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Download EVIDENCE INFORMED PRACTICE MOST TESTED EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS A+ VER and more Exams Advanced Education in PDF only on Docsity!
Defining Evidence - correct answers-A testimony of facts tending to prove or disprove. Order of power of scientific evidence - correct answers-In order of strongest to weakest: Meta-analysis and systematic reviews, Randomized control trials, Cohort studies, Case-control studies, Cross sectional studies, Animal and in vitro studies, Case reports, opinion papers and letters. Evidence-informed practice - correct answers-A clinical practice based on a balance of three elements: current scientific evidence, clinical experience, and the client's wishes. A problem-solving approach to practice that integrates research evidence with clinical expertise, local data and resources, and patient preferences and values. Is more situation based than evidence based practice. What are the 4 key elements of the EIP definition when adopted for nursing? - correct answers-1. Best available evidence from research 2. Clinical expertise 3. Patient preferences and values 4, Local data and resources What is the EIP process (for use in everyday nursing)? - correct answers-Ask, Acquire, Appraise, Apply, Assess (was it effective) Positivist Paradigm - correct answers-The paradigm underlying the traditional scientific approach, which assumes that there is an orderly reality that can be objectively studied; often associated with quantitative research. - Reality exists; real world driven by natural causes - Researcher is independent from those being researched - Values and biases are to be held in check Constructivist Paradigm - correct answers-An alternative paradigm to the positivist paradigm that holds that there are multiple interpretations of reality, and that the goal of research is to understand how individuals construct reality within their context; associated with qualitative research. - Reality is multiple and subjective - Researcher interacts with those being researched - Subjectivity and values are inevitable and desired Characteristics of Quantitative Research - correct answers-- Orderly procedures - Systemic/pre-specified plan - Control over context - Formal measurement - Empirical evidence - Seeks generalizations Characteristics of Qualitative Research - correct answers-- Dynamic design - Holistic - Context-bound - Humans as instruments - Qualitative information - Seeks patterns Purposes of Nursing Research - correct answers-- Identification and description - Exploration - Explanation - Prediction and control - Therapy, treatment, or intervention (screening/treatment/prevention/promotion) - Diagnosis and assessment - Prognosis - Etiology (causation) Confounding or Extraneous Variables - correct answers-Variables that may also have influence on the outcome of an experiment. - Can lead to bias (which is anything that influentces the results of studies) - All the factors you want to control to be able to tell if the independent variable is actually having an impact on the dependent variable - Should try to recognize them prior to in order to limit them Conceptual definition of a variable - correct answers-The abstract or theoretical meaning of a concept being studied (the definition of a concept) - Important to clearly state this in nursing b/c it can have multiple meanings in nursing (ex. what does it mean by stress? perception? external stress?) Operational definition of a variable - correct answers-Description of how variables will be measured or manipulated in a study - the operations (measurements) a researcher must perform to measure the concept and collect the desired information - often refers to how we will measure and refers to tools used 5 Phases of Qualitative research - correct answers-Phase 1: Conceptual Phase Phase 2: Design and Planning Phase Phase 3: Empirical Phase Phase 4: Analytic Phase Phase 5: Dissemination Phase What occurs in the Phase 1: Conceptual Phase of Qualitative research - correct answers-Defining the research problem and questions and what will actually be studied, often involves reviewing literature on the topic to see what has previously been studied What occurs in the Phase 2: Design and Planning Phase of Qualitative research - correct answers-Make decisions about the actual methods used to address the research question What occurs in the Phase 3: Empirical Phase of Qualitative research - correct answers-Collect and prepare the data for analysis What occurs in the Phase 4: Analytic Phase of Qualitative research - correct answers-Analyze the data and intemperate findings What occurs in the Phase 5: Dissemination Phase of Qualitative research - correct answers-Answer question, communicate results and make recommendations for practice Experimental Design - correct answers-Randomized control trail: assigning people randomly to a treatment or control group to determine cause and effect. - Gold standard to reveal causation Quasi-experimental design - correct answers-Involves an intervention and control/comparison group but lacks randomization (also called random assignment) - The ability to make causal conclusions is weakened (due to potential non-equivalence between groups) - Can no longer be certain of a cause and effect relationship b/c differences might be pre-existing Non-experimental design - correct answers-Observational Study - If researchers do not intervene by controlling independent variable, the study is non-experimental (observational) - Not all independent variables ("causes") of interest to nurse researchers can be experimentally manipulated For example, gender cannot ever be manipulated Smoking cannot ethically be manipulated What are disadvantages of experiments? - correct