LEADERSHIP AND MANAGEMENT
FINAL EXAM WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
Driving Forces of EBP in Nursing
-significant contributions to the body of clinical research
-need for decreased variability in implementation of nursing practice
-need for implementation of research in practice to improve effectiveness and efficiency
-societal demands for evidence-based, clinically competent care
-growth of advanced practice roles with development of prescriptive power and evidence based
diagnostic decision making
-increased experience in clinical pathways, standards, protocols, and algorithms
-increase in integrated systematic reviews of research studies found in the nursing, medical, and health
care literature
-need for outcome data to guide patient care
-explosion in information technology with better organized, rapidly retrievable information in the
literature and on the internet
-improved knowledge base facilitating research capable of supporting EBP models
-need to collaborate in complex decision making with patients and other members of the health care
team
-need to improve patient safety
-requirement for evidence based standards of care implemented by the Joint Commission and National
Database on Nursing Quality Indicators
Why is EBP important?
-Up to 85% of healthcare encounters are not based on evidence (ANCC, 2014)
-Up to 25% of patients receive unnecessary and/or potentially harmful care
-EBP contributes to the professional nature of nursing and encourages collaboration
-It involves the integration of clinician-observed evidence and research-directed evidence
-Demonstrates that outcomes of health care are effective, efficient, and safe
Nursing's Imperative
1|Page
,-All nurses must work to remove barriers to evidence-based health care delivery in organizations, such
as lack of staff authority to change practices, insufficient time to work on new practice development,
and limited research knowledge and awareness
-Innovate and change nursing practice
Identify a researchable problem
-The nurse needs to be an observer
-Identify and question situations that require change or result in a less than desirable outcome
-Question the rationale for nursing approaches- is this approach/protocol based in evidence-based
practice?
Twenty-one Competencies for the Twenty-First Century
#3 Provide evidence-based, clinically competent care
#18 Take responsibility for quality of care and health outcomes at all levels
# 21 Continue to learn and help others learn
Assume the Evidence Exists
-Assume the Evidence Exists
-Conduct a systematic search for evidence
-Examine the Evidence
-Conduct systematic critical appraisal of evidence to identify recommendations for improving practice
-Apply the Evidence
-Use judgement (clinical experience) to determine the relevance of evidence to practice
PICO Evidence Based Search
-Used to help develop research questions
-P - Population of Interest
-I - Intervention
-C - Comparison
-O - Outcome
-Example:
In new graduates hired in an acute care hospital (population), does a structured 6 month preceptorship
(intervention) compared to a three month orientation (comparison) result in higher retention rates
(outcome)?
Where Do We Find Evidence?
-Search databases such as Cumulative index to nursing and allied health literature (CINHAL), Medline,
PubMed, others
-Read reviews summarize by others/groups such as the Cochrane Library Group (www.cochrane.org)
-National Guideline Clearinghouse
-READ published literature reviews and meta-analysis
-Performance data; expert recommendations; other QI
Where Can EBP Guidelines be Found?
2|Page
,-Use of information technology such as online resources, such as research publications, provides current
research findings related to areas of practice
-Search databases such as Cumulative index to nursing and allied health literature (CINHAL), Medline,
PubMed, others
-Read reviews summarize by others/groups such as the Cochrane Library Group (www.cochrane.org)
-National Guideline Clearinghouse
-Read published literature reviews and meta-analysis
-Performance data; expert recommendations; other QI
Tax Dollars = Free to You
-AHRQ and the Recovery Act
-The Agency for Healthcare Research and Quality (AHRQ) has opportunities under the American
Recovery and Reinvestment Act of 2009 (Recovery Act) to provide patients, clinicians, and others
evidence-based information to make informed decisions about health care.
-The Recovery Act contains $1.1 billion for comparative effectiveness research. Of the total, $300 million
is for AHRQ to build on its existing collaborative and transparent Effective Health Care program.
Know Your Resources
-Where do I find other affordable resources?
-Options
-Ask employer if they pay fees for you to access a library or subscribe to resources; Up-To-Date, Mosby
-Use free sources on internet
-Subscribe to journal for your practice area
-Start your own Journal Club and share materials
-Consult resources: Education Department, Clinical Nurse Specialist
-Join an organization; membership resources
-If continuing education, see what resources are provided to you
Search Tips
-Select search engine i.e....
