POP HEALTH NURS 4603 EXAM 3 BLUEPRINT
CHAPTER 4: EVIDENCE-BASED PRACTICE AND ETHICS
Distinguishing Evidence-Based Practice, Research, and Quality Improvement
It is important to understand how evidence-based practice (EBP), research, and quality
improvement (QI)/performance improvement (PI) differ, as well as how to recognize
examples of each.
Evidence-Based Practice (EBP):
EBP is a structured approach to clinical decision-making that integrates the best available
research evidence with clinical expertise and patient preferences. It is both systematic and
collaborative, aiming to improve patient outcomes through informed practice.
Steps of EBP include:
• Step 0: Cultivating a spirit of inquiry
• Step 1: Formulating a clinical question using the PICOT format
• Step 2: Searching for and gathering the most relevant evidence
• Step 3: Critically evaluating the evidence for validity, reliability, and applicability
• Step 4: Combining the evidence with clinical expertise and patient values to guide
decisions
• Step 5: Assessing the outcomes of the decision or intervention
• Step 6: Sharing the results of the EBP process
Research:
Research involves the organized collection and analysis of data to investigate a specific
issue or phenomenon. It serves as a foundation for evidence-based practice and often
informs changes in healthcare policies and programs, particularly in community and
public health nursing. Both research and EBP begin with a clearly defined question,
although EBP typically involves fewer steps. The PICOT question used in EBP is similar
in structure and specificity to a research question.
Quality Improvement (QI)/Performance Improvement (PI):
QI/PI focuses on systematically evaluating healthcare processes and outcomes to enhance
care delivery. It involves collecting and analyzing data to identify effective interventions
and improve systems of care. Common strategies include rapid-cycle testing and
monitoring compliance. Unlike research, QI projects generally use convenience samples
and are not designed to produce findings that can be generalized broadly.
While distinctions exist, the boundaries between EBP, research, and QI/PI may sometimes
overlap. Notably, EBP implementation typically does not aim for generalizability, as it focuses
on improving practice within a specific setting.
Impact of Research
Research plays a significant role in shaping nursing practice, patient outcomes, and health
policy.
Effects on Public Health Nursing:
• Strengthens the professional role and influence of nurses
• Improves patient outcomes through evidence-based interventions
• Influences healthcare policy and the overall quality of services
Research highlights health needs in vulnerable populations, identifies gaps in healthcare systems,
and demonstrates cost-effective care strategies. By documenting the effectiveness of nursing
, interventions, research enhances the profession’s credibility and influence on policy
development.
Examples impacting nursing practice:
• Fluoride varnish programs
• Reimbursement policies for sexually transmitted infection services
Role of the Public Health Nurse in Research:
• Applying research findings in practice
• Participating in or conducting research
• Critically evaluating research literature
• Promoting community health through partnerships and policy engagement
• Supporting capacity-building initiatives
Evidence-Based Practice Example: Infant Sleep Position and SIDS
Historically, infants were placed in a prone (stomach) position for sleep to prevent
aspiration. However, research later identified this position as a risk factor for sudden
infant death syndrome (SIDS).
In the early 1990s, experts recommended placing infants on their backs (supine position)
to reduce this risk. This led to the 1994 “Back to Sleep” campaign. Following this
initiative, SIDS rates in the United States declined significantly—from 130 deaths per
100,000 live births in 1990 to 38 per 100,000 in 2016. Despite this improvement, SIDS
remains a leading cause of infant mortality.
The term sudden unexpected infant death (SUID) is now used to include SIDS, accidental
suffocation, and unexplained infant deaths.
Current recommendations include:
• Place infants on their backs for sleep until 1 year of age
• Use a firm sleep surface
• Avoid soft bedding and objects in the sleep area
• Keep the infant’s sleep space in the parents’ room but in a separate bed
• Encourage breastfeeding
• Avoid maternal smoking, alcohol, and drug use
• Offer a pacifier during sleep
VALUES VS. ETHICS IN PUBLIC HEALTH NURSING
Values:
Values are enduring beliefs that guide behavior and decision-making. They form a
hierarchy that influences actions, judgments, and priorities. Values shape perceptions of
fairness, appropriate actions, and desired outcomes.
