Understanding Evidence-Based Practice: PICOT, Reviews, and Quasi-Experimental Designs, Study Guides, Projects, Research of Nursing

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EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE EBP Exam 1 Study Guide Review Notes: • All of the exam material will come from the slides • 100 Qs  MC (choose the best answer), TF onlys • Read the questions carefully, NCLEX style  “not” Need to know What is Nursing Research? • Research: systematic inquiry using disciplined methods to answer questions or solve problems • Nursing Research: Systematic inquiry to develop trustworthy evidence about issues of importance to nurses and their clients • Clinical nursing research: Nursing research designed to guide nursing practice The Importance of Research to Evidence-Based Nursing Evidence-Based Nursing • What is it? o The integration of the best research evidence with clinical expertise and patients’ needs and values ▪ Best Research Evidence: empirical knowledge generated from the synthesis of quality study findings to address a practice problem ▪ Clinical Expertise: the knowledge and skills of athe healthcare professional who is providing care; the strong the clinical expertise, the better is the clinical judgement in using the best research evidence in practice ▪ The needs and values of the patient: • What is it not? o EBP is not a “one size fits all” approach to healthcare o EBP is not a cost-cutting practice or method for rationing healthcare services • What is the purpose? o It produces decisions that are clinically appropriate, cost effect, and result in a positive client outcome o The use of the best clinical evidence in making patient care decision; basis for nursing decisions and influences many clinical practice changes • Note: It is the unique combination of the best research evidence being applied by an expert nurse clinician in providing quality, safe, cost-effective care to patient and family with specific health needs and values that result in EBP Iowa Model of EBP to Promote Quality Care • Incorporates different types of evidence, the collection of data during the process, and emphasizes dissemination of results • To promote needed change in practice you must need triggers EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE o Problem Focused Triggers ▪ Risk management data ▪ Process improvement data ▪ Internal/ external benchmarking data ▪ Financial data ▪ Identification of clinical problem o Knowledge Focused Trigger ▪ New research or other literature ▪ National agencies or organizational standards and guidelines ▪ Philosophes of care ▪ Questions from institutional standards committee • Triggers  launch a set of events o Is the topic a priority for the organization?  if yes, you form a team  assemble relevant research and related literature  critique & synthesize research for use in practice o Is there a sufficient Research Base? ▪ Yes, Pilot the change in Practice • Is there a sufficient research base?  if yes, institute the change in practice  monitor and analyze structure, process, and outcome data  disseminate results ▪ No, Base practice on other types of evidence (case reports, expert opinion, scientific principles, and theory) AND conduct research • Then pilot the change into practice and subsequent steps list above Research Base in EBP Describing Research (need to go over this) • Two Kinds of Research o Basic: Research design to extend the base of knowledge in a discipline for the sake of knowledge production or theory construction rather than for solving an immediate problem o Applied: Research design to find a solution to an immediate practical problem • Four General purposes of research o Describe: Identify and understand nursing phenomenon ▪ Measures at least one thing o Explain: clarify relationships among phenomena, identify possible reasons why events occur ▪ Measures at least two things; Connect them (analysis) o Predict: or not estimate the probability of a specific outcome in a given situation ▪ Measures at least two things; One thing happens before the other; Connect them (analysis) o Control: manipulates the situation to produce the desired outcome EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE ▪ Level II ▪ Meta-analysis • Definition o A technique for quantitatively integrating the results of multiple studies addressing the same or highly similar research question ▪ Meta-synthesis • Definition o The grand narratives or interpretive translations produced from the integration or comparison of findings from qualitative studies • Experimental o Definition ▪ Research using a design in which the researcher controls (manipulates) the independent variable and randomly assigns people to different treatment conditions; randomized controlled trials use experimental designs. o Example  Single Randomized Control Trial ▪ Level III • Quasi- Experimental o Definition ▪ A type of design for testing an intervention in which participants are not randomly assigned to treatment conditions; also called a nonrandomized trial