3215: nursing fundamentals

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3215: nursing fundamentals
2013-12-04 14:12:03
3215 final

nursing fundamentals
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  1. research utilization [RU]
    • the use of study in a practical application unrelated to the original research
    • the emphasis is on repeating research findings into real-world applications
  2. evidence-based practice [EBP]
    • broader than research utilization
    • basing clinical decisions on best possible evidence, typically high-quality research
    • starts with a clinical question
  3. types of research utilization
    • instrumental (direct) utilization
    • conceptual (indirect) utilization
    • persuasive utilization
  4. Instrumental research utilization
    A concrete application of the research, which is normally translated into a material and usable form, such as a protocol or set of guidelines.
  5. Conceptual research utilization
    Research findings from one or more studies that may change one’s thinking but not necessarily one’s particular or observable action
  6. Symbolic (persuasive) utilization
    Involves the use of research findings from one or more studies as a persuasive (or political) tool to legitimate a position or practice
  7. key components of EBP [evidence-based practice]
    • Archie Cochrane
    • David sackett
  8. Archie Cochrane
    • efforts led to development of Cochrane center in Oxford and the Cochrane Collaboration
    • proposed an evidence hierarchy for weighing evidence
  9. Cochrane collaboration
    its aim is to help providers make good health care decisions by preparing and disseminating systemic reviews of the effects of health care interventions
  10. evidence of hierarchy
    • involves ranking evidence sources according to the strength of evidence they provide
    • typically, hierarchies rank evidence relating to the effectiveness of health care interventions
    • evidence hierarchies are not meaningful for certain types of questions (e.g., about meaning and process)
  11. David Sackett
    Evidence-based practice pioneer at McMaster Medical school. This has broadened to the use of best evidence by all health care practitioners
  12. levels of evidence (from strongest to weakest)
    • I. systemic reviews of RCTs
    • II. individual RCTs
    • III. systematic reviews of non-RCTs (correlational)
    • IV. individual correlational studies
    • V. systematic reviews of descriptive studiesVI. individual descriptive studiesVII. opinions of respected authorities and expert committees
  13. systematic reviews of RCTs
    the highest level of evidence  because the strongest evidence comes from careful synthesis of multiple studies
  14. individual RCTs
    seconds highest level, it depends on the nature of inquires
  15. most barriers in research fall into what three categories?
    • 1. quality and nature of the research
    • 2. characteristics of nurses
    • 3. organizational factors
  16. research-related barriers
    • limited availability of strong research evidence for some practice areas
    • scarcity of published replications
  17. Nurse-related barriers
    • attitudes and education are a potential barrier
    • inadequate skills in locating and appraising evidence
  18. organizational barriers
    lack of financial support and staff release time for EBP
  19. systematic reviews
    is in itself a methodical, scholarly inquiry that follows many of the same steps as those for other studies
  20. different types of systematic reviews
    • a narrative (qualitative) integration
    • meta-analysis
    • meta-synthesis
  21. Meta-analysis
    • is a technique for integrating quantitative research findings statistically - it treats the findings from a study as one piece of information
    • - individual studies are the unit of analysis
    • - it provides an objective method of integrating a body of finding and of observing patterns that might not been detected
  22. meta-synthesis
    is distinct from a quantitative meta-synthesis. its less about reducing information and more about interpreting
  23. clinical practice guidelines
    • distill a body of evidence into a usable form. it gives recommendations for evidence-based decision making
    • - typ involves the consensus of a group of researchers, experts, and clinicians
  24. key resources
    • - systematic reviews
    • - traditional narrative reviews
    • - meta-syntheses
    • - meta-analysis
    • - other pre-appraised evidence
    • - models and theories for EBP or RU
  25. what is pre-appraised evidence
    preprocessed or preappraised evidence is evidence that has been selected from primary studies and evaluated for use by clinicians
  26. steps in individual EBP
    • 1. ask questions that are answerable with research evidence
    • 2. search for and assemble evidence
    • 3. appraise and synthesize evidence
    • 4. integrate evidence with other sources
    • 5. assess effectiveness of decision or advice
  27. components for quantitative evidence
    • - population
    • - intervention
    • - comparison*
    • - outcome- time

    ** = not always specified
  28. population
    what are the characteristics of the patients or people?
  29. intervention
    what are the interventions r therapies of interest? or, what are the potentially harmful influences/exposures of concern?
  30. outcome
    what are the outcomes or consequences in which we are interested?
  31. components for qualitative evidence
    • - population
    • - situation
  32. components for qualitative evidence: population
    what are the characteristics of the patients or clients?
  33. components for qualitative evidence: situation
    what, conditions, experiences, or circumstances are we interested in understanding?
  34. templates for clinical questions can ....
    greatly facilitate wording of questions
  35. appraising the evidence
    • - what is the quality of the evidence?
    • - what is the magnitude of effects?
    • - how precise are estimated of effects?
    • - is there evidence of side effects?
    • - what are the costs?
    • - is there relevance to my clinical situation
  36. evidence quality
    • - is the evidence valid
    • - what methods were used?
  37. evidence magnitude of effects
    evidence magnitude of effects
  38. evidence precision of estimates
    how precise the estimate effect is
  39. knowledge-focused trigger
    begins with an innovation or research finding
  40. problem-focused trigger
    begins with a perplexing or troubling clinical situation