225 Comprehensive Final Exam Study Guide
Overview - EBP
●Evidence-Based Practice (EBP)
○A process of using confirmed evidence to deliver holistic care
■Trigger: NSI
○Using current and well-vetted literature to support a change in
nursing practice
○Driving forces for EBP has increased over recent years:
■Patient satisfaction
■Quality of care
■Patient safety
Steps of Evidence-Based Practice
1. Identify a model
a. Iowa Model of EBP
2. Identify a Trigger
a. Nurse Sensitive Indicator (NSI)
i. Hospital-Acquired Pressure Injuries (HAPIs), Catheter
Acquired Urinary Tract Infections (CAUTIs), falls, etc.
3. Develop a Question
a. Background
i. A component of the methodology providing foundational
information about the issue being considered for the study
1. Textbook
ii. Core knowledge
b. Foreground
i. PICOT (the 5 components of an evidence-based question,
used to “zero in” on what you need to know)
1. P - population/problem
a. Determine specific characteristics about the
group (age, gender, diagnosis, unit, etc.)
2. I - intervention
a. The topic under consideration (intended to be
clarified). Should try to include contact,
treatment, patient, insight, and diagnostic test.
3. C - comparison (*optional*)
a. Comparison of interest
4. O - outcome
a. Should be an anticipated result of the
intervention
5. T - timeframe
a. Use if the outcome is influenced by the passage
of time
ii. Clinical Question
1. Too specific can be a problem
iii. EBP directed
4. Determine if the problem is a priority (to the organization)
5. Form a Team
6. Assemble and synthesize the body of knowledge
a. Consult a Librarian
b. Literature Review (aka Literature/Synthesis Matrix)
i. A format for organizing the literature under consideration
for making a practice change (3-5 y/o)
1. Secondary Source
a. An explanation of facts from sources other than
the original/primary researcher
i. Would make you a taker of evidence
(utilization of previous research)
ii. Expert Opinion
1. Information provided by an
individual who is viewed as an
authority based on criteria
established applicable to the
designated problem or situation
7. Determine if there is sufficient evidence
a. Yes → then go back to step 2
b. No → conduct further research
i. Gaps in the Literature
1. An opportunity for further research; the information
about the topic seems to be incomplete
ii. Primary Source
1. A report of findings from a research study by the one
conducting the research
a. Would make you a giver of research (filling in a
gap in the literature by doing research)
c. Levels of Evidence (p. 49)
i. A hierarchical framework to determine the strength of an
article
●
Conducting Research
●Types of Research
○Mixed-Method
■Using both qualitative and quantitative methodologies in a
research study
●Quantitative
○A systematic, empirical investigation of
observable activities using statistical measures
to reach a conclusion
○Focus on “how many” or “how much”
○Use three components: population,
intervention/exposure, and outcome
●Qualitative
○The analysis of a phenomenon through the
compilation of abundant narrative notes
through selected techniques
○Focus on “feel” or “experience”
○Utilize 2 components: population and situation
○Translational Research
■Using both basic and applied research findings to ensure
the best practices are incorporated within a population
●Applied Research
○Patient or population centered research that
attempts to use research results in a practical
approach
○Directly impacts practice
○*most nursing research is applied research*
●Basic Research
○Research for the sake of gaining new
knowledge
●Parts of a Research Study
○Methodology
■The planned endeavor as to how a study will be conducted
●Purpose
○A component of the methodology of a study
that defines why the study is being done
●Factors Contributing to Research
○Feasibility
■The consideration of variables that may support or hinder
the successful completion of a study (time, finances, etc.)
●People who have contributed to Research
○Virginia Henderson
■A nurse sage who compiled all of nursing
research/resources over an 18 year period (basis of the
CINAHL database); Nursing and Allied Health Literature
The Healthcare Environment
●Quality Department
○Stores data (typically gives reports quarterly)
○Quality Improvement
■A process used to review policies and areas of practices to
validate current practice
●Process Improvement
○A systematic approach to identify steps are in
place to meet expected outcomes
○Has a local impact (unit, regional, etc.)
