In what ways can nurses incorporate evidence into nursing practice? select all that apply.

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Chapter 01: Integrating Research, Evidence-Based Practice, and Quality Improvement

Processes

LoBiondo-Wood & Haber: Nursing Research: Methods and Critical Appraisal for

Evidence-Based Practice, 9th Edition

MULTIPLE CHOICE

1. Nursing research is significant to the profession of nursing because it promotes: a. more specifically defined nursing practice responsibilities. b. decreased liability within the practice of nursing. c. generation of a specialized body of nursing knowledge for use in nursing practice. d. expansion of the scope of nursing practice into other disciplines.

ANS: C

Feedback A Research aids in documenting accountability of nurses, but professional guidelines already exist regarding responsibility. Each state has a Nurse Practice Act with rules and regulations that define scope of practice. B Liability is a legal concept related to a nurse’s legal scope of practice and professional standards of practice. Research does not change a nurse’s liability. C Nursing research generates a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet constantly shifting challenges of health care delivery to multiple populations. It provides a foundation for evidence-based nursing care and quality improvement activities. D Although research can document nursing accountability, each state’s Nurse Practice Act defines the scope of nursing practice for that state.

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1. An aspect of the scientific investigation of nursing practice that is also a fundamental concept of American Nurses Association (ANA)’s Code for Nurses is: a. professional accountability. b. standards of care. c. legal scope of practice. d. advanced practice nursing activities.

ANS: A

Feedback A Scientific investigation promotes accountability, a hallmark of the nursing profession and a fundamental concept of the ANA’s Code for Nurses. B Standards of care are defined by ANA, as well as specialty nursing organizations. The Code for Nurses states that nurses should conform to standards, but standards per se are not part of the Code. C Legal scope of practice is defined by each state’s Nurse Practice Act and elaborated in its rules and regulations. D The ANA Code applies to nursing practice in general, not advanced practice.

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PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 7

1. Nurses need to be able to understand the nursing research process: a. to identify potential subjects for clinical research studies. b. to assist as accurate data collectors in clinical research studies. c. to teach patients and families the importance of participating in research. d. to evaluate nursing research reports for relevance to their own clinical practice.

ANS: D

Feedback A Subject identification is determined by the nurse researcher. B Data collectors need to understand their role in the study; they do not need to understand the entire research process. C Subject recruitment is the responsibility of the nurse researcher. D Nurses need to understand the research process in order to critically read research reports and determine if nursing practice should incorporate the research findings as valid evidence.

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1. The action that demonstrates the role of a knowledgeable consumer of nursing research is: a. designing a nursing research study. b. analyzing data to determine a study’s outcomes. c. evaluating the credibility of research findings. d. implementing an intervention found to be effective in one clinical case study.

ANS: C

Feedback A A consumer uses and applies research to practice but is not responsible for designing a study. B A consumer does not conduct data analysis of a study; the study’s primary investigator analyzes data. C A consumer of nursing research needs to understand the research process to determine the merit and relevance of evidence presented in research studies. D A consumer would not implement an intervention on the basis of a single case study.

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1. Members of the nursing staff are to participate in a unit-based clinical research study. Which research-related actions would be expected of a nurse with a baccalaureate nursing degree? a. Using critical appraisal skills to understand and assess the steps of the research process b. Providing expert nursing consultation about the way in which clinical services are

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1. What is the primary value of evidence-based nursing practice? a. Implementing the most cost-effective nursing practices when providing patient care b. Incorporating research findings with clinical expertise when individualizing patient care c. Separating nursing research as unique from the research of other disciplines d. Developing new nursing theories to promote the growth of nursing science

ANS: B

Feedback A Cost-effective nursing interventions can occur based on evidence, but it is not the primary value of evidence-based nursing practice. B Evidence-based practice allows the nurse to systematically integrate the best available research evidence with individual clinical expertise, as well as the patient’s values and preferences, when making clinical decisions. C Developing a unique body of nursing knowledge is important, but it is not the primary value of developing evidence-based nursing practice. Also, nurse researchers should be able to collaborate with researchers in other disciplines. D Developing abstract nursing theory is important, but evidence-based nursing is focused on the more concrete application of knowledge in clinical practice.

