Chapter 10: Evidence-Based Practice

NUR 300 Chapter 10: Evidence-Based Practice Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 10th Edition MULTIPLE CHOICE 1. What is evidence-based public health (EBPH)? a. An integration of the best available nursing expertise b. Derived from community principles to fit the area where it is practiced c. A health endeavor that makes informed use of evidence d. Comprised of only public health records ANS: C EBPH is a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. EBPH includes more than public health records. EBPH is not an integration of nursing expertise. EBPH is not derived from community principles. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 2. A nurse is using clinical experience and client preference to guide clinical decision making. Which of the following is being demonstrated by the nurse? a. Evidence-based practice b. Internal evidence c. Research utilization d. External evidence ANS: B Internal evidence refers to the use of the nurse’s clinical experiences and the client’s preferences. Evidence-based practice includes the best available evidence from a variety of sources, including research studies, nursing experience and expertise, and community leaders. Research utilization is the process of transforming research knowledge into practice and the use of research to guide clinical practice. External evidence includes research and other evidence, like reports and professional guidelines. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 3. In what country was the term evidence-based first used? a. Canada b. Great Britain c. the United States d. Australia ANS: A The term evidence-based was first attributed to Gordon Gyatt, a Canadian physician at McMaster University in 1992. Great Britain, the United States, and Australia did not use this term before it was used in Canada. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 4. A nurse providing care in the 1970s follows a process when making clinical decisions. Which of the following processes would have been used? a. Evidence-based nursing practice b. The science of medicine c. Evidence-based medicine d. Research utilization ANS: D Research utilization projects in the 1970s provided a guide to clinical practice. The term evidence-based was not used until 1992 and was first applied to medicine before it was used in nursing. There was a growing consensus in the 1970s among nursing leaders that scientific knowledge should be used as a basis for nursing practice, so there was a shift away from the practice of medicine. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 5. A nurse makes clinical judgments based upon trial and error and past clinical experiences. Which of the following problems can result from using these data sources in clinical decision making? a. Not all sources of information are reliable. b. Authority always leads to faulty decision making. c. Ethical knowledge is noNtUtaRkeSnIinNtoGaTcBco.uCntO. M d. This process generally leads to poor outcomes. ANS: A Nurses have always used various resources for problem solving. However, not all of these resources are reliable, and all have not consistently produced desired outcomes. Authority does not always lead to faulty decision making. Ethical knowledge should be taken into account when making clinical judgments. Trial and error may or may not lead to poor outcomes. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 6. A nurse is looking for evidence-based practice (EBP) to support the methods used to facilitate smoking cessation. Which of the following types of evidence would be the best for the nurse to examine? a. Scientific literature found in systematic reviews b. Double-blind randomized controlled trial c. Quasi-experimental studies d. Expert opinion ANS: A Because it is difficult to find or perform randomized controlled trials in the community, other types of evidence have been highlighted as the best evidence in public health literature upon which to base EBPH practice; scientific literature found in systematic reviews is one type that is recommended. Although randomized controlled trials are the highest level of evidence with quasi-experimental studies and expert opinion both being lower on the list of evidence. It would not be possible to implement randomized control trials or quasi-experimental studies when studying smoking cessation. Expert opinion would not be as helpful when looking at methods that have literature that support their use. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 7. Which type of research is defined as the gold standard of evidence in evidence-based practice? a. Clinical expertise b. Randomized controlled trials c. Case studies d. Systematic review ANS: B The double blind randomized controlled trial (RCT) generally provides the highest level of evidence, followed by other randomized controlled trials. Clinical expertise, case studies, and systematic reviews are not at the top of the hierarchy of evidence. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care N R I G B.C M 8. A public health nurse (PHN) would like to incorporate evidence-based practice into the clinical practice at the health department. According to Melnyk and associates, which of the following steps should the nurse take first? a. Integrating the evidence with clinical expertise b. Cultivating a spirit of inquiry c. Asking clinical questions d. Searching for the best evidence ANS: B According to Melnyk and Fineout-Overholt et al., the first step is step 0: cultivating a spirit of inquiry. Integrating evidence with clinical expertise is step 4. Asking clinical questions is step 1. Searching for the best evidence is step 2. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care 9. What term is used to identify a summary of the research evidence that relates to a specific question and to the effects of an intervention? a. Evidence-based practice b. Meta-analysis c. Systematic review d. Narrative review ANS: C A systematic review is a summary of the research evidence that relates to a specific question and to the effects of an intervention. Evidence-based practice includes the best available evidence from a variety of sources, including research studies, nursing experience and expertise, and community leaders. Meta-analysis is a specific method of statistical synthesis used in some systematic reviews, where the results from several studies are quantitatively combined and summarized. A narrative review is a review done on published papers that support the reviewer’s particular point of view or opinion and is used to provide a general discussion of the topic reviewed. DIF: Cognitive level: Remembering TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care 10. A nurse is reading a systematic review when researching the best practices to promote increased safety among toddlers. Which of the following information would the nurse most likely find? a. Results of randomized controlled trials b. A description of the methods used to search for evidence c. Data compiled on a particular question d. An in-depth review of the literature completed by one person ANS: B A systematic review is usually done by more than one person and describes the methods used to search for the evidence. It is a method of identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research relevant to a particular research question. N R I G B.C M DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 11. A nurse is grading the strength of evidence when critiquing a research study. Which of the following domains will the nurse need to consider? a. Randomness, sample size, and blinding b. Selection, variables, and description c. Nursing, medicine, and physiology d. Quality, quantity, and consistency ANS: D Quality, quantity, and consistency are the three domains for evaluating systems. The others are not criteria used to grade the strength of evidence. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care 12. A public health nurse (PHN) uses a published systematic review to determine which exercises should be incorporated into a newly developed older adult exercise program. Which of the following resources would most likely contain this information? a. Evidence-Based Practice for Public Health Project b. PubMed c. Cochrane Public Health Group (PHRG) d. Task Force on Community Preventive Services ANS: C The PHRG works with contributors to produce and publish Cochrane reviews of the effects of population-level public health interventions. The PHRG undertakes systematic reviews of the effects of public health interventions to improve health and other outcomes at the population level, not those targeted at individuals. The Evidence-Based Practice for Public Health Project provides access to numerous databases of interest concerning public health. PubMed is a bibliographical database that includes references for nursing, medicine, dentistry, the health care system, and preclinical sciences. The Task Force on Community Preventive Services is charged with determining the topics to be addressed by the CDC’s Community Guide and the most appropriate means to assess evidence regarding population-based interventions. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care