●Nursing Research Council
○Examine EBP projects
●IRB
○Review research proposals
●RN Residency Programs
○For new graduates
Nurses’ Role in EBP
●First question: “Is the care I am giving based on the best possible
evidence?”
○When considering EBP ask “Am I competent to do a project?”
●Every nurse’s responsibility to be familiar with the most recent research
to assure the safety and quality of patient care (**Most nurses believe it
is outside of their responsibility**)
○Be a part of creating a blame-free environment that is supportive
of EBP
○Be able to pose practice questions
○Collaborate with other nurses
●Best Practice
○Nursing Action that produces the most desirable patient
outcome as determined through scientific data
●Clinical Judgment/Decision Making
○Includes conclusions about a patient’s status and needs with a
determination of a method to implement to best meet patient
needs including an assessment of the patient response
●Bundling
○Multiple identified interventions that, taken together, enhance
clinical outcomes
Organizations
●Academy of Medicine/IOM
○By 2020, 90% of decision making needs to be evidence-based
■2011 IOM and RWJ Foundation report on future of nursing
●Promoted interdisciplinary nursing projects, models
of care, and solutions to improve health and health
care
●8 research priorities; Five are:
○Delivery Models
○Reimbursement
○Care trends
○Nurse residencies
○Funding for nurses training
●Affordable Care Act (ACA)
○Expanded nursing roles and responsibilities
○Increased attention to societal needs while maintaining the
traditional nursing focus
○Has an emphasis on research
○Focused on readmissions and hospital-acquired conditions…
prompted innovation and emphasized population health and
community based on primary care
●2010 Carnegie Foundation
○Called for change in nursing education
○Nurses are to have a foundation grounded in inquiry and research
to provide evidence-based care
○EBP is a basis for holistic care
●American Nurses Association (ANA)
○Nurse Sensitive Indicators (NSIs)-measures and indicators that
reflect the structure, processes, and outcomes of nursing care
■Can reflect the impact of nursing care
●Hospital Care Quality Information from the Consumer Perspective
(HCAHPS)
○Nationwide, standardized, publicly reported patient satisfaction
Quantitative
Quantitative Method
●Most research happens in healthcare environments and academic/university
settings
●Is “etic” in nature; an outsider’s view, objective
●Deductive in approach (top down)
●Institutional Review Board (IRB)
○Every academic setting and most healthcare settings will have an IRB
○Main purpose is the protection of human subjects/study participants
○Avoid vulnerable populations (elderly, children, mentally/physically
disabled, etc.)
○Avoid controversial topics for study
●Department of Health and Human Services
●Feasibility
○Do you have all the resources?
○Are the stakeholders interested/supportive?
○Are the necessary partnerships in place?
●Steps in Developing a Quantitative Study
○Starts with a researchable question and possibly a hypothesis
○Literature review (LOE--develop a literature matrix)
○Background (why is this topic relevant for practice?)
○Purpose (Why is the researcher doing this?)
○Decided whether a theory/model would be needed to help support the
research project
●Research Question / Hypothesis
○A researchable question; able to collect and analyze data
○5 variables
■Demographic
●Characteristics of the study participants (age, gender, etc.)
■Extraneous
●A variable that confuses the association between the
independent and dependent variables; for this reason, it
needs to be restricted either within research design or
through statistical procedures
●Confounding
○A type of extraneous variable that is not controlled
for; it regularly fluctuates with the independent
variable and affects the dependent variable
■Independent
●Can be manipulated
●Cause, intervention
■Dependent
●Effect, outcome
●Lit. Review
○A rigorous examination of research related to a topic of interest that is
documented to categorize a research problem or as the beginning of a
research use project
○Look for gap
●Theory
○Vocab
■Concept
●An idea; gives a name to an abstract idea
■Construct
●Slightly more complex than a concept, may be deliberately
invented (or constructed); often used interchangeably with
concept
■Model
●Can serve as a framework
●Example: Iowa Model of EBP
■Theory
●An explanation for some aspect of reality
●Explain and organize your findings
●Provides structure
●Similar to a framework
○Both are abstract
○Both guide development of research
○Both are tested through quantitative research
■Framework
●The conceptual foundation of a study; sometimes
classified as a theoretical framework, for projects centered
on a theory, and as a conceptual framework, for projects
with a connection to a definite conceptual model
■Relational statement
●The explanation of the connection between concepts
●Example: fatigue can impair performance
○Fatigue and performance are concepts
○Can impair: relational term that explains the
connection between these concepts
○Theories mentioned
■Florence Nightingale’s Environmental Theory
●Florence Nightingale's environmental theory is based on
five points, which she believed to be essential to obtain a
healthy home, such as clean water and air, basic sanitation,
cleanliness and light, as she believed that a healthy
environment was fundamental for healing.