-Google
-MSN
-Yahoo
-Bing
-Read HELP information
-Keyword help
-Mesh Medical Subject Headings; controlled vocabulary
-Use of Boolean Operators; AND, OR, NOT
-Phrases; Use double quotation marks "" or not
How to Apply Evidence to Practice
-Conduct systematic search for available literature
-Critical appraisal of literature (enlist clinical nurse specialists, nurse practitioners, experts, etc.)
-Clinical judgment to determine relevance
3|Page
, -Implement practice changes and evaluate results
-Models to Guide Evidence-Based Practice Review and Implementation
-CURN; Conduct and utilization of research in nursing
-Stetler Model
-ACE Star Model of Knowledge Transformation
-Iowa Model of Evidence-Based Practice to Promote Quality Care (Kelly, p. 124)
-Johns Hopkins Nursing Evidence-Based Practice Model
CURN - Conduct and Utilization of Research in Nursing
exemplifies a structured, formal organizational process that requires organizational commitment,
resources, and research expertise
Stetler model -
Individual nurses, such as practitioners, educators, and policymakers, summarize research and use the
knowledge to influence educational programs, make practice decisions, and impact political decision
making
ACE Star Model Provides a framework for nurses to transition through 5 stages:
-Discovery of evidence
-Evidence summary
-Translation
-Integration
-Evaluation
Discovery of evidence
This is a knowledge generating stage. In this stage, new knowledge is discovered through the traditional
research methodologies and scientific inquiry. Research results are generated through the conduct of a
single study. This may be called a primary research study and research designs range from descriptive to
correlational to causal; and from randomized control trials to qualitative. This stage builds the corpus of
research about clinical actions.
Evidence summary
the task is to synthesize the corpus of research knowledge into a single, meaningful statement of the
state of the science. This stage is also considered a knowledge generating stage, which occurs
simultaneously with the summarization. Evidence summaries produce new knowledge by combining
findings from all studies to identify bias and limit chance effects in the conclusions. The systematic
methodology also increases reliability and reproducibility of results. The following terms are used to
refer to various forms of evidence summaries. The rigorous evidence summary step distinguishes EBP
from the old paradigm of research utilization. Largely due to the work of the Cochrane Collaboration,
rigorous methods for systematic reviews have been greatly advanced, using meta analytic techniques
and developing other statistical summary strategies, such as Number Needed to Treat (NNT).
Translation
4|Page
FINAL EXAM WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS|FREQUENTLY TESTED
QUESTIONS AND
SOLUTIONS|NEWEST|GUARANTEED
PASS 2026/2027
Driving Forces of EBP in Nursing
-significant contributions to the body of clinical research
-need for decreased variability in implementation of nursing practice
-need for implementation of research in practice to improve effectiveness and efficiency
-societal demands for evidence-based, clinically competent care
-growth of advanced practice roles with development of prescriptive power and evidence based
diagnostic decision making
-increased experience in clinical pathways, standards, protocols, and algorithms
-increase in integrated systematic reviews of research studies found in the nursing, medical, and health
care literature
-need for outcome data to guide patient care
-explosion in information technology with better organized, rapidly retrievable information in the
literature and on the internet
-improved knowledge base facilitating research capable of supporting EBP models
-need to collaborate in complex decision making with patients and other members of the health care
team
-need to improve patient safety
-requirement for evidence based standards of care implemented by the Joint Commission and National
Database on Nursing Quality Indicators
Why is EBP important?
-Up to 85% of healthcare encounters are not based on evidence (ANCC, 2014)
-Up to 25% of patients receive unnecessary and/or potentially harmful care
-EBP contributes to the professional nature of nursing and encourages collaboration
-It involves the integration of clinician-observed evidence and research-directed evidence
-Demonstrates that outcomes of health care are effective, efficient, and safe
Nursing's Imperative
1|Page
,-All nurses must work to remove barriers to evidence-based health care delivery in organizations, such
as lack of staff authority to change practices, insufficient time to work on new practice development,
and limited research knowledge and awareness
-Innovate and change nursing practice
Identify a researchable problem
-The nurse needs to be an observer
-Identify and question situations that require change or result in a less than desirable outcome
-Question the rationale for nursing approaches- is this approach/protocol based in evidence-based
practice?
Twenty-one Competencies for the Twenty-First Century
#3 Provide evidence-based, clinically competent care
#18 Take responsibility for quality of care and health outcomes at all levels
# 21 Continue to learn and help others learn
Assume the Evidence Exists
-Assume the Evidence Exists
-Conduct a systematic search for evidence
-Examine the Evidence
-Conduct systematic critical appraisal of evidence to identify recommendations for improving practice
-Apply the Evidence
-Use judgement (clinical experience) to determine the relevance of evidence to practice
PICO Evidence Based Search
-Used to help develop research questions
-P - Population of Interest
-I - Intervention
-C - Comparison
-O - Outcome
-Example:
In new graduates hired in an acute care hospital (population), does a structured 6 month preceptorship
(intervention) compared to a three month orientation (comparison) result in higher retention rates
(outcome)?
