Question 1

The team has reviewed several research studies regarding treatment of pancreatitis in older adult women. One intervention is found to be particularly effective, but it requires a specific piece of expensive equipment and complex provider training. In which part of the FAME framework does this intervention score poorly?

Accepted Answer

1. "F" stands for feasibility and determines if the evidence is immediately practicable or if it requires extensive training and resources. Some evidence is also found to be impracticable. The evidence in this scenario falls in the middle to lower range.
2. "A" stands for appropriateness. Appropriateness concerns the ethics of using the evidence or intervention. There is no information to suggest that this intervention is not ethical.
3. "M" stands for meaningfulness. The standard ranges from evidence that provides a rationale for practice development to evidence that is unlikely to make sense to practitioners. This intervention is effective and there is no evidence that the rationale for using it is not clear.
4. "E" stands for effectiveness. The standard ranges from extensive validation with limited contradictory findings to concepts that need development. There is no indication that this intervention would score poorly on this rating.

Question 2

The nurse researcher is interested in conducting research into a specific clinical problem. The research design will require that the participants be deceived about the purpose of an intervention. What should the researcher consider about this design?

Accepted Answer

1. It is not illegal to deceive study participants. The IRB must approve this design.
2. Approval from the IRB will depend upon the reason the participants are being deceived.
3. This is not a common practice, but is appropriate in some situations.
4. The IRB must approve the study and approval will rest on the researcher's ability to prove that this is a critical element of the study.

Question 3

Which patient would be considered to belong to a vulnerable population when included in research? Select all that apply.

Accepted Answer

1. Neonates are considered a vulnerable population.
2. Persons with mental illness are considered a vulnerable population.
3. Pregnant women and fetuses are considered vulnerable populations.
4. Persons who are hospitalized are not considered part of a vulnerable population based upon the hospitalization alone.
5. Persons confined to institutions such as prisons are considered part of a vulnerable population.

Question 4

A nursing research team from a hospital would like to quickly disseminate findings from its study to the nurses in its local area. Which strategy should this team employ?

Accepted Answer

1. This is a very good method of disseminating the findings to a national forum, but takes time and would not be the best plan for these nurses.
2. This is a good forum for dissemination of findings, but locating a conference that is local and will be held quickly is difficult. The planner of such a conference generally chooses the poster presentations through a selection process that takes time and is held several weeks prior to the date of the conference.
3. This is the best way for these results to be disseminated. This event could be co-sponsored by the hospital and any nursing programs in the area. These events do take planning, but are not as planning intensive as national events.
4. When practice journals describe research findings, it is generally done as part of a secondary article. While some staff nurses are more likely to read about findings in a practice journal, the entire study would not be published. Also, having an article accepted for inclusion in a journal is a time consuming process.

Question 5

The nurse is overwhelmed with the amount of information concerning vitamin D supplementation in post-menopausal women. Which strategy would be the most appropriate for this nurse to use to find the best practice information on this topic?

Accepted Answer

1. While the nurse might learn a great deal from this search, the number of "hits" on a general search engine would be daunting. It is also not likely that all of the information retrieved would be scientifically- or evidence-based. Identifying the evidence-based recommendations would be very time consuming.
2. In order to read enough information, the nurse would have to search the journals for appropriate articles and then find the journals, either in print or online full text. This would be a time-consuming endeavor.
3. Sites such as Joanna Briggs have already reviewed the evidence and have used the hierarchy of evidence levels to categorize the information. This would be the quickest method to find reputable evidence.
4. The information on the WHO site is not only for healthcare professionals, but is also for the general public. It is likely that very good information is available, but locating it in this huge site might be time consuming.

Question 6

The nurse researcher is developing a PICO question for a study. Which consideration should be made when writing the "O" section of this question?

Accepted Answer

1. "O" is the outcome, such as risk of disease, a complication or a side effect, or an adverse outcome.
2. This is section "I." The "I" can be related to prognostic factors, risk behaviors, exposure to disease, clinical intervention, or treatment.
3. This is section "C." The "C" can be related to another treatment or no treatment.
4. This is the "P" section, the group that is being studied, written is specific terms.

Question 7

Which example of best practice review would likely be assigned a Level I?

Accepted Answer

1. This is considered as level VI evidence.
2. Level I evidence is the highest or best level. It is evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence based clinical practice guidelines based on systematic reviews of RCTs.
3. Expert opinion is level VII evidence.
4. This type of evidence is categorized as level III.

Question 8

The high school student is very interested in healthcare research and is trying to decide which healthcare profession to enter. What should this student consider when examining leadership roles in research that nurses can assume? Select all that apply.

Accepted Answer

1. Nurses act as designers and principle investigators in their own research.
2. Participating in interprofessional studies and trials is a common role for the nurse.
3. Depending upon educational level, nurses do manage clinical trials.
4. Nurses of many different educational levels serve as patient advocates in decisions about clinical trial participation.
5. The nurse serves in many roles in healthcare research, including leadership roles. This high school student should consider advanced education in nursing beyond a basic degree.

Question 9

Over the last six months, patient satisfaction surveys have begun to mention that the facility is not as clean as expected. How should an administrator using evidence-based management (EBM) strategies deal with this information?

Accepted Answer

1. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.
2. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.
3. EBM encourages the manager or administrator to "face the hard facts" and not to make excuses for evidence. The administrator should treat the organization as a work in progress and use this information to encourage housekeeping workers to improve.
4. Demanding an answer to the situation is not an EBM principle. The administrator should see the organization as a work in progress. Something has occurred to impact the hospital's cleanliness. That issue should be addressed and rectified, but it is not necessary to be demanding and accusatory.

Question 10

The nurse executive wishes to encourage the use of evidence-based practice (EBP) in the clinical areas of the hospital. When talking to nurse managers about this decision what benefits of EBP should the nurse executive emphasize? Select all that apply.

