Week 3 - Ethics in Research and EBP Flashcards

Question

What are some resources for EBP in nursing

Answer 1

models of the EBP process preprocessed and pre appraised evidence

Answer 2

Clinical practice guidelines Appraisal of Guidelines Research and Evaluation (AGREE and AGREE II) *most evidence is based in guidelines which are mounted on a ton of research*

Answer 3

1. Ask 2. Acquire 3. Appraise 4. Apply 5. Assess

Answer 4

0 - Cultivating the Sense of Inquiry

Answer 5

Knowledge Focused Triggers Problem Focused Triggers

Answer 6

Begins with an innovation or research finding (eg: might emerge in a journal club) / something that catches your eye and you look into it

Answer 7

Begins with a perplexing or troubling clinical situation ex: Why are nurses passing out more than they should

Answer 8

Ask: Ask a well-worded clinical question that can be answered with research evidence.

Answer 9

Search for and retrieve the best evidence to answer the clinical question.

Answer 10

Critically appraise the evidence for validity and applicability to the problem and situation.

Answer 11

After integrating the evidence with clinical expertise, patient preferences, and local context, apply it to clinical practice.

Answer 12

Evaluate the outcome of the practice change.

Answer 13

PICO - the framework for asking the question

Answer 14

Patient population Intervention or issue of interest Comparison intervention or group ** Outcome Time frame** ** not always specified

Answer 15

I and C are compared C would be the control O is the DV

Answer 16

population situation (processes, exp, cultures, hx, condition of interest)

Answer 17

Ethno - Culture Grounded - Process Phenom - Experience

Answer 18

A template of PICOT that can greatly facilitate wording of questions - can reword article titles to make them make more sense too ex: In (population), what is the effect of (intervention), in comparison to (comparison), on (outcome) in (timeframe)

Answer 19

Step 2: Acquire research evidence Can use PICOT as keywords to search the database find research

Answer 20

CINAHL (first line) MEDLINE Cochrane Collaboration Agency for Healthcare Research and Quality** National Guideline Clearinghouse** ** good place to look for clinical practice guidelines and is directly applicable to clinical practice

Answer 21

Quality Magnitude Quantity Consistency Applicability Level of Evidence

Answer 22

to what extent is the evidence valid- how serious is the risk of biases in this research?

Answer 23

How large is the effect of the intervention or influence (I) on the outcome (O) in the population of interest (P)? Are the effects clinically significant? Is it significant enough to change behavior and practice to improve care

Answer 24

How much evidence is there? How many studies have been conducted, and did those studies involve a large number of participants?

Answer 25

How consistent are the findings across various studies? We want to see consistent agreement across studies

Answer 26

To what extent is the evidence relevant to my clinical situation and patients? How well can this apply to care bedside, community care, large groups, family care

Answer 27

Applicability of research

Answer 28

Pyramid of evidence levels that is applicable to research appraisal by seeing where the study falls in regard to what type and level of evidence it is it looks at the level of study design 7 Levels

Answer 29

Systematic Review of RCTs and nonrandomized trials / Reviews of Literature and Studies Quantitative evidence Considered the highest level/ best level

Answer 30

Experimental Controlled Trials or Quasi Experimental Studies - Quantitative evidence

Answer 31

Systematic Reviews of NON experimental studies - still quantitative evidence

Answer 32

Individual Correlational Observational Studies Still quantitative

Answer 33

Systematic Review of Qualitative Studies (which is hard to do since they are not made to be reviewed like that)

Answer 34

Single Qualitative Study - not good evidence to make practice change since it was not meant to be generalized to change practice Not that its bad quality, just its design isnt for application purposes

Answer 35

Opinions of Authorities and Expert Committees Highly susceptible to group think and outside pressure

Answer 36

high quality research (needs systematic critique)

Answer 37

hierarchy of evidence

Answer 38

quality (individual studies look more to this) quantity consistency (lit reviews look more at this)

Answer 39

the extent to which a study’s design, conduct, and analysis has minimized selection, measurement, and confounding biases (internal validity)

Answer 40

the number of studies that have evaluated the question, overall sample size across all studies, magnitude of the treatment effect, strength from causality assessment, such as relative risk or odds ratio

Answer 41

whether investigations with both similar and different study designs report similar findings (requires numerous studies)

