Nursing Chapter 5: Evidence-Based Practice

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Questions and Answers

What is essential to distinguish before applying research findings to practice?

Intermediate outcomes and clinical outcomes (correct)

Patient satisfaction and clinical outcomes

Cost-effectiveness and clinical guidelines

Qualitative data and quantitative data

Which method can be used to develop a point-of-care strategy?

Writing a research paper

Asking a clinical question (correct)

Collaborating with pharmaceutical companies

Conducting a literature review

What is the first step in clinical decision making regarding a patient's health-care decisions?

Assessing available resources

Collecting and analyzing evidence

Reviewing clinical guidelines

Determining the outcome the patient desires (correct)

What has increased federal funding for nursing research aligned with the National Institute for Nursing Research?

Collaboration with other NIH institutes Signup and view all the answers

How should improvement in intermediate outcomes be treated in relation to clinical outcomes?

It may not lead to improvements in clinical outcomes Signup and view all the answers

Which components are essential for evidence-based practice decisions?

Patient preferences and values Signup and view all the answers

What is the main aim of nursing research in clinical practice?

To conduct studies that enhance nursing knowledge Signup and view all the answers

Who is credited with the origins of evidence-based practice?

Archie Cochrane Signup and view all the answers

What is the primary difference between practice standards and guidelines?

Standards dictate inflexible practices while guidelines allow for individual decisions Signup and view all the answers

What is the highest level of evidence for changing practice according to research designs?

Systematic review or meta-analysis of randomized controlled trials Signup and view all the answers

Which of the following is considered Level Three evidence?

Well-designed controlled trials without randomization Signup and view all the answers

What is a primary function of the Agency for Healthcare Research and Quality (AHRQ)?

To improve the quality and effectiveness of healthcare Signup and view all the answers

Which type of study is classified as Level Five evidence?

Systematic reviews of qualitative studies Signup and view all the answers

What is a characteristic of Level Six evidence?

Single descriptive or qualitative study without broader implications Signup and view all the answers

What is an important aspect to consider when evaluating clinical practice guidelines?

The creator of the guideline Signup and view all the answers

What role does the National Guideline Clearinghouse serve?

It is an electronic repository for clinical practice guidelines Signup and view all the answers

Why is double-blinding important in research designs?

It enhances the objectivity and validity of results Signup and view all the answers

Which type of evidence may still be used in rare situations despite being weak?

Expert opinions and committee reviews Signup and view all the answers

What is the purpose of developing evidence-based tables in practice?

To assist in clinical decision-making Signup and view all the answers

Study Notes

Evidence-Based Practice

Originates from research findings to inform clinical decisions.
Involves collaboration among clinicians, bodies of evidence, and patient preferences.
Implementation requires systematic steps for effective integration into practice.

Aims of Nursing Research for Clinical Practice

Pursues knowledge to address pertinent clinical questions.
Aims to validate and expand existing nursing knowledge.
Gathers published literature to guide clinical decision-making.

A Brief History of Evidence-Based Practice

Developed from Archie Cochrane's advocacy for rigorous research validation.
Initially conceptualized in nursing as Research Utilization (R U).
Evolved into the broader concept of Evidence-Based Practice (E B P).

Development of Best Practice Guidelines

Traditional methods relied on past common practices.
Modern guidelines are based on scientific evidence, improving care quality.
Agency for Healthcare Research and Quality (AHRQ) leads E B P initiatives.

AHRQ Guidelines and Implementation

AHRQ aims to enhance healthcare quality, safety, efficiency, and effectiveness.
Guidelines provide frameworks for healthcare providers and insurance assessments.
Address barriers to implementation through public-private partnerships.

Clinical Practice Guidelines

Standards provide rigid frameworks applicable in all situations.
Guidelines offer flexibility for individualized patient care decisions, with rationale for deviations.

Development of Evidence-Based Practice Guidelines

Involves identifying topics, expert panel input, systematic literature reviews, and consensus on recommendations.
Includes external review before finalizing guidelines.

Research Designs and Evidence Levels

Level One: Systematic review or meta-analysis of randomized controlled trials (RCTs) represents the highest evidence.
Level Two: Single well-designed RCT establishes causal relationships.
Level Three: Controlled trials without randomization assess treatment effectiveness amid controlled variables.

Further Research Designs

Level Four: Well-designed case control or cohort studies, including observational studies, help evaluate disease progression and causation.
Level Five: Systematic reviews of descriptive or qualitative studies provide population characteristics and insights.
Level Six: Single descriptive or qualitative studies alert to rare cases but lack generalizability.
Level Seven: Opinions of authorities serve as a final evidence source, albeit less reliable.

Evaluating Clinical Practice Guidelines

Critical evaluation questions include guideline authorship, revision date, clinical importance, and evidence strength relevant to patient care.

Evidence Application in Clinical Practice

Distinguishing between intermediate and clinical outcomes is essential before applying research findings in practice.
Example: Effect of ACE inhibitors on congestive heart failure outcomes.

Developing Point-of-Care Strategies

Involves asking clinical questions, accessing evidence resources, searching, analyzing results, and integrating findings into patient care.

Building Evidence for Practice

National Institute for Nursing Research promotes funding and aligns nursing research with broader NIH initiatives.
Multiple knowledge acquisition methods enhance understanding and application.

Clinical Decision-Making with Patients

Begin by clarifying the desired patient outcomes.
Collect, analyze evidence, and assess intervention effectiveness in terms of desired health results.

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Description

Explore the essential principles of Evidence-Based Practice in nursing as covered in Chapter 5. This quiz will examine how clinician decisions, a convincing body of evidence, and patient preferences intertwine in promoting effective healthcare outcomes.