or a controlled trial without randomization o Example  Single Non-Randomized Trial ▪ Level IV • Non-Experimental o Definition ▪ Studies in which the researcher collects data without introducing an intervention; also called observational research’ o Example  Single perspective / cohort study ▪ Level V • Non-Experimental o Definition EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE ▪ Level VI ▪ Studies in which the researcher collects data without introducing an intervention; also called observational research’ o Example  Single case- control study • Non-Experimental o Definition ▪ Studies in which the researcher collects data without introducing an intervention; also called observational research’ o Example  Single cross- sectional study (a survey) ▪ Level VII • Qualitative o Definition ▪ The organization and interpretation of narrative data for the purpose of discovering important underlying themes, categories, and patterns ▪ Data is based on observations, narratives, pictures and text o Example  Single In-Depth Qualitative Study ▪ Level VII • What type of study ?? • Expert Opinions, Case Reports, Etc • PPT Question o The strongest level of evidence is obtained from individual correlational studies. ▪ A) True ▪ B) False EBP In Nursing Key Evidence-Based Practices (is this the same as basic rationales for EBP) Sources of Evidence • Hierarchy of Preprocessed Evidence (pre-appraised: Pre-appraised: evidence that has been selected from primary studies and evaluated for use by clinicals) o Clinical Practice Guidelines (top of hierarchy) ▪ Pre-appraised ▪ Distill a body of evidence into a usable form, Give specific recommendations for evidence-based decision- making; Guideline development typically involves the consensus of a group of researchers, experts and clinicians ▪ Consensus recommendations EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE ▪ Authoritative group • Governmental bodies • Professional Boards ▪ Pro : Usually easier to integrate into clinical practice ▪ Con : Worst case is biased opinion o Systematic Reviews ▪ Pre-appraised ▪ Structured, reliable method to search and report ▪ Uses meta-analysis (aka math) to summarize results ▪ Pro : review combines results from many studies ▪ Con : need large volume of high quality studies o Primary Studies ▪ Not pre-appraised for quality and use in practice ▪ Pro : Direct from source and newest knowledge ▪ Con : Need technical knowledge and may not link clearly to practice Cochrane Library • Founded by Archie Cochrane o Definition: Collection of metanalyses that review a large combination of results for many studies ▪ You DO need a large volume of these studies o Archie Cochrane called for efforts to make research summaries about interventions available to health care providers o Efforts led to the development of Cochrane Center in Oxford and the Cochrane Collaboration . ▪ Its aim is to help providers make good decisions by preparing and disseminating systematic reviews of the effects of health care interventions. Systematic Reviews Three Kinds of Review • Review paper o Systematic review ▪ Integrates research evidence about research question; summary state of scientific literature ▪ Methods very clear and can be replicated ▪ Carefully developed using sampling and data collection procedures o Clinical guideline ▪ Make recommendations for clinical practice ▪ Methods not focus, may not be replicable o Narrative review ▪ A qualitative approach that focuses on the story as the object of the inquiry • Literature review in a manuscript EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE o Meta-synthesis: systemic review and analysis of qualitative studies ▪ Qualitative: Looking at quality, life experiences, not measured reviewing ▪ What is it? • Umbrella term, broadly representing “A family of methodology Chico approaches to develop new knowledge based on rigorous analysis of existing qualitative research findings” • Not a literature review • Intentional and coherent approach to analyzing data across qualitative studies • Process that enables researchers to identify a specific research question and then search for, select, appraise, summarize, and combine qualitative evidence ▪ Problems with meta-synthesis • Can’t compare apples and oranges • Too few studies • Too many low-quality studies • File Drawer issues  statistically significant findings more likely to be published more Qualitative vs Quantitative research (know the difference between qualitative vs quantitative, the 4 types of qualitative, the 4 types of quantitative) • Quantitative o Understanding a reality that exists o Data are based on surveys, biological measures and other sources that can be quantified numerically o The organization and testing of numeric data through statistical procedures for the purpose of describing phenomena or assessing the magnitude and reliability of relationships among them o Purpose of Reaserch ▪ Experimental  Control (causal relationship) ▪ Non Experimental  Describe, Explain, Predict o Categories of Quantitative research ▪ Descriptive • Research that typically has as its main objective the accurate portrayal of people’s characteristics or circumstances and/or the frequency with which certain phenomena occur. ▪ Correlational • Research that explores the interrelationships among variables of interest, with no researcher intervention. ▪ Quasi-experimental EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE • A type of design for testing an intervention in which participants are not randomly assigned to treatment conditions; also called a nonrandomized trial or a controlled trial without randomization ▪ Experimental • Research using a design in which the researcher controls (manipulates) the independent variable and randomly assigns people to different treatment conditions; randomized controlled trials use experimental designs • Researcher actively introduces intervention • Clinical Trial • Note : Explicitly designed to test causal relationships-to test whether an intervention caused changes in the outcome • Example: o Single RCT ▪ Non-experimental • Researchers observers, collect data without introducing treatments • Observational Studies • Examples: o Single Prospective/Cohort Study o Single Case-Control Study o Single Cross-Sectional Study • Qualitative o Understanding peoples’ perception of reality o Data are based on observations, narratives, pictures and text that can be summarized through themes, categories or other units o The organization and interpretation of narrative data for the purpose of discovering important underlying themes, categories, and patterns o Categories of qualitative research ▪ Phenomenological • Concerned with the lived experiences of human; an approach to thinking about what life experiences of people are like and what they mean • Definition: A qualitative research tradition, with roots in philosophy and psychology, that focuses on the lived experience of humans. • The phenomenological researcher asks the questions: What is the essence of this phenomenon as experienced by these people? or what is the meaning of the phenomenon to those who experience it? • Example: EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE o Tornøe and colleagues (2015) used a phenomenological approach in their study of nurses experiences with spiritual and existential care for dying patients in a general hospital. ▪ Grounded theory • Definition: An approach to collecting and analyzing qualitative data that aims to develop theories about social psychological processes grounded in real-world observations. • A major component a grounded theory is the discovery of a core variable that is central and explaining what is going on in the social scene • Grounded theory researchers strive to generate explanations of phenomena that are grounded in reality. • Example o Keogh and colleagues (2015) used grounded theory methods to understand how mental health service users transitioned home from a hospital stay. The researchers found that the core variable was the patients’ management of preconceived expectations. ▪ Ethnographic • Definition: A branch of human inquiry, associated with anthropology, that focuses on the culture of a group of people, with an effort to understand the worldview and customs of those under study • The primary research tradition in anthropology, provides a framework for studying the patterns and lifeways of a defined cultural group in a holistic fashion. • Example: o Sandvoll and colleagues (2015) used ethnographic methods to explore how nursing home staff members managed unpleasant resident behaviors in two public nursing homes in Norway. ▪ Historical research • Systematic studies designed to discover facts and relationships about past events. ▪ Level of evidence: Single In-Depth Qualitative Study Theoretical & Conceptual Frameworks Nursing Theory • What is it? o Theories consists of two or more concepts and set of propositions that form a logically interrelated system, providing a mechanism for deducing hypothesis ▪ picture of our reality o Model: Representation of reality EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE • The model embodies a number of propositions that can be used in developing and testing interventions and understanding health behaviors. • For example, one HPM proposition is that people engage in behaviors from which they anticipate deriving valued benefits, and another is that perceived competence (or self-efficacy) relating to a given behavior increases the likelihood of performing the behavior. • Practice (didn’t mention to know it) o Developed for use within a specific range of nursing situations, usually prescriptive (least abstract) o Examples of practice nursing theories ▪ Limited to specific population and setting ▪ Often not named theories What is IMRaD? Know what each section is. Know the structure of research articles. • What is IMRaD? o The organization of a research report into four main sections: The Introduction, Method, Results, and Discussion sections. o IMRaD is the most prominent norm for the structure of a scientific journal article of the original research type. • Article Structure: IMRaD o What are the structure of research articles? ▪ Abstract ▪ Introduction • Why was the study undertaken? What was the research question, the tested hypothesis or the purpose of the research? ▪ Method • When, where, and how was the study done? What materials were used or who was included in the study groups (patients, etc.)