Where Do We Find Evidence?
-Search databases such as Cumulative index to nursing and allied health literature (CINHAL), Medline,
PubMed, others
-Read reviews summarize by others/groups such as the Cochrane Library Group (www.cochrane.org)
-National Guideline Clearinghouse
-READ published literature reviews and meta-analysis
-Performance data; expert recommendations; other QI
Where Can EBP Guidelines be Found?
2|Page
,-Use of information technology such as online resources, such as research publications, provides current
research findings related to areas of practice
-Search databases such as Cumulative index to nursing and allied health literature (CINHAL), Medline,
PubMed, others
-Read reviews summarize by others/groups such as the Cochrane Library Group (www.cochrane.org)
-National Guideline Clearinghouse
-Read published literature reviews and meta-analysis
-Performance data; expert recommendations; other QI
Tax Dollars = Free to You
-AHRQ and the Recovery Act
-The Agency for Healthcare Research and Quality (AHRQ) has opportunities under the American
Recovery and Reinvestment Act of 2009 (Recovery Act) to provide patients, clinicians, and others
evidence-based information to make informed decisions about health care.
-The Recovery Act contains $1.1 billion for comparative effectiveness research. Of the total, $300 million
is for AHRQ to build on its existing collaborative and transparent Effective Health Care program.
Know Your Resources
-Where do I find other affordable resources?
-Options
-Ask employer if they pay fees for you to access a library or subscribe to resources; Up-To-Date, Mosby
-Use free sources on internet
-Subscribe to journal for your practice area
-Start your own Journal Club and share materials
-Consult resources: Education Department, Clinical Nurse Specialist
-Join an organization; membership resources
-If continuing education, see what resources are provided to you
Search Tips
-Select search engine i.e....
-MSN
-Yahoo
-Bing
-Read HELP information
-Keyword help
-Mesh Medical Subject Headings; controlled vocabulary
-Use of Boolean Operators; AND, OR, NOT
-Phrases; Use double quotation marks "" or not
How to Apply Evidence to Practice
-Conduct systematic search for available literature
-Critical appraisal of literature (enlist clinical nurse specialists, nurse practitioners, experts, etc.)
-Clinical judgment to determine relevance
3|Page
, -Implement practice changes and evaluate results
-Models to Guide Evidence-Based Practice Review and Implementation
-CURN; Conduct and utilization of research in nursing
-Stetler Model
-ACE Star Model of Knowledge Transformation
-Iowa Model of Evidence-Based Practice to Promote Quality Care (Kelly, p. 124)
-Johns Hopkins Nursing Evidence-Based Practice Model
CURN - Conduct and Utilization of Research in Nursing
exemplifies a structured, formal organizational process that requires organizational commitment,
resources, and research expertise
Stetler model -
Individual nurses, such as practitioners, educators, and policymakers, summarize research and use the
knowledge to influence educational programs, make practice decisions, and impact political decision
making
ACE Star Model Provides a framework for nurses to transition through 5 stages:
-Discovery of evidence
-Evidence summary
-Translation
-Integration
-Evaluation
Discovery of evidence
This is a knowledge generating stage. In this stage, new knowledge is discovered through the traditional
research methodologies and scientific inquiry. Research results are generated through the conduct of a
single study. This may be called a primary research study and research designs range from descriptive to
correlational to causal; and from randomized control trials to qualitative. This stage builds the corpus of
research about clinical actions.
Evidence summary
the task is to synthesize the corpus of research knowledge into a single, meaningful statement of the
state of the science. This stage is also considered a knowledge generating stage, which occurs
simultaneously with the summarization. Evidence summaries produce new knowledge by combining
findings from all studies to identify bias and limit chance effects in the conclusions. The systematic
methodology also increases reliability and reproducibility of results. The following terms are used to
refer to various forms of evidence summaries. The rigorous evidence summary step distinguishes EBP
from the old paradigm of research utilization. Largely due to the work of the Cochrane Collaboration,
rigorous methods for systematic reviews have been greatly advanced, using meta analytic techniques
and developing other statistical summary strategies, such as Number Needed to Treat (NNT).
Translation
4|Page