■Orem’s Self Care Theory
●The theory identifies five methods of helping: acting for
and doing for others; guiding others; supporting another;
providing an environment promoting personal
development in relation to meet future demands; and
teaching another.
■Patricia Benner’s “From Novice to Expert”
●The five identified levels are novice, advanced beginner,
competent, proficient, and expert. As a learner moves
through these five skill levels, changes occur in three
specific areas of performance (Benner, 1984).
■Lewin’s Change Theory
●The Change Model
○
●Lewin's theory proposes that individuals and groups of
individuals are influenced by restraining forces, or
obstacles that counter driving forces aimed at keeping the
status quo, and driving forces, or positive forces for change
that push in the direction that causes change to happen.
■Dreyfus Model of Skill Acquisition
●
●Sampling
○Target Population
■The total population to whom the research outcomes are going
to be generalized
○Accessible Population
■Individuals and/or groups accessible for a specific participation
study, frequently a nonrandom division of a target population
○Sample
■A division of a population chosen to participate in a study
○Participants
■Inclusion (eligibility) criteria
●Characteristics that must be met to b considered for
participation in a study
■Exclusion criteria
●Characteristics that, if present, would make person
ineligible for participation in a study even if they met all of
the other inclusion criteria
■Representative sample
●A sample that bears a resemblance to the target
population
■Informed Consent
●The decision of an individual to participate in a research
study based on an understanding of the project’s purpose,
procedures, risks, benefits, alternative procedures, and
limits of confidentiality
○Non-Probability/Non-Random Sampling
■Convenience sampling
●Most common approach in nursing research studies
■Cohort/Quota sampling
●a non-probability sampling method in which researchers
create a sample involving individuals that represent a
population. Researchers choose these individuals
according to specific traits or qualities.
○Probability/Random Sampling
■Simple Random
●a subset of a statistical population in which each member
of the subset has an equal probability of being chosen
■Stratified Random
●a method of sampling that involves the division of a
population into smaller sub-groups known as strata. In
stratified random sampling, or stratification, the strata are
formed based on members' shared attributes or
characteristics such as income or educational attainment.
■Systematic Random
●the random sampling method that requires selecting
samples based on a system of intervals in a numbered
population.
○For example, Lucas can give a survey to every fourth
customer that comes into the movie theater.
■Cluster Sampling
●researchers divide a population into smaller groups known
as clusters. They then randomly select among these
clusters to form a sample. Cluster sampling is a method of
probability sampling that is often used to study large
populations, particularly those that are widely
geographically dispersed
○Rule of 30
■Respectable number for research/sample size
○Sampling Error
■error in a statistical analysis arising from the
unrepresentativeness of the sample taken
●Data Collection
○Approaches
■Observation
●Researchers use all of their senses to examine people in
natural settings or naturally occurring situations
■Survey
●a research method used for collecting data from a
predefined group of respondents to gain information and
insights into various topics of interest
■Questionnaire
●a research instrument consisting of a series of questions
for the purpose of gathering information from
respondents
■Access existing data
●Large data bases: CDC, NIH, CMS, etc.
■Novel data
●Data collected in current research study
○Tools
■BP cuff, pulse ox., thermometer, diagnostic tests, surveys, etc.
■Validity
●the extent to which a concept is accurately measured in a
quantitative study
○For example, a survey designed to explore
depression but which actually measures anxiety
would not be considered valid.