answers-- Not all variables can be manipulated (either realistically or ethically) - very common problem in nursing - Often not feasible or ethical - Expensive - Hawthorne effect: knowledge of being in a study may cause people to change their behaviour (is why blinding is important) Blinding - correct answers-ls the concealment from one or more groups involved in the study (ex. participants don't know if they are control or not or researcher doesn't know) - Prevents Biases A good quantitative design is one that: - correct answers-- Appropriately tests the hypotheses or answers the research questions - lacks bias (error) - controls extraneous or confounding variables (this minimizes bias) - has sufficient ability to detect statistically significant findings Random sampling - correct answers-Every potential participant has an equal chance of being selected. Stratified sampling - correct answers-A type of probability sampling in which the population is divided into groups with a common attribute and a random sample is chosen within each group. - ex. want equal number of men vs women in our sample so you first divide into groups of men and women and then select from the two groups - Can still be confident that there is good representation Cluster Sampling - correct answers-Divide the population into separate groups (clusters) and select a random sample of the clusters Systematic Sampling - correct answers-Select every kth case from a list - ex. take every 5th person who comes in - Have to be careful about bias in this type (that is embedded) Types of probability sampling - correct answers-Random sampling, stratified sampling, cluster sampling, systematic sampling Types of non-probability sampling - correct answers-Convenience sampling, consecutive sampling, snowball sampling Convenience sampling - correct answers-Select the most conveniently available ppl Consecutive sampling - correct answers-Recruit all ppl from an accessible population over a specific period of time Snowball sampling - correct answers-Subjects are asked to recommend other potential subjects - is good for use when specific populations are difficult to access. Power analysis - correct answers-A statistical method to determine the acceptable sample size that will best detect the true effect of the independent variable. - Is calculated to indicate how many subjects are needed Why is it important to calculate the sample size estimate? - correct answers-- Too small a sample can lead to committing an error in the results (ex. stating that there is no difference b/w groups where there is one) - Recruiting more subjects than needed can result in needless expense Types of quantitative data - correct answers-- Self-report - participants responses to questions poised/asked by the researcher - Patient-reported outcomes (PRO) - Direct observation (knowing or unknowing) - Biophysiologic measures (objective standard measures, ex. CBC) Social desirability bias - correct answers-The tendency to respond to questions in a socially desirable manner Extreme response set bias - correct answers-tendency to consistently express extreme attitudes or feelings, leading to distortions (to always answer "strongly" option and not use the middle of the scale) Acquiescence response set bias - correct answers-- Always agree or always disagree without considering what the question asks - Can counter this by making it a mix of questions that if you agree its good or bad (will show if they are just clicking) words to understand the same thing, one person says this is depression and someone else says no depression is this) Levels of measurement - correct answers-nominal, ordinal, interval, ratio Nominal Measurement - correct answers-A measure for which different scores represent different, but not ordered, categories. - lowest level; involves using numbers simply to categorize attributes e.g., professional role, procedure (give 5 different cities numbers 1-5 to distinguish them but not rank them and then having ppl indicate where they were born, ex. winnipeg = 2 and so | would answer 2 and afterwards you count how many 2 you have) can't get an average, it is very limited Ordinal Measurement - correct answers-A measure for which the scores represent ordered categories that are not necessarily equidistant from each other. - order/ranks people on an attribute e.g., mild, moderate, severe (numbers ranking daily living 1-4 indicating that someone who is a 4 is more independent than a 2), does not tell you the difference between the numbers though (there is no meaning full difference between the scores) Interval Measurement - correct answers-A measure for which a one-unit difference in scores is the same throughout the range of the measure. - ranks people on an attribute and specifies the distance between them e.g., intelligence, temperature in Celsius (you can start doing stats, but you don't have an absolute 0 (should be nothing at that level but theres still something) There is equal intervals of change between the numbers but 0 doesn't mean absence of anything Ratio Measurement - correct answers-A measurement in which the distance between scores has meaning; it includes a true and meaningful zero point - highest level; ratio scales, unlike interval scales, have a meaningful zero and provide information about the absolute magnitude of the attribute e.g., cell count, cases of H1N1 in MB (0 = compete absence of that construct) Descriptive Statistics - correct answers-Numerical data used to measure and describe characteristics of groups. Includes measures of central tendency and measures of variation. - Parameters: descriptor for a population - Statistics: descriptive index from a sample Inferential Statistics - correct answers-Procedures used to draw conclusions about larger populations