? ▪ Results • What answer was found to the research question; what did the study find? Was the tested hypothesis true? ▪ Discussion • What might the answer imply and why does it matter? How does it fit in with what other researchers have found? What are the perspectives for future research? Is it something that can replicated? • Writing Style o Explained by wine glass model or hourglass model o Typically first presents "(a) the subject that positions the study from the wide perspective", "(b) outline of the study", develops through "(c) study method", EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE and "(d) the results", and concludes with "(e) outline and conclusion of the fruit of each topics", and "(f) the meaning of the study from the wide and general point of view". ▪ (a) and (b) are mentioned in the section of the "Introduction", (c) and (d) are mentioned in the section of the "Method" and "Result" respectively, and (e) and (f) are mentioned in the section of the "Discussion" or "Conclusion" Florence Nightingale • Who was she? o First nursing theorist who believe the environment had a strong influence on patient outcomes • What did she contribute? o First nursing theory  Nightingale’s Environmental Theory Conceptual Framework ▪ Grand theory o There are 10 key aspects of the theory: ▪ Patients should have clean air and a temperature- controlled environment ▪ Patients should have access to direct sunlight and not be subjected to unnecessary noise, especially when sleeping Rooms should be kept clean ▪ Hospital facilities should be well- constructed Bedding should be changed and aired frequently ▪ Patients should be kept clean and nurses should wash hands frequently ▪ Patients should be offered a variety of scenery, such as new books or flowers, to prevent boredom ▪ Nurses should be positive but not offer false hope to patients or make light of their illness ▪ Offer a variety of small meals instead of large ones, and do not do patient care while patient is eating as it is distracting ▪ Consider not only the individual patient but the context of where he or she lives • Presentation methods? o Use of the pie chart Shared/Borrowed Theories • Where do they come from? EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE o Other sciences but are applicable to the field of nursing • Bandura’s Social Cognitive o Theory of Self Efficacy and Behavior ▪ Stresses the importance of observational learning , imitation and modeling. ▪ His theory integrates a continuous interaction between behaviors, personal factors - including cognition - and the environment referred to as reciprocal causation model. However, Bandura does not suggest that the three factors in the triadic model make equal contributions to behavior. ▪ The influence of behavior, environment and person depends on which factor is strongest at any particular moment. • Becker’s Health Belief Model o Health Beliefs and Health Behavior ▪ The health belief model (HBM) is a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. ▪ The health belief model was developed in the 1950s by social psychologists at the U.S. Public Health Service and remains one of the best known and most widely used theories in health behavior research. ▪ The health belief model suggests that people's beliefs about health problems, perceived benefits of action and barriers to action, and self- efficacy explain engagement (or lack of engagement) in health- promoting behavior. ▪ A stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior • Prochaska’s Transtheoretical Model (know very well) o Stages of Change and Motivation o An integrative, biopsychosocial model to conceptualize the process of intentional behavior change o The Transtheoretical Model is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change. o Whereas other models of behavior change focus exclusively on certain dimensions of change (e.g. theories focusing mainly on social or biological influences), the TTM seeks to include and integrate key EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE ▪ Vaccine independent ▪ Autism dependent o Does taking Prozac improve depressive symptoms? ▪ Prozac independent ▪ Improvement of symptoms dependent o You are doing chores to earn your allowance. For each chore you do, you earn $3. ▪ What is the dependent variable? • The dependent variable is the amount of money you earn because the amount of money you earn depends on how many chores you do. What is causation? • Cause  Effect • A relationship between two variables wherein the presence or value of one variable (the “cause”) determines the presence or value of the other (the “effect”). • 3 criteria to establish causation o 1) Relationship (Statistical) o 2) Timing (Temporal Precedence) o 3) Rule Out (Other Potential Causes) ▪ You rule out other potential causes by randomization and statistical adjustment (control) Know confounding variables are • Confounding Variables o 3rd variable o Potential other causes o A confounding variable is an “extra” variable that you didn’t account for. o They can ruin an experiment, give you useless results, suggest there is correlation when in fact there isn’t, and introduce bias. o Ex: • Control ▪ Research looking at weight gain • Activity level (Independent Variable) • Weight gain (Dependent variable) • Age (Confounding Variable)  the older you get, the less mobile you are, etc o Covariate o Potential Other cause o Researcher measures (or randomizes) to account for effect RCT & Ethics Experiment (control/manipulate) EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE • Sample • Randomization (manipulation) • Intervention and Control • Outcome Quantitative: levels of evidence • Experimental  Single RCT o Purpose of research: Control o Independent ▪ Cause, predictor ▪ Intervention vs control o Dependent ▪ Effect, outcome RCT • Randomized Control trials  gold standard for interventions • Intervention: manipulate, with specific procedures • Control: comparison group o No treatment o Placebo o Standard care or treatment o Attention control o Wait list, delayed treatment • Randomization: procedure to assign intervention versus control • Strict protocols for study for example inclusion, follow up, measurement, reporting and analysis Two Kinds of Random • Random Assignment o Researchers assign participants to level of IV (intervention versus control) ▪ Inferences about internal validity • Random Sample o all members of population have equal chance to be in sample ▪ Inferences about external validity PICO in RCT EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE Quasi Experimental Designs • Similar to experimental designs • May involve manipulation of the IV • However, they do not meet one of the following criteria: o Lack of randomization, or o Lack of control group Commonly used quasi-experiment • Non-equivalent control group o Researchers are unable to randomly assign subjects to groups • Time series designs o One group over long series of time with multiple measures Research Ethics • The Nazi medical experiments of 1930s and 1940s are the most famous example of recent disregard for ethical conduct o Used prisoners of war and “racial enemies” in medical experiments • These studies were unethical not only because they were exposed people to harm but also because subjects could Ethical Codes EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE • A statistical index (quantifies) expressing the magnitude of the relationship between two variables, or the magnitude of the difference between groups on an attribute of interest (e.g., Cohen’s d) • Also used in meta-summaries of qualitative research to characterize the salience of a theme or category. What is forest plots? • A graphic representation of effects in the sample of studies in a metanalyses, permitting a visual assessment of variation in effects across studies (i.e., heterogeneity). What is bias? • Any influence that distorts the results of a study and undermines validity. What is publication bias? How do you measure it? • Publication bias o The bias resulting from the fact that published studies overrepresent statistically significant findings, reflecting the tendency of researchers, reviewers, and editors to not publish nonsignificant results o Sometimes called the bias against the null hypothesis • How do you measure it? o There are statistical procedures to detect and correct for publication biases, but opinions vary about their utility. o Another way to prevent publication is by 1) contacting key researchers in the flied to see if they have done studies or know of studies that have not been publish 2) hand searching the tables of contents of relevant journals and reviewing abstracts from conference proceedings. o Forest plots? What does random assignment mean? • Random assignment: o The assignment of participants to treatment conditions in a random manner (i.e., in a manner determined by chance alone); also called randomization Know what evidence-based practice is and what it is not • Evidence Based Practice o What is it? ▪ The integration of the best research evidence with clinical expertise and patients’ needs and values o What is it not? ▪ EBP is not a “one size fits all” approach to healthcare ▪ EBP is not a cost-cutting practice or method for rationing healthcare services EBP EXAM 1 STUDY GUIDE CH 1,2,3,4,5,18 2023 UPDATE Basic Rationales for EBP in nursing Purpose of research • Systematic inquiry that uses orderly methods to answer questions or solve problems. • Goal: gain knowledge that would be useful for many people Clinical practice guidelines are and are not • Make recommendations for clinical practice • Methods not focus—may not be replicable Good research should read like a recipe  someone can repeat it