■Reliability
●how consistently a method measures something
○Cronbach’s Alpha (number between 0.0-1.0--0.8-1.0
strong)
■a measure of internal consistency, that is, how
closely related a set of items are as a group. It
is considered to be a measure of scale
reliability.
■Examples of validity and reliability
●an alarm clock that rings at 7:00 each morning, but is set
for 6:30. It is very reliable (it consistently rings the same
time each day), but is not valid (it is not ringing at the
desired time)
●For example, if your scale is off by 5 lbs, it reads your
weight every day with an excess of 5lbs. The scale is
reliable because it consistently reports the same weight
every day, but it is not valid because it adds 5lbs to your
true weight. It is not a valid measure of your weight.
○Bundling
■a structured way of improving the processes of care and patient
outcomes: a small, straightforward set of evidence-based
practices — generally three to five — that, when performed
collectively and reliably, have been proven to improve patient
outcomes.
●Data Analysis
○Internal validity
■the extent to which you can be confident that a cause-and-effect
relationship established in a study cannot be explained by other
factors.
■the degree of confidence that the causal relationship you are
testing is not influenced by other factors or variables.
○External validity
■Generalizability
■Ability to transfer results of study to another population
○Descriptive statistics
■Range
●the difference between the maximum and the minimum
value of a sample on a given variable
■Central tendencies (mean, median, mode)
■Percentages
■Standard deviation
●a measure of how dispersed the data is in relation to the
mean. Low standard deviation means data are clustered
around the mean, and high standard deviation indicates
data are more spread out
○Inferential statistics
■T-test
●Difference between 2 variables
■ANOVA
●Difference between more than 2 variables
■Pearson Product Moment
●Relationship between variables
■Chi Square
●a statistical test used to compare observed results with
expected results. The purpose of this test is to determine if
a difference between observed data and expected data is
due to chance, or if it is due to a relationship between the
variables you are studying.
○Errors
■Type 1 (False Positive)
●Example: Test says you have COVID and you actually don’t
■Type 2 (False Negative)
●Example: Test says you don’t have COVID but you actually
do
○Power Analysis
■can be used to determine whether a study has a good chance of
providing a statistically significant result if a difference truly
exists in the population. For nurse researchers, understanding
the likelihood of achieving statistically significant results is
important.
■a calculation that helps you determine a minimum sample size
for your study
●Translation & Dissemination
○Translation
■the process whereby knowledge is passed anywhere along the
translational pathway i.e. research findings are translated into
practice, policy or further research
●Applied research
○designed to answer specific questions aimed at
solving practical problems.
○Basic research
■Research for the sake of gaining new
knowledge
○Dissemination
■Internal
●To the healthcare organization: huddle, in-service
education, bulletin board, research week poster
■External
●To the organization: poster at a professional meeting,
article publication, podium presentation at a professional
meeting
●Levels of Evidence
○Level 1 - Meta-analysis (Strongest)
■Re-evaluation of existing data
○Level 2 - Experimental Design
■Has an intervention
○Level 3 - Quasi-Experimental
■Has an intervention
■No control group
○Level 4 - Non-Experimental
■Evidence from well-designed case-control or cohort studies.
■“Survey research”
○Level 5 - Purely Qualitative
■Evidence from systematic reviews of descriptive and qualitative
studies (meta-synthesis).
Qualitative
Background
●Based in sociology, anthropology, and philosophy
●Aim of qualitative research →Seeks to have more of an in-depth
understanding of a phenomenon/experience
●Emic perspective
○Insider’s view; reveals how participants feel about themselves
●Inductive in nature (bottom up/specific to general)
●Examines the quality of something
●Socially constructed nature of reality
●Ideal for the holistic approach of nursing
●Data are in text format
●Meta-synthesis (qualitative version of a meta-analysis)
●Discipline is the basis for qualitative research
Benefits
●Often the first step in a phenomenon not yet fully explored
●Development of a theoretical framework
●Means of exploring a human experiences not fully understood
●May offer immediate clinical applicability
Approaches/Options
●Case study: a comprehensive and scrutiny of an identified case situation
○a qualitative research method that concentrates on supplying a
comprehensive description and scrutiny of an unique case
situation (Ex: teen mom bonding)
●Ethnography: values and customs of groups of individuals
○a type of qualitative research that conscientiously illustrates the
customs of a grouping of individuals (Ex: waitresses, nursing
students, etc.)