from small samples of data. - Numerical data that allow one to generalize- to infer from sample data the probability of something being true of a population Population Parameters - correct answers-Characteristics of a population that are inferred from characteristics of a sample - Descriptors for a population - Is an average or percentage describing the whole population. Sample Statistics - correct answers-Numerical data describing characteristics of the sample - Descriptive index from a sample measures of central tendency - correct answers-mean, median, mode Mode - correct answers-the most frequently occurring score(s) in a distribution - Used for: gross descriptor, especially of nominal measures Median - correct answers-The middle score in a distribution; half the scores are above it and half are below it - useful mainly as descriptor of typical value when distribution is skewed (e.g., household income) Mean - correct answers-The arithmetic average of a distribution, obtained by adding the scores and then dividing by the number of scores. - most stable and widely used indicator of central tendency Variability - correct answers-The degree to which scores in a distribution are spread out or dispersed. - Heterogeneity: great variability Threats to Internal Validity: History - correct answers-Events occurring during study, but unrelated to investigation, impact upon the DV. - Things that happen at the same time that could explain the results Threats to Internal Validity: Maturation - correct answers-Processes that result simply from the passage for time - Normal time related changes - Ex. Study on post-op pain and you measure the pain on different days (you are going to have naturally decreased pain with increase time) Threats to internal validity: Mortality - correct answers-Differential loss of participants from groups - More drop out of one group than the other (not always death) Threats to internal validity: Selection - correct answers-Biases arising from preexisting differences between groups being compared. This is the single biggest threat to studies that do not use an experimental design. - Generally in non randomized studies - Need to randomize to try to avoid these biases Threats to internal validity: Knowledge of who receives the intervention - correct answers-Can occur if subjects or those measuring outcomes know subject group assignment. This is reduced by blinding, in which subjects and thase measuring outcomes do not know the group assignments. - Know who gets treatment (can + or - influence) Threats to internal validity: Recall bias - correct answers-Can occur when subjects are asked to recall past actions or events (such as in case-control studies). Subjects may give answers that are "socially acceptable" or that they "think" is what happened. - Give answers they think happened (think you want to hear) What is external validity? - correct answers-the degree to which the investigator can extend or generalize a study's results to other subjects and situations. - ls dependent on the reliability and validity of the study procedures Threats to external validity - correct answers-- Inadequate sampling of study participants - Unfortunately, enhancing internal validity can sometimes have adverse effects on external validity (it is too specific). What is qualitative research? - correct answers-- Qualitative research seeks to develop an understanding of phenomena (i.e. human experience) - Focused on meaning (i.e. how do people make sense of their lives and experiences) - Rich narrative materials and flexible research design - Constructivist paradigm - multiple perspectives of reality (why it is important to ask someone about there perspectives, goal is not to measure one level but rather to look for themes) How does qualitative research contribute towards clinical decision-making? - correct answers-- Helps us understand clinical phenomenon arising from experiences and values of patients! - Answers questions about the meaning of someones experiences or the appropriateness of an intervention. - There is value in merging quantitative and qualitative evidence to optimize clinical outcomes When would you use qualitative research approach? - correct answers-- The nature and type of the research question (Concerned more with the how, why and what and less with the numbers) - The epistemological stance of the researcher (How you like to ask questions in relation to what you think is important for finding answers) - The skills and training of the researcher - The resources available for the research project (Ability to get grants for one vs the other) Qualities of qualitative research - correct answers Emergent design (Start with some ideas of how to carry out ideas but participants may give answers that change the direction of the study) - Natural setting - Researchers as key instruments - Multiple sources of data (interviews, art, story telling) Emic perspective - correct answers-the perspective of the insider, the one belonging to the cultural group in question Etic perspective - correct answers-the perspective of the outside observer Grounded Theory - correct answers-- Aims to develop theories about social processes that are grounded in real-world observations - Systematic method of qualitative research - Data collection, analysis, sampling occur simultaneously - Go to the ppl who have experienced the process and find out what the process is - In-depth interviews: usually larger sample size due theoretical sampling - Constant comparison (Categories elicited from the data are constantly compared with data obtained earlier in the search for commonalities and variations) - Theoretical saturation - Theory development research - The final grounded theory describes processes by which people move through experiences