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Evidence Based Practice
The fundamental principle that the provision of quality care will depend on our ability to make choices that have been confirmed by sound scientific data, and that our decisions are based on the best evidence currently available.
a structured process of investigating facts and theories, and expolring connections
ways of looking at the world that define both the problems that can be addressed and the range of legitimate evidence that contributes to solutions
the objective of outcomes management has generated a renewed understanding of the link between clinical management decisions, treatment decisions, and measured documentation of effectiveness.
the study of success of interventions in clinical practice, with a focus on the end results of patient care in terms of disability and survival.
focuses on a linear relationship between pathology and resulting impairments.
Health is viewed as the absence of disease and the assumption is made that disease and injury can be treated and cured.
a framework for assessing the effect of acute and chronic conditions by emphasizing functional consequences and social role.
This model demonstrates the relatinships among pathology, impairments, functional limitations, and disability.
International Classification of Functioning, Disability, and Health (ICF)
The result of an international and multidisciplinary effort to provide a common language for the classification & consequences of health conditions.
Rather than focusing on disability, its intent is to describe how people live with their helath condition.
Evidence based practice
the contientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
the integration of best research evidence with our clinical expertise and our patient's unique values and circumstances.
the components of a good cinical question:
- P atients
- I ntervention
- C omparison
- O utcome
one of the sources of knowledge
useful in that it offers a common foundation for communication and interaction within a society or profession
a source of knowledge
authorities often become known as expert sources of info based on their success, expertise or reputation.
Trial and Error
source of knowledge
method of gathering data & was probably the first approach to solving a problem
major disadvantage is that it is haphazard & unsystematic
Logical Reasoning p. 15
a method of knowing that combines personal experience, intellectual faculties, and formal systems of thought.
Two types: deductive and inductive reasoning
Deductive reasoning p. 14
Characterized by the acceptance of a general proposition, or premise and the subsequent inferences that can't be drawn in certain cases. Contains:
- 1. Major premise: ex: all living things must die
- 2. Minor premise: man is a living thing
- 3. conclusion: Therefore, all men must die.
inductive reasoning p. 15
reflects the revers type of logic, developing generalizations from specific observations.
the most rigorous process for acquiring new knowledge, incorporating elements of deduction and induction in a systematic and controlled analysis of phenomenon.
a systematic, emperical, controlled, & critical examination of hypothetical propositions about the associations among natural phenomenon.
measurement of outcomes using numerical data under standardized conditions.
it's advantage is it's ability to summarize scales and to subject data to statistical analysis.
.....I'm standing right behind you.
more concerned with a deep understanding of a phenomenon through narrative description which typically is obtained under less structured conditions.
......just kidding (Haha! You looked!) :)
done to obtain emperical data that can be used to develop, refine, or test theory.
directed toward solving immediate practical problems with functional applications and testing the theories that direct practice.
the application of basic scientific findings to clinically relevant issues, and simultaneously, the generation of scientific questions based on clinical dilemmas.
investigations where the researcher manipulates and controls one or more variables, and observes the resultant variation in other variables
the major purpose of an experiment is to is to compare conditions or intervention groups, to suggest cause and effect relationships.
investigations that are generally more descriptive or exploratory in nature and that do not exhibit direct control over the studied variables.
often referred to as observational research
a type of experimental research that provides a basis for comparing two or more conditions for the purpose of determining cause and effect relationships.
randomized controlled trial (RCT)
is considered the "gold standard" of experimental designs, typically involving the controlled comparison of an experimental intervention and a placebo.
single-subject designs (experimental research)
an alternative model used to examine the cause of outcomes within the clinical exvironment.
a researcher examines a phenomenon of interest and explores its dimensions, including how it relates to other factors.
epidemiology (exploratory research)
health researchers examine associations to describe and predict risks for certain conditions using COHORT and CASE-CONTROL STUDIES.
correlational methods (exploratory research)
the researcher is able to search for the relationship of other factors and may generate predictions that these relationships suggest. . . By establishing associations, researchers can also test or model theoretical propositions. Many efforts in outcomes research use this approach to study relationships among pathologies, impairments, functional limitations and disability.
predictive models (exploratory research)
can then (after making predictions based on the 'correlational method') be used as a basis for decision making, setting expectations, and prognosis.
methodological studies (exploratory research)
will use correlational methods to demonstrate reliablility and validity of measuring instruments.
historical research (exploratory reseach)
reconstructs the pasy, on the basis of archives or other records, to generate questions or suggest relationships of historical interest to a discipline.
the researcher attempts to describe a group of individuals on a set of variables, to document their characteristics.
developmental research (descriptive research)
is intended to investigate patterns of growth and change over time within selected segments of a population, or it may chronical the natural history of a disease or disabiity.
normative studies (descriptive research)
focus on establishing normal values for specific variables, to serve as guidelines for diagnosis and treatment planning.
qualitative research (descriptive research)
involves collection of data through interview and observation, in an effort to characterize human experience as it occurs naturally, and to generate hypotheses about human behavior.
