (bias)
or 
Systematic error
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8
Q

Evidence Pyramid

What are the levels top to bottom?

A 
Systems 
Summaries
Synopses 
Syntheses
Studies
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9
Q

What level of the evidence pyramid does this fall into?

Computerized decision support software and Electronic health records

A

Systems

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10
Q

What level of the evidence pyramid does this fall into?

Evidence based textbooks, practice guidelines

ex) Dynamed, National Guideline Clearinghouse, UMHS Practice guidelines

A

Summaries

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11
Q

What level of the evidence pyramid does this fall into?

Pre-appraised Abstracts of Studies & Synthesis

ex) DARE, ACP Journal Club

A

Synopses

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12
Q

What level of the evidence pyramid does this fall into?

Systematic reviews

ex) Cochrane DSR, PubMed Clinical Queries (systematic review)

A

Syntheses

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13
Q

Secondary or Pre-appraised

A

Syntheses

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14
Q

Primary/Original

A

Studies

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15
Q

What level of the evidence pyramid does this fall into?

Primary Research

ex) PubMed Clinical Queries (Studies)

A

Studies

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16
Q

Different types of Studies

A

Randomized Control Trials
Cohort Studies
Case Control Studies
Case reports/Case series

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17
Q

Different types of Syntheses

A

Meta Analyses

Systematic Reviews

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18
Q

Best to start at the ___ of the pyramid!

A

Top

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19
Q

Secondary/Pre-appraised studies are those that?

A

Have multiple articles that are summarized and appraised

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20
Q

Primary/Original studies are those that?

A

One one study is reported

The reader must appraise study for quality

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21
Q

Appraisal =

A

Good Quality

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22
Q

Three discrete steps to appraise an article are?

A

1) Are the results of the study valid?
2) What are the results?
3) How can I apply these results to patient care?

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23
Q

Five Step Evidence Based Nursing Process

A

PEACE model

Problem Identification
Evidence Review
Appraise Evidence
Care Integration 
Evaluate Care Integration
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24
Q