Accepted Answer

1. This is a very important aspect of EBP to the nurse executive and to nursing managers.
2. Individual decision making about healthcare is still an important facet of care when using EBP.
3. Improvement of healthcare quality is a fact about EBP that should appeal to nurse managers and to staff nurses.
4. EBP does make care more patient-centered. This should be appealing to nurse managers and staff nurses.
5. There is no evidence that EBP increases involvement of third party payers in healthcare decisions.

Question 11

The experienced staff nurse complains that use of evidence-based practice (EBP) guidelines has "reduced nursing to a cookbook profession." What is meant by this comment?

Accepted Answer

1. This is not the meaning of "cookbook" in this scenario. The EBP guidelines are not always easy to follow and the profession remains challenging. The challenge is in individualizing the guidelines to the specific patient and situation.
2. This is not the meaning of "cookbook" in this scenario. The guidelines require professional education and clinical decision making. There is no indication that using EBP will reduce the required education level of nurses or that other, less educated persons will have the clinical decision making skills to employ EBP guidelines.
3. The term "cookbook" has been used to complain that using guidelines results in care that is too prescribed and directed. This should not be true of EBP guidelines as they are written to be patient-centered and to be modified to fit the particular patient and patient situation.
4. The purpose of EBP guidelines is to provide the best interventions or treatments to the individual patient, given the individual situation. This does require some interpretation, but the purpose of the guidelines is also to limit this need.

Question 12

Arrange the five steps of the evidence-based practice process in order of their use. 
A) Evaluate practice decisions. 
B) Collect best evidence. 
C) Integrate the evidence. 
D) Appraise the evidence. 
E) Write a PICO question.

Accepted Answer

The answer of Arrange the five steps of the evidence-based...

Question 13

Place the steps of the evidence-based management (EBM) process in correct order. 
A) Formulate the question. 
B) Assess the evidence. 
C) Acquire research evidence. 
D) Apply the evidence. 
E) Present the evidence.

Accepted Answer

The answer of Place the steps of the evidence-based management...

Question 14

Which option best fulfills the "P" portion of a PICO question?

Accepted Answer

1. This is the most descriptive of these options.
2. This statement does not include how long the infants have been breast fed and if they have been exclusively breast fed or are supplemented with formula feedings.
3. This statement does not clarify the age of the women being studied or the length of time since diagnosis.
4. Poor is a subjective term as is "for some time."

Question 15

The nurse executive has instituted a very effective program that encourages nursing staff involvement in research. Nurses are suggesting research topics, helping to collect data, and have assisted with data analysis. What should be the nurse executive's next goal for these nurses?

Accepted Answer

1. This is an important consideration, but is not the next step in this scenario.
2. This is an important goal for these nurses, but is not the next step in this particular scenario.
3. The nurses must have resources and time to conduct research, but in this scenario, research is being conducted. For this example, this is not the most important next step as the research has been completed.
4. This is the most important next step for this work. If the results of studies are to impact the provision of nursing care, they must be disseminated beyond the unit where they are first tested.

Question 16

The staff nurse has long wondered if some common nursing interventions are helpful to patient outcomes. Where would this nurse find evidence-based practice information to help solve this dilemma? Select all that apply.

Accepted Answer

1. Research journals report evidence-based research study results on many topics, including traditional interventions.
2. The opinion of nursing experts should reflect evidence-based care.
3. Established nursing theories have been tested and include evidenced-based information.
4. Traditions are often passed down from nurse to nurse and are not necessarily based in science. They are not necessarily bad, either, but have no basis in science.
5. Clinical expertise does not always correlate to use of evidence-based practice.

Question 17

The nurse is involved in basic research. Which study topic would the nurse most likely research?

Accepted Answer

1. This is applied research.
2. This is applied research.
3. Historical research is research that adds to the nursing knowledge base and is considered basic research.
4. This is applied research.

Question 18

Which research topics would likely be included in the National Institute of Nursing Research (NINR) Intramural program? Select all that apply.

Accepted Answer

1. The Intramural program is managed through the Division of Intramural Research and is comprised of the Symptom Management Unit (which would conduct this study), the Pain Research Unit, and the Research Training Unit.
2. The Intramural program is managed through the Division of Intramural Research and is comprised of the Symptom Management Unit, the Pain Research Unit (which would conduct this study), and the Research Training Unit.
3. The Intramural program is managed through the Division of Intramural Research and is comprised of the Symptom Management Unit, the Pain Research Unit, and the Research Training Unit (which would conduct this study).
4. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program.
5. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program.

Question 19

The newly licensed nurse is concerned about the rapidity with which nursing care information changes. What characteristic would be best to help manage this concern?

Accepted Answer

1. General Internet search engines do not always provide quality information for healthcare providers. These search engines also provide large amounts of sources that can be overwhelming.
2. The knowledge of where and how to find good evidence is an ability that is valuable to both the newly licensed and more experienced nurses.
3. Library print resources are a source of good information, but may lag behind the most up-to-date information. This is the second best choice to answer this question.
4. Unfortunately, there is no guarantee that experienced nurses have kept current with evidence-based practice.

Question 20

What are the advantages of using systematic reviews to learn about evidence-based practice issues? Select all that apply.

Accepted Answer

1. These reviews help to assess consistency of the information and explain any inconsistencies of findings across the studies.
2. The review increases power in suggesting the cause and effect relationship.
3. These reviews help to increase efficiency in time between research and clinical implementation.
4. There is no proof that this intervention is the best one available, but it does rank the strength of the interventions reviewed.
5. Having many people participate in reviews helps to reduce bias from random and systematic error, which then improves true reflection of reality.

Quiz 16: Evidence-Based Practice and Management