Answer 42

Evidence will be integrated into own clinical expertise and knowledge of the clinical setting - the integration from qualitative research can also provide rich insights into how a pt exp a problem or about barriers to complying with a treatment --> think of the smoking women study story So its you starting to use it in the practice environment

Answer 43

implementation

Answer 44

EBP is not just research and published evidence: Pt hx and circumstances have sig bearing on nurse choice of intervention Also availability of resources must be considered - feasibility, cost benefit, transferability, cost benefit analysis View if it will really translate to this particular pt population

Answer 45

to help implement (step 4) evidence into practice

Answer 46

EBP Model promotes EBP

Answer 47

promotes quality care in practice

Answer 48

Did you achieve the desired outcomes and make a change? If so, were the patients satisfied with the results? Were there barriers or issues?

Answer 49

Step 6: Disseminate Outcomes of the EBP Decision or Change

Answer 50

Often positive outcomes are not shared with others- so communication among areas can help Numerous strategies exist to do this including personal communication, conference presentation, and peer reviewed article publications

Answer 51

Diffusion of Innovation and Early adapters v Laggards

Answer 52

There is a long gap for people to uptake new information and behavior Could take almost 20 years for wide adoption of a practice change from the research's beginning - there is resistance

Answer 53

HCAHPS and Press Ganey

Answer 54

"Hospital Consumer Assessment of Healthcare Providers and Systems" It is a national survey required by Centers for Medicare and Medicaid services at hospitals accepting those insurances It requires hospitals to send out pt satisfaction surveys and allow others to view hospitals and their pt satisfaction scores

Answer 55

Private for profit organization that polls health care consumers to assess quality of care including HCAHPS in the survey Not all hospitals can afford them

Answer 56

read widely and critically attend professional conferences insist on evidence that a procedure is effective become involved in a journal club pursue and participate in EBP projects ASSUME A STANCE OF SKEPTICISM

Answer 57

1. Research Related Barriers (ex: Scarcity of published replications) 2. Nurse Related Barriers (ex: insuff skills in locating and appraising evidence, no love for research) 3. Organizational Barriers (ex: lack of financial support and staff release time for EBP, or funding)

Answer 58

lack of knowledge information overload lack of role models lack of time or money resistance to change misperception that you need an advanced degree to read and understand research disinterest when there is bedside care to be done

Answer 59

support from leaders and peers adequate time to do so resources journal clubs and EBP rounds

Answer 60

DETERMINED EFFORT

Answer 61

jenner and smallpox nazi medical experiments Tuskegee syphilis study willowbrook study jewish chronic disease hospital study

Answer 62

implied consent

Answer 63

German Nazi Physicians tortured under the guise of testing limits of human endurance and tolerance No attempt to relieve pain, high mortality rates, no informed consent

Answer 64

what occurred in WWII

Answer 65

30s-70s USPHS, CDC recruited 400 AA male sharecroppers for a syphilis experiment - one group with and one without Withheld Penicilin treatment once available, risk outweighed benefits, forced infection, no autonomy respected, coercive rewards, taken advantage of by own gov't

Answer 66

50s-72 Parents coerced to sign consent for mentally disabled children to be infected with Hep B and study inoculation of IM v PO in order to get them into a state school institution 350 children - some received gamma globulin treatment while others didnt, purposefully infected, unable to give informed consent, coercive Ripple effect led to institutionalization --> community care in NYS

Answer 67

60s Oncology pts injected with their own cancerous cells while pts and physicians were unaware Investigator wanted to know rejection response, no informed consent documented and claimed to have verbal consent no evidence of IRB Scientific misconduct, fraud, deceit

Answer 68

24 yo healthy female died 1 mo after experimental treatment to induce asthma symptoms Inadequate Review of Literature occurred - did not review and include how hexamethonium can sometimes cause adverse effects in informed consent sheet

Answer 69

died within hours of getting bronchoscopy with 4x the amount of lidocaine received 150$ - coercive reward

Answer 70

there needs to be enough to compensate but not enough to be seen as coercive

Answer 71

Nuremberg Code - Response to Nazi Atrocities Declaration of Helsinki 1978 - BELMONT REPORT 1995 - ANA Ethical Guide in Nursing Research 2012 - ICN Code of Ethics for Nurses 2015 - ANA Declares Year of Ethics and Revised Code

Answer 72

a situation in research in which the rights of study participants are in direct conflict with requirements of a study

Answer 73

Does a new medication prolong life in pts with AIDS? Are nurses equally empathetic in their treatment of male and female pts in the ICU?

