nursing fundamentals

Frage	Antworten
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
evidence-based practice [EBP]	- broader than research utilization - basing clinical decisions on best possible evidence, typically high-quality research - starts with a clinical question
types of research utilization	- instrumental (direct) utilization - conceptual (indirect) utilization - persuasive utilization
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.
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
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
key components of EBP [evidence-based practice]	- Archie Cochrane - David sackett
Archie Cochrane	- efforts led to development of Cochrane center in Oxford and the Cochrane Collaboration - proposed an evidence hierarchy for weighing evidence
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
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)
David Sackett	- Evidence-based practice pioneer at McMaster Medical school. This has broadened to the use of best evidence by all health care practitioners
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 studies VI. individual descriptive studies VII. opinions of respected authorities and expert committees
systematic reviews of RCTs	the highest level of evidence because the strongest evidence comes from careful synthesis of multiple studies
individual RCTs	seconds highest level, it depends on the nature of inquires
most barriers in research fall into what three categories?	1. quality and nature of the research 2. characteristics of nurses 3. organizational factors
research-related barriers	- limited availability of strong research evidence for some practice areas - scarcity of published replications
Nurse-related barriers	- attitudes and education are a potential barrier - inadequate skills in locating and appraising evidence
organizational barriers	- lack of financial support and staff release time for EBP
systematic reviews	is in itself a methodical, scholarly inquiry that follows many of the same steps as those for other studies
different types of systematic reviews	- a narrative (qualitative) integration - meta-analysis - meta-synthesis
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
meta-synthesis	is distinct from a quantitative meta-synthesis. its less about reducing information and more about interpreting
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
key resources	- systematic reviews - traditional narrative reviews - meta-syntheses - meta-analysis - other pre-appraised evidence - models and theories for EBP or RU
what is pre-appraised evidence	preprocessed or preappraised evidence is evidence that has been selected from primary studies and evaluated for use by clinicians
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
components for quantitative evidence	- population - intervention - comparison* - outcome - time * * = not always specified
population	what are the characteristics of the patients or people?
intervention	what are the interventions r therapies of interest? or, what are the potentially harmful influences/exposures of concern?
outcome	what are the outcomes or consequences in which we are interested?
components for qualitative evidence	- population - situation
components for qualitative evidence: population	what are the characteristics of the patients or clients?
components for qualitative evidence: situation	what, conditions, experiences, or circumstances are we interested in understanding?
templates for clinical questions can ....	greatly facilitate wording of questions
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
evidence quality	- is the evidence valid - what methods were used?
evidence magnitude of effects	assess whether findings are clinically important - how powerful are the effects
evidence precision of estimates	how precise the estimate effect is
knowledge-focused trigger	begins with an innovation or research finding
problem-focused trigger	begins with a perplexing or troubling clinical situation

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