Key functions of values:
• Serve as standards for behavior and attitudes
• Guide moral judgment
• Reflect human needs
Important values influencing healthcare decisions include:
• Self-determination (the right to make personal health decisions)
• The right to health and well-being
• Equal access to quality healthcare
CHAPTER 4: EVIDENCE-BASED PRACTICE AND ETHICS
Distinguishing Evidence-Based Practice, Research, and Quality Improvement
It is important to understand how evidence-based practice (EBP), research, and quality
improvement (QI)/performance improvement (PI) differ, as well as how to recognize
examples of each.
Evidence-Based Practice (EBP):
EBP is a structured approach to clinical decision-making that integrates the best available
research evidence with clinical expertise and patient preferences. It is both systematic and
collaborative, aiming to improve patient outcomes through informed practice.
Steps of EBP include:
• Step 0: Cultivating a spirit of inquiry
• Step 1: Formulating a clinical question using the PICOT format
• Step 2: Searching for and gathering the most relevant evidence
• Step 3: Critically evaluating the evidence for validity, reliability, and applicability
• Step 4: Combining the evidence with clinical expertise and patient values to guide
decisions
• Step 5: Assessing the outcomes of the decision or intervention
• Step 6: Sharing the results of the EBP process
Research:
Research involves the organized collection and analysis of data to investigate a specific
issue or phenomenon. It serves as a foundation for evidence-based practice and often
informs changes in healthcare policies and programs, particularly in community and
public health nursing. Both research and EBP begin with a clearly defined question,
although EBP typically involves fewer steps. The PICOT question used in EBP is similar
in structure and specificity to a research question.
Quality Improvement (QI)/Performance Improvement (PI):
QI/PI focuses on systematically evaluating healthcare processes and outcomes to enhance
care delivery. It involves collecting and analyzing data to identify effective interventions
and improve systems of care. Common strategies include rapid-cycle testing and
monitoring compliance. Unlike research, QI projects generally use convenience samples
and are not designed to produce findings that can be generalized broadly.
While distinctions exist, the boundaries between EBP, research, and QI/PI may sometimes
overlap. Notably, EBP implementation typically does not aim for generalizability, as it focuses
on improving practice within a specific setting.
Impact of Research
Research plays a significant role in shaping nursing practice, patient outcomes, and health
policy.
Effects on Public Health Nursing:
• Strengthens the professional role and influence of nurses
• Improves patient outcomes through evidence-based interventions
• Influences healthcare policy and the overall quality of services
Research highlights health needs in vulnerable populations, identifies gaps in healthcare systems,
and demonstrates cost-effective care strategies. By documenting the effectiveness of nursing
, interventions, research enhances the profession’s credibility and influence on policy
development.
Examples impacting nursing practice:
• Fluoride varnish programs
• Reimbursement policies for sexually transmitted infection services
Role of the Public Health Nurse in Research:
• Applying research findings in practice
• Participating in or conducting research
• Critically evaluating research literature
• Promoting community health through partnerships and policy engagement
• Supporting capacity-building initiatives
Evidence-Based Practice Example: Infant Sleep Position and SIDS
Historically, infants were placed in a prone (stomach) position for sleep to prevent
aspiration. However, research later identified this position as a risk factor for sudden
infant death syndrome (SIDS).
In the early 1990s, experts recommended placing infants on their backs (supine position)
to reduce this risk. This led to the 1994 “Back to Sleep” campaign. Following this
initiative, SIDS rates in the United States declined significantly—from 130 deaths per
100,000 live births in 1990 to 38 per 100,000 in 2016. Despite this improvement, SIDS
remains a leading cause of infant mortality.
The term sudden unexpected infant death (SUID) is now used to include SIDS, accidental
suffocation, and unexplained infant deaths.
Current recommendations include:
• Place infants on their backs for sleep until 1 year of age
• Use a firm sleep surface
• Avoid soft bedding and objects in the sleep area
• Keep the infant’s sleep space in the parents’ room but in a separate bed
• Encourage breastfeeding
• Avoid maternal smoking, alcohol, and drug use
• Offer a pacifier during sleep
VALUES VS. ETHICS IN PUBLIC HEALTH NURSING
Values:
Values are enduring beliefs that guide behavior and decision-making. They form a
hierarchy that influences actions, judgments, and priorities. Values shape perceptions of
fairness, appropriate actions, and desired outcomes.
Key functions of values:
• Serve as standards for behavior and attitudes
• Guide moral judgment
• Reflect human needs
Important values influencing healthcare decisions include:
• Self-determination (the right to make personal health decisions)
• The right to health and well-being
• Equal access to quality healthcare