Answer 74

Beneficence Respect for Human Dignity Justice

Answer 75

Imposes a duty on researchers to minimize harm and maximize benefits Above all, do no harm

Answer 76

includes the right to self determination and the right to full disclosure

Answer 77

Includes participant's right to fair treatment and their right to privacy

Answer 78

1. Right to freedom from harm and discomfort / minimize harm; maximize benefits 2. Right to protection from exploitation - participants should not be at a disadvantage and the special relationship should not be exploited

Answer 79

1. Right to self determination (absence of coercion) | 2. Right to Full disclosure (absence of deception or concealment)

Answer 80

you decide voluntarily to participate without risking prejudicial treatment and you have the right to ask questions, refuse to answer questions, and drop out

Answer 81

receiving a description of the study, the persons right to refuse participation, and potential risks and benefits

Answer 82

1. right to fair treatment | 2. right to privacy

Answer 83

Concerns the equitable distribution of benefits and burdens of research

Answer 84

confidentiality and anonymity ensures that research is not more intrusive than it needs to be and that privacy is maintained

Answer 85

Risk Benefit Assessments Informed Consent Confidentiality Procedures Debriefings and Referrals Treatment of Vulnerable Groups - Children, Disabled, Terminally Ill, Institutionalized, Pregnant External reviews and the protection of human rights Ethical issues in using animals in research

Answer 86

means participants have adequate information about the study, comprehend the information, and have the power of free choice, enabling them to consent to or decline participation voluntarily

Answer 87

1. have adequate info about the research 2. can comprehend the info 3. have free choice to participate in or withdraw from the study

Answer 88

signed consent form

Answer 89

e.g. consent form for self administered questionnaires

Answer 90

Renegotiated over time - used in qualitative studies

Answer 91

Anonymity Confidentiality in the Absence of Anonymity Certificate of Confidentiality (NIH)

Answer 92

researchers cannot link participants to their data

Answer 93

other confidentiality procedures will need to be implemented - taking steps to ensure breach of confidentiality does no occur

Answer 94

a certificate obtained to prevent forced disclosure of confidential information to authorities

Answer 95

Debriefings can be held following data collection so participants can ask questions or share concerns Researchers can demonstrate interest in participants by offering to share study findings with them after data is analyzed Also, researchers may assist participants by making referrals to appropriate health, social, or psychological services

Answer 96

study participants that require special protections since they may be incapable of giving fully informed consent, may be high risk for unintended side effects, or are children who cannot make a truly informed decision about voluntary participation

Answer 97

they will need to be reviewed and given permission by an external review for protection of human rights ex: human subjects committees, IRBs, research ethics boards

Answer 98

True Rationale: One of the first international efforts to establish ethical standards was the Nuremberg Code. These ethical standards were developed in 1949 in response to the Nazi atrocities.

Answer 99

D -Privacy Rationale: The principle of justice ensures a research subject’s right to privacy and fair treatment. The right to self-determination and the right to full disclosure are ensured by the principle of respect for human dignity. The right to protection from harm is ensured by the principle of beneficence.

Answer 100

True Rationale: Children, because of their inability to make a truly informed decision about voluntary participation in a research study, are considered vulnerable and thus require special protection.

Answer 101

It was created due to the national research act of 1964 it made the 3 principles of ethical conduct - Justice, beneficence, and Autonomy

Answer 102

When rights of participants are in dilemma with the requirements of the study

Answer 103

It is implied consent in medicine - we care assuming they want care unless otherwise told Research needs consent

Answer 104

Beneficence

Answer 105

Idea and Concept that people won't be exposed to more risk than what they are exposed to over their daily lives

Answer 106

provide benefit for that group (like if its children, benefit the children or that group of children)

Answer 107

no longer than 2 syllable words and at a 5th grade reading level

Answer 108

signature (in informed consent)

Answer 109

if no ID information is gained, they may have no blatant informed consent signing

Answer 110

consent changing over time - updating based on things UNIQUE TO QUALITATIVE RESEARCH Renegotiate to have them maybe join another study after (qual)

Answer 111

do not gather identifiable information that can link back to the person Not possble in all cases of research

Answer 112

Can use if the person is at hihg risk plsu we ca ll hteen

Week 3 - Ethics in Research and EBP Flashcards

(141 cards)