Quizzes 1. The three main components of Evidence-Based Practice (EBP) are: - Best research evidence, Patient values and preference, clinical expertise 2. Identify 3 barriers to incorporating EBP into practice: - Workplace culture, ability to access and assess, resources 3. The EBP Process is similar to what other processes? - nursing research, nursing process, problem-solving 4. Identify 3 major components of an article: references, methods, reviews of literature 5. You hear about a new skin care policy to reduce skin breakdown/ulcers at a national conference. You decide to form an interdisciplinary team to work on implementing this policy into your own unit. What type of "trigger" is this? Knowledge-focused trigger 6. In this PICO question: Do sleep hygiene apps improve quality of sleep in teenagers compared to no intervention?...What part of the PICO does "no intervention" imply? Comparison 7. Who is an example of a "stakeholder" in a study in the PICU to incorporate trauma-informed care into daily rounds? - trauma-informed care expert, care team (doctors, nurses, RT), current/ former parents of a PICU patient 8. What type of threat to internal validity would it be if the researcher "hand-picked" their sample? Selection bias 9. Which of the statements are true regarding Level IV Evidence? (Select all that apply) - they can be descriptive, they are non-experimental, they include qualitative designs 10. A researcher wants to understand the lived experience of a recent refugee living in Omaha. What is the best design for the study? Qualitative non-experimental 11. In qualitative research, what is the equivalent term to "generalizability" in quantitative research? Transferability 12. What are types of Qualitative Designs? (Select all that apply) - ethnography & phenomenology 13. The number of patients that successfully used the call light after education would be an example of what kind of outcome variable? Patient-related 14. Measures the researcher uses to hold the conditions of the study consistent to minimize possible bias in selection of subjects, randomization, or assignment to experimental and control group as well as error in the measurement of the dependent variables is referred to as CONTROL 15. Which of the following would a nurse researcher do to promote intervention fidelity in his/her study? - collect data in the same way from each subject and under the same conditions 16. Internal validity assess for which of the following? - if the change in the dependent variable or study outcome was related to the independent variable 17. Which of the following best describes external validity? - the degree to which findings can be generalized to other populations or other environments 18. To avoid selection bias — include randomized group 19. Which of the following is NOT a component of intervention fidelity? - internal validity 20. Intervention fidelity includes training, delivery, enactment 21. Which of the following measures of control are generally easier for the researcher to control? Internal 22. As more controls are included in a study design, internal validity improves, external validity declines 23. An evidenced-based practice project would need to evaluate which of the following - quality studies obtained from a search using key words - findings from individual studies obtain from a search using key words - a synthesis of findings from all relevant studies obtained from a search using key words 24. The nursing value that is reflected by the nurse's concern and advocacy for the welfare of patients, other nurses, and other healthcare professionals is which of the following? Altruism 25. The nurse learns in report that the patient in room 223, Mr. X, has no insurance and entered the country illegally. The nurse provides high-quality care to the other patients to which she is assigned, but is slow to answer Mr. X's call light and is dismissive toward his family. Which nursing value has the nurse violated? - social justice 26. Common exemplars of professional nursing behaviors include: (select all that apply) - compassion, courage, integrity 27. Who is responsible for developing the scope and standards of nursing practice? ANA 28. A patient suffered a brain injury and has not brain activity. The patient has a living will which states no heroic measures. The family requests that no additional heroic measures be instituted for their loved one. The nurse respects this decision in keepin with the nursing value of: AUTONOMY 29. The Model of Professional Nursing Practice Regulation culminates at the top to represent: - self-determination of the nurse in exercising judgments 30. A patient refuses a simple procedure that you believe is in the patient’s best interest. What two ethical principles are in conflict in this situation? AUTONOMY AND BENEFICENCE 31. An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. What does the nurse manager understand based on The Americans with Disabilities Act of 1990 requirements for employers? MAKE REASONABLE ACCOMODATIONS FOR PERSONS WHO ARE DISABLED ( The purposes of the ADA are to eliminate discrimination against persons with disabilities and to provide consistent, enforceable standards to address discrimination in the workplace.) 