●Grounded theory: Basis of the development of a new theory
○a general methodology for developing theory that is grounded in
data and systematically gathered and analyzed
●Phenomenology: better understand the “lived experience” (i.e. what’s it
like to be…?)
○a type of qualitative research in which the researcher endeavors
to comprehend how individuals experience a phenomenon
Negative Case (nice to know)
●The complexity of the data is to be welcomed because it allows for a
more subtle and nuanced analysis. Contradictions in the data can give
rise to unexpected findings, which ultimately strengthen theory. In
fact, qualitative researchers actively look for "negative cases" to
support their arguments. A "negative case" is one in which
respondents' experiences or viewpoints differ from the main body of
evidence. When a negative case can be explained, the general
explanation for the "typical" case is strengthened.
Sampling
●Convenience
○the process of selecting individuals to be in the sample who are
accessible and/or who volunteer (also called accidental sampling)
●Purposive/purposeful
○a non-probability sampling method in which the researcher
chooses study participants based on personal decisions about
which individuals would be most representative of the general
population (also called judgmental sampling)
●Theoretical
○ a way of collecting data, and deciding what data to collect based
on the theory and categories that emerge from your data.
●Snowballing /networking technique
○a type of sampling in which every research contributor is asked to
recommend additional prospective research participants (also
called network sampling)
Data Collection
●Interview
○a data collection technique in which an interviewer poses
questions to a respondent
●Focus Group
○A small group of people assembled to participate in a
moderator-facilitated discussion geared toward the designated
topic being researched
●Observation
○A way to gather data by watching people, events, or noting
physical characteristics in their natural setting
●Saturation
○in qualitative research, the time when no new information is
being obtained and repetition of information is consistently heard
Data Analysis
●Occurs simultaneously with data collection
●Is called content analysis
●Thematic analysis
○Linear in nature
○It is usually applied to a set of texts, such as an interview or
transcripts. The researcher closely examines the data to identify
common themes – topics, ideas and patterns of meaning that
come up repeatedly.
●Constant-comparison
○the data-analytic process whereby each interpretation and
finding is compared with existing findings as it emerges from the
data analysis.
Managing Biases
●Bracketing
○a strategy used by qualitative researchers to set aside personal
interpretations to avoid bias
●Mixed Method (multi-method)
○Use of qualitative and quantitative methods
●Triangulation (data collection, data analysis, researcher): adds validity to
data.
○the use of multiple methods to study one research question
○Benefits of using triangulation
■Combining qualitative and quantitative methods to
●Increase confidence in study data
●Expand the understanding of a phenomenon
●Reveal unique data
●Integrate theories
Rigor
●Credibility
○Truth value
○Verification by participants
○Data are taken back to the subjects to ensure accuracy
●Transferability
○Whether the findings apply to other populations
○Fully describe the sample, setting, and data
○The more information provided, the more the reader has to
understand and compare to other settings.
○Whether findings from one qualitative study can be transferred to
a similar context to establish trustworthiness
●Dependability
○Also called Auditability
○“If other researchers can follow the investigators decisions
throughout the study and come to similar conclusions the study
is auditable”
○Audit trail gives evidence of rigor
○The quality of being trustworthy and reliable regarding a study; if
someone else did exactly what you did, they would get the same
result
●Confirmability
○Freedom from bias/neutrality
○Analyst triangulation (review findings with informants/study
participants/review by experts)
●Authenticity
○end product of the aforementioned points of rigor
●Trustworthiness
○an expression used in the appraisal of qualitative data; it is
measured based on the decisive factors of credibility,
transferability, dependability, and confirmability
Dissemination
●“From bench to bedside”
○Translational research