Use ___ to identify the Problem in the peace model

A

PICO

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25
"A consistent systematic way to identify the components of a clinical issue"
PICO
26
What does PICO stand for?
P - Population I - Intervention C - Comparison O - Outcome
27
Identify the parts of this PICO question Among discharged patients, does the receipt of discharge phone calls, compared to no discharge phone calls improve patient experience scores?
``` P = discharged patients I = receipt of discharge phone call C = no discharge phone call O = improve patient experience scores ```
28
Why is PICO useful to you?
Lays the foundation to the 5 step evidence based nursing practice Helps clarify the actual issue you want to address Saves time searching - as you can focus your research on evidence that will best address your question
29
The initial an one of the most difficult steps in evidence based practice An iterative process
Formulating a PICO question
30
Question Types (4)
Intervention or therapy Etiology Prognosis/Prediction Meaning
31
What study design tries to determine which treatment leads to the best outcome? Ie) Experimental studies (RCT)
Intervention of Therapy
32
What study design tries to determine the greatest risk factor of a condition? Ie) Observational studies (eg cohort, case control, observational)
Etiology
33
What study design tries to determine the progression of a disease? Ie) Observational studies (eg. cohort, case control, observational)
Prognosis/Prediction
34
What study tries to understand the meaning of an experience? Ie) Qualitative research
Meaning
35
What type of study does this describe? - Researchers actively introduce intervention or treatment - Often called clinical trials in medical research - Can be randomized (RCT) or quasi experimental (when randomization is not performed)
Experimental studies
36
What type of study does this describe? - Researchers collect data without intervening or introducing treatments - Often called non-experimental research - Can be cohort study, case control study, cross-sectional study, they differ in the time frame of how data are collected
Observational Studies
37
Types of Observational studies (3)
Cohort Case Control Cross Sectional
38
Time Frames for Cross Sectional study
Exposure and Outcome is in the present
39
Time Frames for Case Control study
Exposure or No Exposure in the Past | Outcome or No Outcome in the Present
40
Time Frames for Cohort study
Exposure or No Exposure in the Present | Outcome or No Outcome in the Future
41
Example of what type of observational study? Is use of public transport system in NYC associated with covid 19 sx?
Case Control Outcome = covid 19 -> look back overtime through their travel patterns
42
What study design would be most appropriate to address this question type? You work in the inpatient setting and observe suboptimal environmental cleaning practices. You wonder if patients are at increased risk for infection if the individual they are rooming with has an active infection
Observational study
43
Purpose of a ______ Study - To explain and predict - To confirm and validate - To test theory - Seeks generalizations
Quantitative
44
Purpose of a ______ Study - To describe and explain - To explore and interpret - To build theory - Seeks patterns
Qualitative
45
What are the methods of data collection for a Quantitative study?
Representative Large sample Standardized Instruments
46
What are the methods of data collection for a Qualitative study?
Informative Small Sample Observations, Interviews
47
What is the form of reasoning in the anaylsis for a Quantitative study?
Deductive
48
What is the form of th reasoning in the analysis of a Qualitative study?
Inductive (deductive and inductive)
49
How are findings communicated in a Quantitative study?
Quantitative (numerical) information Statistics Aggregated data
50
How are findings communicated in a Qualitative study?
Qualitative (non-numerical) information Narratives Individual quotes
51
Quantitative Research Concepts
``` Study purpose/Aim Study population and sampling Variables Measurement Error Hypothesis Testing ```
52
States an expectation, a predicted answer to the research question
Research hypothesis
53
Subset of people in a defined setting
Sample
54
People in a defined setting
Population
55
Attributes of patients and clinical events that vary and can be measured
Variables
56
Independent variable
purported cause or predictor variable
57
Dependent variable
outcome variable
58
Extent to which a tool measures the actual condition it is meant to measure
Validity
59
Consistency of measures over time
Reliability
60
Bias ie systemic error
"The systematic introduction of error into a study that can distort the results in a non-random way"
61
Error (2)
``` Bias (systematic error) Random error (chance) ```
62
Null hypothesis
Assume no relationship; akin to "presumed innocence"
63
P values
likelihood results due to chance
64
Confidence intervals
contains range of true value | measure of precision
65
Directional hypothesis
Predicts direction of a relationship
66
Non-Directional hypothesis
Predicts the existence of a relationship, not its direction
67
Are Hypothesis proven?
Never proved or disproved
68
Used only in statistical testing Expresses the absence of a relationship Statistical testing performed to provide the probabilistic information to support or reject it
Null Hypothesis
69
Face Validity
Does an instrument appear to measure phenomenon of interest, weakest form of validity
70
Content Validity
Extent to which an instrument includes dimensions of the phenomenon under study ie) scale for measuring pain includes questions about severity and sensation of pain (dull, throbbing, itching)
71
Construct Validity
Does the instrument perform as expected between similar and dissimilar constructs
72
Convergent validity
like constructs have similar scores ie) expect to see similarities between pain and distress scores
73
Discriminant vailidity
unlike constructs do not have similar constructs ex) pain scores would differ from intelligence scores
74
Instrument reliability
The consistency with which an instrument measures the target attribute
75
Internal consistency
The extent to which all items on an instrument are measuring the same attribute appropriate for most multi-item instruments
76
Cronbach's alpha
Used to assess reliability
77
Alphas >/- ____ are highly desirable
0.80 Alpha of 1 = total agreement of all items (this is not desirable bc then their just duplicates of each other)
78
Stability
The extent to which scores are similar on two separate administrations of an instrument (test, retest- taking your BP twice are they similar)
79
Measurement
The assignment of numbers to represent the amount of an attribute present in an object or person, using specific rules. Used to operationalize or MEASURE variables in a quantitative study
80
4 classes of measurement
Nominal Ordinal Interval Ratio
81
Colors of the rainbow Race Gender
Nominal
82
Likert scale strongly agree to disagree | Letter grades
Ordinal
83
What class of measurement? Temperature
Interval
84
What class of measurement? Weight
Ratio
85
Nominal
Classify characteristics into categories, no inherent order
86
Ordinal
Ranking objects based on their relative standing on an attribute; inherent ordering between categories, but size of intervals not specified
87
Interval
Objects ordered on a scale that has equal distances between points on a scale (but no absolute zero)
88
Ratio
Equal distances between score units; there is a rational, meaningful zero
89
Selection bias
Flawed sample selection procedures; preexisting differences exist between groups being compared; study sample not representative of a larger population
90
Measurement bias
Biases arise when measures are not valid or reliable Or are performed inconsistently between study groups ex) before and after compliance of hand hygiene not measured the same, before by cameras, after by self report
91
Social desirability bias
Biases that stem from desire to report favorable informatin

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