32. You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The team leader at the clinic advises that: CARE CAN BE PROVIDED AS LONG AS CONSENT IS VOLUNTARY AND INFO ABOUT TREATMENT AND OPTIONS IS PROVIDED ( All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.) 33. Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? BENEFICENCE 34. Which ethical principle is primarily involved in informed consent? AUTONOMY 35. The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? FIDELITY 36. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: MORAL DISTRESS ***Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers. Steps for EBP Select EBP Topic (PICO) Form a Team Retrieve Evidence Critically appraise the evidence Synthesize evidence EBP recommendations Decision to change practice Convert EBP to Policy/Procedures Implement Practice Change Evaluate Practice Change Disseminate Explain PICO Framework to develop hypothesis Population/Disease Intervention or variable of interest Comparison, Outcome, Time Population-everyone in your required gender or age range Target Population-everyone who has your intervention Accessible population-people who have your intervention who you can access power analysis-determines sample size is for a quantitative studies using a. You can do this a priori (before) or after pot hoc Qualitative you would keep collecting data until it continues to repeat. 9. Identify differences in purpose between experimental and non-experimental designs Experimental-determines causality, has intervention (independent variable) and dependent variable (outcome). Produces causality Non-experimental design-only gives probability, produces correlation 10. Identify independent vs dependent variables Independent variable-intervention Dependent variable-outcome 11. Understand extraneous variable and how to minimize extraneous variables extraneous variable-Things that might cause the internetion to work Identify if there are differences between group and within group 12. Identify how to minimize bias Use random samples, use blind or double blind, have peer reviews,have others review the design of the experiment Random assignment 14. Identify research study design by time ● ● ● ● Retrospective- Looking backwards. For example: looking at chart analysis Cross-Sectional- Do something at a point of time. For example: checking bloods levels in a pregnant woman at 12 weeks Longitudinal- Doing something at different point of time of the research. For example: checking blood levels in a pregnant woman at 3 weeks, 6 weeks and 9 weeks. Prospective- Looking forward. For example: Identified PICO and now I am going to recruit my sample. 18. Explain identify how Qualitative studies differ from quantitative studies in purpose, sampling, collecting data, and analyzing data. Qualitative Design ● ● ● ● ● ● Answers questions How & Why; uses WORDS Investigates topics where little is known generates theory Sampling-informants not subjects ■ Purposive- very specific informants bc they need to have the independent variable you’re looking for ■ Snowball-you get some study participants who are part of your target population then reachout to their contacts to increase the number of participants ■ Data Saturation- continue the study until you keep getting the same results Collecting Data-in-depth interview, direct observation. Requires fieldwork and time intensive Analyzing & Interpreting Data-involves descriptive data reduction analysis & interpretation, will code key words and run through algorithm. the researchers will gather and discuss reflections or other subjective information and come to a consensus on how to interpret it. Evaluation & Trustworthiness ■ Credibility-similar to internal validity ■ Transferability-Can the findings from one study be transferred to a similar context ● adequate sampling ● achieving data saturation ■ Dependability-similar to reliability, Findings are reflective of the data (audit trail) ■ Confirmability -similar to objectivity, Findings are substantiated by participants member checks or audit trail 21. Identify ethical considerations related to research ● ● ● ● ● Voluntary consent is essential Avoid unnecessary suffering and injury Well-being takes precedence over science Respect for Human Dignity ● Right to self determination- ppl have the right to participate and withdraw from the study ● Right to full disclosure- inform the participants about nature of the study, they have the right to refuse participation, researchers responsibilities, the risks & benefits that would occur Beneficence ● Subjects should be protected from exploitation. ● Participation in research should achieve scientifically & socially important aims ● ● Subjects shouldn’t be placed at a disadvantage or exposed to situations for which they aren’t prepared. Justice ● Rights to Fair