or time (stages or phases) Data Saturation - correct answers-Answers the question of how to know when to stop interviewing (when you start to hear the same things again and again) Mixed Methods - correct answers-- Combines or associates both qualitative and quantitative forms - More than simply collective two types of data - Merges the data and results are interpreted from both data sets - Can be important in studying health care which is complex (you are able to get effects with numbers but also find out pt feelings about it) - Ex. maggot studies What are the types of sampling for qualitative research - correct answers-- Purposeful Sampling - Snowball or network - Convenience sampling - Theoretical Sampling - Data Saturation - Theoretical Saturation Purposeful (purposive) sampling - correct answers-purposely select the participants b/c they know them to acertain degree and they pick them (previous exposure and they select them purposefully — ex. they want a type one diabetic who is young, someone who has had it for 5 years) Convenience sampling - correct answers-Researcher has clear criteria for inclusion and exclusion and they put out posters or news letters to groups stating what they are interested in recruiting (they have clear criteria in mind but don't know who will contact them) Theoretical sampling - correct answers-Used in grounded theory specifically, select participants who they can help follow a developing theme Data saturation - correct answers-Sampling until you get repeated information and themes (you feel like you have a good handle from participants on what the experience is like) Important components of qualitative data collection - correct answers-- Flexible data collection plans that evolve as the study progresses - there is a plan, training, etc but unlike quantitative which is very percised on time of collection, there can be less specific on collection and can evolve depending on how the interview is going and on the data that you find (data you find can lead you to look for other things) - Purposefully selected sites and people (ppl are always those with the experience of the phenomenon) Varied types of data: textual data and images, interviews, art (a lot of types of data depending on what he question is) - Gain people's trust (edit out things that will identify them, make sure story is heard in quotes but not in a way that will out them) - Maintain reflexivity: the researcher's awareness of the part they play in the study and the possible effects on their data (they know they are the researcher but are also trying to stand back and they have arole in effecting the study) Methods of qualitative data collection - correct answers-- Qualitative observation - historical example: is WWII Nazi medical experiments, Freezing experiments, Tuskegee Syphilis study, CIA brainwashing experiments What is the Tuskegee Syphilis Study? - correct answers-- 600 low income African american males - Free medical exams, meals and burial insurance - Not offered a cure even though one existed - lied to about what they were being treated for (said it was bad blood What are the CIA Brainwash experiments? - correct answers-In the 1950-65 mental health patients were given high levels of electric shock therapy without their consent - MK ULTRA was a part of this and took place at McGill What is the declaration of Helsinki - correct answers--developed by World Medical Association -provides basic principles for medical research (with humans) - It places the interests of the individual above society What is the Belmont Report? - correct answers-Ethical principles and guidelines for the protection of human subjects of research - est. 1978 What are the Belmont Principles for research? - correct answers-- Respect for persons - Beneficence - Justice What falls under respect for persons in the belmont principle? - correct answers- Right to self determination and autonomy - Voluntary participation, freedom from coercion What is meant by beneficence in the belmont principle? - correct answers-- Freedom form exploration and harm (risks identified and minimized through exclusion criteria) - Risk/benefit ratio (both physical and mental) - Do goad - do no harm What is meant by justice in the belmont principle? - correct answers-- Right to fair and non-prejudicial treatment (fair selection of participants) - Right to privacy (anonymity and confidentiality) What are some examples of new ethical dilemmas that are arising? - correct answers-- The Human genome Project and Stem cell research (who owns the data and what is ethical regarding its use) - Research in venerable populations (Is it fair to conduct research in poor nations and not make the cures and treatments avalible to them b/c they are too expensive) - Inclusion of women of childbearing age in research What is the Tri Council Policy Statement? - correct answers-Developed through MRC/CIHR, NSERC and SSHRC - accepted by Health Canada - Only research adhering to the standards of the Council will receive funding in Canada - Used by research ethical boards REBs across Canada - Avoids any one disciplinary perspective, aims to provide a shared ethical framework for funding agencies and clinical institutions What is one limitation of the Tri Council Policy and how do we mitigate this? - correct answers-is doesnt always hold for research funded by cooperations and private insustries - Need to look at who approved the ethics for the study and who did the research for ethics (not all follow things if praviate company) What are the TCPS Ethical Principles? - correct answers-- Respect for human dignity - Respect for Free and informed consent - Respect for vulnerable persons - Respect for privacy and confidentiality - Respect for justice and inclusiveness - Balancing harms and benefits 