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1. A novice nurse researcher is comparing the processes used in nursing research and in evidence-based practice. What differences, if any, exist between the two processes? a. As scientific processes, they are fundamentally the same and should result in parallel outcomes. b. Both processes involve testing a question with an appropriate design and specific methodology. c. In a research study the question is tested with an appropriate design and specific methodology, whereas in evidence-based practice, the question is used to search the research literature to find answers. d. In evidence-based practice, qualitative studies are critically appraised to answer a clinical question, whereas in nursing research, quantitative studies are reviewed to provide a foundation for the study. ANS: C

Feedback A The research process and the evidence-based practice process, though similar, have fundamental differences as well. B This definition applies to the research process, not the evidence-based practice process. C Nursing research includes developing a design for a study, whether quantitative or qualitative, reviewing the literature, and carrying out a specific methodology to find answers to a question. In contrast, evidence-based practice includes a review of completed research studies to identify answers to a clinical question.

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D Both the research process and the evidence-based practice process include critical review of quantitative and qualitative studies.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: Page 7

1. A nurse is analyzing a research article. Where in the article is the nurse likely to find the research question and study purpose? a. Introduction b. Data analysis c. Findings d. Data collection

ANS: A

Feedback A The research question and study purpose is generally found early in the report: in the abstract, the introduction, or at the end of the literature review or conceptual framework section. B The research question and study purpose are defined before the data analysis section of the research article. C The research question and study purpose are defined before the findings section of the research article. D The research question and study purpose are defined before the data-collection section of the research article.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: Page 8, Table 1.

1. The nurse researcher is conducting a research study using subjects who will be interviewed regarding their experience with postpartum depression. Why would the researcher select a qualitative, rather than a quantitative, research design? a. Quantitative research is usually conducted in natural settings using data that are words rather than numbers. b. Qualitative research seeks to explain cause-and-effect relationships between variables. c. Quantitative research typically uses a convenience sample, seeking to answer a clinical question about a human experience. d. Qualitative research collects data from a small number of subjects, allowing for in-depth study of a phenomenon. ANS: D

Feedback A Qualitative, not quantitative, research is usually conducted in natural settings using data that are words rather than numbers. B Quantitative, not qualitative, research seeks to explain cause-and-effect relationships between variables. C Qualitative, not quantitative, research seeks to answer a question about a human experience.

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(but investigate the same research question) reported similar findings. D Quantity refers to the strength of the findings in the statistical analyses.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 14

1. The nurse is analyzing a qualitative research article. In which section of the article is the nurse likely to find a summary of legal-ethical issues considered in the study? a. Data collection or procedures b. Findings or results c. Discussion or implications d. Abstract or introduction

ANS: A

Feedback A Legal-ethical issues are typically discussed in the article’s data-collection or procedures section, usually when discussing the sample. B The research results are typically found in the findings or results sections. C Recommendations are typically found in the discussion or implications sections. D The research question and study purpose are typically found in the abstract or introduction.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 8, Table 1.

1. The nurse is analyzing a qualitative research article. In which section of the article should the nurse expect to find a discussion of the research findings? a. Procedures b. Methods c. Sample d. Results

ANS: D

Feedback A Data analysis is typically included in the data analysis or procedures section. B Instruments and their validity and reliability are included in the methods or instruments sections. C The research sample and legal-ethical issues are included in the sample or subjects section. D The discussion of the findings will be located in the results or discussion section.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 8, Table 1.

1. The nurse is using the critical reading process to analyze a research article. The nurse identifies the main theme of the article and states it in two sentences, using the nurse’s own words. The nurse is using a strategy to promote which type of understanding? a. Preliminary

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b. Comprehensive c. Analysis d. Synthesis

ANS: B

Feedback A Strategies for preliminary understanding include activities such as using a dictionary and identifying key variables of the study. B Strategies for comprehensive understanding include restating the main idea or theme of the article in one’s own words. C Strategies for analysis understanding include using criteria to critique the steps of the research process used in the study. D Strategies for synthesis understanding include writing a summary of the strengths and weaknesses of the study.

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1. The nurse is using the critical reading process to analyze a research article. The nurse is using a list of criteria to determine how well the researcher performed each step of the research process. The nurse is using a strategy to promote which type of understanding? a. Preliminary b. Comprehensive c. Analysis d. Synthesis

ANS: C

Feedback A Strategies for preliminary understanding include activities such as highlighting or underlining identified steps of the research process. B Strategies for comprehensive understanding include restating the main idea or theme of the article in one’s own words. C Strategies for analysis understanding include using criteria to critique the steps of the research process used in the study. D Strategies for synthesis understanding include writing a summary of the strengths and weaknesses of the study.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) REF: Page 10

1. Which of the following is a critical step for the quality improvement process in health care settings? a. Outlining general long-range goals b. Identifying current successful practices c. Testing practice changes slowly and tentatively d. Adopting a practice change as a new standard of care

ANS: D

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Feedback Correct All nurses are responsible for protecting the rights of patients. All nurses should be aware that research is related to practice. All nurses can be a part of a clinical team that applies research to practice. Incorrect Disseminating research in scientific reports is an activity generally performed by nurses with master’s or higher educational preparation. Developing theoretical explanations for findings is an activity generally performed by nurses with master’s or higher educational preparation.