Treatment- Subjects should receive what they are due or owed. Equitable selection of subjects & their treatment. ● Privacy-Freedom of participants to determine circumstances under which information is shared or withheld ● Anonymity-Subjects identities even by the researcher can’t be linked to their responses ● Confidentiality-Subjects’ identities & their information will not be publicly divulged Internal validity-is the outcome due to the ppl inside the study External validity- if this works here can we use this in other areas If a study is pulling population from multiple sites it increases external validity Threats to internal validity ● ● ● ● ● ● Selection bias (have targeted population that will improve study results) History-events going on at the time and may create shifts or outliers Maturation-participants changing over time Testing- how many times have they taken this, are they going to remember Instrumentationmortality/attrition- if lots of ppl left the study or if ppl died what si the reason (decreases internal validity Threats to external validity —--Amount of sites Level 4, non-experimental Descriptive-describe the relationships ● ● ● exploratory ● comparative ● Survey Correlational-is there a correlation between grades and student location ● relationships not causality (causality is experimental) ● Descriptive correlation designs ● predictive correlational designs ● model-testing correlational designs (testing a hypothesis) Case study-look at one or two case studies TERMS Professional negligence - can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. History -Nursing regulation began in the U.S. in the early 1900’s -1938 New York first state with Mandatory Licensure Law -1970’s Licensure Mandatory in all states -10th Amendment of the U.S. Constitution provides states can enact reasonable laws to protect it’s citizens professional licensure -1953 LB 200 passed in NE for licensure of nurses This is better known as the Nurse Practice Act Nurse Practice Act The law that governs and defines the practice of nursing - Outlines the scope of practice -Provides for the Board of Nursing and their statutory charge -Protects titles -Defines licensure Methods of Licensure - NCLEX (exam) - Endorsement from another jurisdiction Nurse Licensure Compact - Started in 2000 – 29 states joined between 2000 and 2015 -January 19, 2018 enhanced NLC began -New requirement includes fingerprint background checks, no felony convictions, no misdemeanor convictions rationally related to practice of nursing -Nebraska is part of the eNLC Nebraska Board of Nursing - Provide for the health, safety, and welfare of the citizens. 1. Ensure nurses meet minimum standards of proficiency and competency. 2. Ensure programs of nursing meet the educational needs of the student and qualify students to serve the public safely. 3. Regulate the field of nursing in the interest of consumer protection in the state. Duties of the Board -Adopt reasonable and uniform standards for nursing practice and nursing education -Issue or decline to issue advisory opinions defining acts which, in the opinion of the board are or are not permitted in nursing practice (Scope of Nursing Practice Decision-Making Framework: http://dhhs.ne.gov/publichealth/Licensure/Documents/scopeofpracticeflowchart.pdf) - Approve all educational programs which meet the requirements of the Act - Collect data regarding nursing (Workforce supply and demand) -Provide consultation and conduct conferences, forums, studies, and research on nursing practice and education - Administer the LPN-C Act (previously; changed in 2017) -Administer the Nurse Licensure Compact Act - Join organizations that develop and regulate national nursing licensure examinations and promote health, safety and welfare of citizens through regulation of nursing practice (National Council of State Boards of Nursing) - Establish rules and regulations -Standards for delegation and supervision of nursing practice -Approving and classifying educational programs Negligence or malpractice Failure to follow Standards of Practice -Failure to use equipment responsibly Failure to communicate Failure to document Failure to assess/monitor patient’s condition Failure to Act as a patient advocate ● Nursing legal standards include: ● Clinical standards of care ● Liability ● Negligence ● Malpractice Provision 1-The nurse practices with compassion and respect for inherent dignity, worth and unique attributes of every person. Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family group, community or population Provision 4 The nurse has authority, accountability, and responsibility for nursing practice: makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care Provision 5 The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Provision 6 The nurse, through individual and collective effort, establishes, maintains , and improves the ethical environment of the work settings and conditions of employment that are conducive to safe, quality health care. s, health, and safety of the patient.