case study OR case series (descriptive research)
may consist of a description of one or several patients, to document unusual conditions or the effect of innovative interventions.
surveys OR questionnaires
used to collect data on subject characteristics or opinions, as part of descriptive, exploratory, or experimental studies.
systematic reviews (synthesis of literature)
present a comprehensive analysis of the full range of literature on a particular topic, typically an intervention, diagnostic test, or prognostic factors.
meta-analysis (synthesis of literature)
is a process of statistically combining the findings from several studies to obtain a summary analysis.
involves a systematic process of sequential steps that guide thinking, planning, and analysis.
the research process
we conceptualize research as a series of nine sequential steps (see pg. 24 for diagram), recognizing that the order may vary and the steps may overlap in different research models. These steps are grouped into five major categories: (1) identify the research question; (2) design the study; (3) methods; (4) data analysis; and (5) communication
the research process STEP 1 - Identify the Research Question
during this stage the researcher must define the type of individual to whom the results will be generalized. Through a review of scientific literature, the researcher should be able to provide a rationale for the study, a justification of the need to investigate the problem, and a theoretical framework for interpreting results.
the research process STEP 2 - Design the study
the researcher designs the study and plans methods of subject selection, testing, and measurement so that all procedures are clearly mapped out. The researcher must carefully define all measurements and interventions so that the methods for data analysis are clear. The completion of the first two steps - Indentifying the Question and Designing the Study - results in the formulation of a research proposal.
the research process STEP 3 - Methods
the researcher implements the plans designed in steps 1 and 2. Data collection is typically the most time consuming part of the research process. After data are collected and recorded, the researcher must reduce and collate the info into a useful form of analysis. Forms or tables are created for compiling the "raw data."
the research process STEP 4 - Data Analysis
involves analyzing, interpreting, and drawing valid conclusions about the obtained data. It is pulling together all of the materials relevant to the study and applying them to the generalized or theoretical framework. It is at this stage that the research hypothesis will either be supported or rejected.
the research process STEP 5 - Communication
researchers have a duty to share their findings with the appropriate audience so that others can apply the information either to clinical practice or to further research. Research reports can take many forms including journal articles, abstracts, oral presentations, and poster presentations.
are created out of a need to organize and give to a complex collection of individual faacts and observations. Theory is a set of interrelated concepts, definitions, or propositions that specifies relationships among variables and represents a systematic view of specific phenomena. The ultimate goal of clinical research is to further intellectual progress by contributing to the scientific base of practice through the development of theory.
Theroies serve several purposes. They summarize existing knowledge, giving meaning to isolated empirical findings. They allow us to predict what should occur, give a set of specific circumstances. And they help stimulate the development of new knowledge by providing motivation and guidance for asking significant clinical questions
components of theories - Concepts
concepts are abstractions that allow us to classify natural phenomena and empirical obsevations.
components of theories - Variables
when concepts can be assigned values, they can be manipulated as variables, so that their relationships can be examined. In this context, variables become the concepts used for building theories and planning research. The methods for measuring or evaluating them must be clearly delineated.
components of theories - Constructs
constructs are concepts that represent nonobservable behaviors or events. They are invented names for abstract variables that cannot be seen directly, but are inferred by measuring relevant or correlated behaviors that are observable.
are formed once the concepts that relate to a theory are delineated. A proposition states the relationship between variables, which can be described in several ways. Examples are hierarchical proposition, quantitative proposition, and temporal proposition.
shows a vertical relationship, establishing ordered levels of concepts.
based on the frequency or duration of a specific behavior. For example, theories of fatigue are based partly on the concept of repetitions of exercise and how that relates to muscular endurance.
orders concepts in time and states a sequence of events.
used to simplify many of the infinitely complex concepts we deal with in professional practice.
used to demonstrate how the real behavior might occur.
used to describe the relationship among variables by using symols to represent them.
are data based and evolve through a process of inductive reasoning, beginning with empirically verifiable observations.
is developed on the basis of great insight and intuitive understanding of an event and the variables most likely to impact on that event. It's developed with few or no prior observations, and often requires the generation of new concepts to provide adequate explanation.
characteristics of theories
a theory should provide a thorough and rational explanation of observed facts. It should be economical i.e. the most efficient explanation of the phenomenon. It should reflect that which is judged significant by those who will use it.
acceptance of theory can change
many theories that are accepted today will be discarded tomorrow because of new evidence or they may be superseded by new theories that integrate the older ones.
the more that research does not disconfirm a theory, the more the theory is supported. In actuality, we can never "prove" or "confirm" a theory, we can only demonstrate that a theoretical premise does not hold true in a specific situation.
physical stress theory
states that changes in levels of physical
a change in the basic framework that governs the way knowledge is pursued.
when a theory reaches the level of absolute consistency, its called a law.
used to reflect theories that attempt to reconcile several theoretical perspectives in the explanation of sociology, psychological, physiological phenomena. A metatheory places specific research questions within a broader framework and encourages the integration of theorizing for a range of potentially disparate ideas.