Question 1

A health care provider is concerned about the high number of clients with type 2 diabetes who have poor glucose control. In order to implement evidence-informed practice to manage this problem, what would be the best reference for the health care provider to use?

A) Published protocols
B) Current research findings
C) Opinions of colleagues
D) Media reports

Current research findings

Accepted Answer

Evidence-informed practice in community health nursing challenges CHNs to integrate the best evidence into their clinical practice. Current research findings will explicate the evidence of the most successful interventions. (Randomized clinical trials are the gold standard of research for evidence-informed practice.) Protocols and opinions often reflect tradition rather than the most current scientific evidence. Although many media reports seek expert opinion, many are not research based or focused on scientific evidence.

Question 2

What best represents the first step to take when using evidence-informed practice in the clinical setting?&#10;A) Eliminating all protocols and standards that are not evidence based&#10;B) Gathering data on the clinical problem&#10;C) Formulating the clinical question&#10;D) Revising mission statements and organizational philosophies

Accepted Answer

The first step in the evidence-informed practice process is formulating the question, which includes defining and refining the question. To Answerwer the client clinical question that has been formulated, the sources of evidence-informed practice related to community health nursing include the best available evidence.

Question 3

A CHN implemented an education program that incorporated computer games to reinforce learning in a community of older adults. Although earlier research had demonstrated evidence of improved retention of information by using this method, the CHN found exactly the opposite effect in this group of clients. What would be the most likely cause of the poor outcome in the education program?

A) Failure to consider client and contextual differences
B) Inadequate incorporation of evidence into practice
C) Inferior quality of the available research evidence
D) The CHN's lack of skills in evaluating the evidence

Accepted Answer

Evidence-informed practice cannot be applied as a universal remedy without attention to client differences. When evidence-informed practice is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to that particular community. For example, computer games may be an excellent choice for younger groups but is often not suitable for older adults, who may face challenges with learning new technology.

Question 4

What action by a nurse leader would best implement evidence-informed practice at a community nursing centre that serves a large Cuban immigrant population?&#10;A) Having university experts with cultural competency expertise review the centre's policies&#10;B) Having weekly staff meetings for the purpose of determining which methods seem to work best when helping immigrants&#10;C) Including Cuban immigrants from the community on the centre's advisory board&#10;D) Sending centre staff to conferences and seminars that focus on providing health care to immigrants from Spanish-speaking countries

Accepted Answer

Although all of the proposed options are good, in order to determine whether the centre's practice is serving the needs of the population, the nurse executive will need to consult members of the population being served. This meAnswer that evidence would be applied to practice with input from the community. For example, decisions related to the services to be offered in a community health nurse (CHN)-managed clinic would be made with input from the clinic's advisory board, which should include community leaders and consumers of the clinic's services. The needs of Cuban immigrants may not be the same as those of immigrants from other Spanish-speaking countries, such as Mexico or Spain.

Question 5

A CHN plans to use evidence-informed practice to guide the development of health education programs that are most likely to increase retention of information in elementary school children. What represents the best way to use evidence-informed practice in this situation?

A) Asking other CHNs about what they included in their own education programs
B) Comparing and contrasting findings from randomized clinical trials related to learning in elementary school children
C) Developing a series of games to accompany the programs developed to promote health
D) Seeking out and examining information on the Internet on health education programs for elementary school children

Accepted Answer

Randomized clinical trials are the gold standard for evidence gathering in evidence-informed practice.

Question 6

How can a CHN best facilitate incorporation of evidence-informed practice in the clinical setting?&#10;A) Elimination of all protocols and standards that are not evidence based&#10;B) Group reflection on the ideals and expectations of nursing care&#10;C) Incorporation of more client/practice-oriented research into decision making&#10;D) Revision of mission statements and organizational philosophies

Accepted Answer

Evidence-informed practice demands changes. It requires the incorporation of more practice-oriented research and more collaboration between cliniciAnswer and researchers. Emphasis should be on decision making using the various sources of evidence. When CHNs access scientific knowledge of all types, they need to choose the most relevant information for each client's clinical situation.

Question 7

Which activity to determine the best way to address an outbreak of a new infectious disease exemplifies evidence-informed practice?&#10;A) Reviews policies and procedures&#10;B) Reviews outcomes of clinical trials&#10;C) Reviews several nursing textbooks&#10;D) Gets information from the Internet

Accepted Answer

Evidence-informed practice is defined as combining the best evidence derived from research with clinical practice, knowledge, expertise, and unique client expectations, preferences, or choices when making clinical decisions. Getting ideas from the Internet is helpful only if evidence-informed practice sites are accessed; however, most Internet sites do not offer information grounded in evidence-informed practice.

Question 8

A nursing administrator aims to develop a work environment conducive to the implementation of evidence-informed practice. What is the best approach to achieve this goal?&#10;A) Conducting market research to determine customer satisfaction with evidence-informed practice&#10;B) Eliciting opinions from CHNs on how evidence-informed practice will affect workload&#10;C) Increasing access of nursing research sources, including nursing research journals, in the libraries of health care institutions&#10;D) Sending staff to conferences related to incorporation of evidence-informed practice into practice

Accepted Answer

Inadequacy of nursing research sources, including nursing research journals, in the libraries of health care institutions can create a barrier to the implementation of evidence-informed practice in community-based nursing agencies. Increased nursing research holdings can help CHNs to quickly access current evidence-informed findings and recommendations.

Question 9

What is the biggest challenge for CHNs who are familiar with evidence-informed practice and want to implement it in their care of clients?&#10;A) Interpreting vast amounts of evidence and integrating it into practice&#10;B) Advocating for change and convincing others that it is beneficial&#10;C) Distinguishing evidence-informed practice from practice based on old standards&#10;D) Showing clients that evidence-informed practice will improve their health outcomes

Accepted Answer

The challenge for the CHN is accessing the evidence, interpreting it, and integrating it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.

Deck 5: Evidence-Informed Practice in Community Health Nursing