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1. For the baccalaureate nursing student, education in nursing research should result in: ( Select all that apply. ) a. mastering the development of research protocols. b. gaining basic understanding of the research process. c. learning how research is related to clinical nursing practice. d. developing skill as a primary investigator in research. e. becoming a knowledgeable consumer of nursing research.

ANS: B, C, E

Feedback Correct The student should gain an initial understanding of the importance of research in nursing practice. The student should learn how research is related to clinical nursing practice. The student should learn skills in the critical analysis of research to assist in decisions about applying research findings in nursing practice. Incorrect Mastery of research protocol development is generally attained at the master’s or higher-degree level of education. Developing skill as a primary investigator is generally attained at the doctoral level of education.

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1. Developing nurse researchers at a younger age is a priority for the future in the nursing profession because it should: ( Select all that apply. ) a. enhance the discipline’s scientific development. b. increase the longevity of research careers. c. receive more research funding for professional organizations. d. promote mentoring opportunities for novice researchers. e. increase nursing’s role in pharmaceutical research.

ANS: A, B, D

Feedback Correct Developing young researchers increases the number of researchers contributing to the science of the discipline. Introducing nurses to research at a younger age allows them sufficient

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time to develop in-depth research programs in their careers. Introducing nurses to research at a younger age allows them time and opportunity to be mentored by experienced researchers, as well as to learn to become mentors themselves. Incorrect Younger researchers do not guarantee research monies.

Pharmaceutical studies are medical research and are not considered

nursing research studies.

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1. A nurse makes these statements. Which one has the greatest potential as an area of nursing research? a. “Most of our hospital’s admissions come in at night.” b. “It is difficult to find personnel willing to work the nightshift.” c. “It seems that most of the patient falls on our unit occur during the nightshift.” d. “The personnel on the nightshift are not attending promptly to the needs of our patients.” ANS: C

Feedback A This statement is broad and not specific to patient care. It would need to be defined in much more detail to have potential for nursing research. B This broad statement is important to managers responsible for staffing a health care facility. However, it does not show potential for investigation that would contribute to the body of nursing knowledge. C This statement identifies a specific, important patient problem. Its exploration has potential to contribute to the body of nursing knowledge. D This is a broad subjective observation that does not suggest any approach for investigation or potential for contributing to the body of nursing knowledge.

PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 25, Table 2.

1. The nurse has identified a clinical problem as a potential research question. The next step should be: a. identify the variables. b. formulate the research hypothesis. c. perform a literature review. d. determine financial resources for the research project.

ANS: C

Feedback A It is too early to identify variables. They will be confirmed by the literature review. B Although the researcher may have a preliminary hunch about the hypothesis, it cannot be formulated until the research question is formalized after the literature review is completed. C The literature review helps to further define the research question by identifying gaps in the literature, the need for replication of prior research, or the need to extend the knowledge base in a particular research area. It also identifies variables essential to consider in refining the research question. D The financial resources needed for the project cannot be determined until the study’s design and methodology are finalized.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 25, Table 2, page 26

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1. In a research study, properties of interest that differ in value are: a. variables. b. concepts. c. hypotheses. d. assumptions.

ANS: A

Feedback A This is the widely accepted and often-cited definition of variables. B A concept is an abstraction that names an object or phenomenon. C A hypothesis is a prediction that helps to answer a research question. D Assumptions are statements accepted as true.

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1. A nurse researcher proposes a study of teenage mothers and their experience with postpartum depression. Considerations that would affect the feasibility of the study would be: a. availability of participants. b. direction of the hypotheses. c. gaps in the literature. d. design of the study.

ANS: A

Feedback A A study’s feasibility is determined by practical considerations, such as availability of subjects, equipment, facilities, and money. B The direction of the hypothesis is irrelevant to a study’s feasibility. C Gaps in the literature provide support for the research study and do not affect its feasibility. D The design of the study is shaped by the research question and is not directly related to the study’s feasibility.

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1. The most significant difference between independent and dependent variables is: a. the dependent variable should change in response to manipulation by the independent variable. b. the independent variable should change in response to manipulation by the dependent variable. c. although both the dependent and independent variables are manipulated, only the dependent variable is considered an intervention. d. although both the dependent and independent variables are manipulated, only the independent variable is considered an intervention. ANS: A

Feedback

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A Infant health is the consequence or presumed effect that changes regarding maternal employment. Thus it is the dependent variable. B Maternal employment is presumed to effect a change in the infant’s behavior (the dependent variable). Thus, maternal employment is the independent variable. C The first 6 months of life refers to the time the subjects (mothers and infants) will be observed in the study. D Health care professionals constitute the population to be studied.

PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 29

1. A nurse has defined the research question as, “How does oral nutritional supplementation during dialysis treatments affect the serum albumin levels of adult patients who have chronic kidney disease Stage 5?” In this question, the independent variable is: a. adult patients with chronic kidney disease Stage 5. b. oral nutritional supplementation. c. during dialysis treatments. d. serum albumin levels.

ANS: B

Feedback A The population being studied is adult patients with chronic kidney disease Stage 5. B Oral nutritional supplementation is the intervention administered to effect a change in the patients’ serum albumin levels. Thus oral nutritional supplementation is the independent variable. C The time of the intervention is defined as during dialysis treatments. D The study expects to affect the serum albumin levels of patients who receive the intervention. Thus serum albumin levels constitute the dependent variable.

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1. A nurse has defined the research question as, “Is there a relationship between self-esteem and body weight among postmenopausal women?” What type of research-question format (or research design) is implied by this question? a. Correlational non-experimental b. Comparative non-experimental c. Quantitative experimental d. Phenomenological non-experimental

ANS: A

Feedback A Self-esteem and body weight are variables that are related in an associative way. The word relationship strongly suggests correlational design studies. B A comparative non-experimental study would compare differences between two or more groups.

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C A quantitative experimental study would include an intervention and measure its effect numerically. D A phenomenological design would measure the meaning or impact of a phenomenon; “the lived experience.”

PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 30, Table 2.

1. A nurse has defined the research question as, “What is the lived experience of late-stage pregnancy loss among women older than 35 years?” What type of research-question format (or research design) is implied by this question? a. Correlational non-experimental b. Comparative non-experimental c. Quantitative experimental d. Phenomenological non-experimental

ANS: D

Feedback A This research question does not indicate an association between variables, which would be studied in a correlational design. B A comparative non-experimental study would compare differences between two or more groups. C A quantitative experimental study would include an intervention and measure its effect numerically. D The question concerns “lived experience,” which implies a grounded-theory study design.

PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 30, Table 2.

1. Which research question is testable as currently written? a. Should parents addicted to crack cocaine be permitted to raise their children? b. Is the classroom an appropriate place to teach sex education to 10-year-old children? c. Are older adults living in assisted-living facilities satisfied with their level of social interaction? d. Is a positive HIV/AIDS status a sufficient reason for limiting the employment of elementary school teachers? ANS: C

Feedback A This question suggests a value statement that is not testable. B This question suggests a value statement that is not testable. C This example implies variables that can be measured and suggests a comparative non-experimental design study. The independent variable is residing in assisted-living facilities, as compared with not residing in assisted-living facilities. The dependent variable is social interaction. D This question suggests a value statement that is not testable.

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1. Which hypothesis is non-directional? a. Hospitals with an infection-control nurse will have fewer instances of sepsis among inpatients than hospitals without an infection-control nurse. b. There will be a greater weight loss among dieting patients who receive a weekly supportive telephone call from a dietitian than among dieting patients who do not receive a weekly supportive phone call. c. There will be a difference in stage of disease for prostate cancer among men who had an abnormal prostate-specific antigen screening compared with men who had an abnormal digital rectal examination screening. d. Children who receive weekly counseling for 1 year after the death of a parent will perform better in school than children who do not receive weekly counseling after the death of a parent. ANS: C

Feedback A This hypothesis gives the expected direction (i., fewer). B This hypothesis gives the expected direction (i., greater). C This hypothesis has no expected direction. It suggests a difference but does not indicate the direction of the difference. D This hypothesis gives the expected direction (i., better).

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1. The nurse has defined the hypothesis as, “There will be no difference in the number of adverse events among patients discharged 2 days after an abdominal hysterectomy compared with patients discharged 4 days after an abdominal hysterectomy.” This statement is an example of what? a. Directional hypothesis b. Non-directional hypothesis c. Research hypothesis d. Null hypothesis ANS: D

Feedback A Because no direction is indicated, this is not a directional hypothesis. B A non-directional hypothesis indicates the existence of a relationship between variables but does not indicate the direction. This hypothesis indicates no relationship between variables. C A research (or scientific) hypothesis is a statement of the expected relationship of the variables. This hypothesis indicates no relationship between variables. D This is a null (or statistical) hypothesis, stating that there is no relationship between the independent (postoperative days) and dependent (adverse events) variables. If in the statistical analysis a significant relationship is found, the null hypothesis would be rejected.

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REF: Page 36

1. The nurse notes these statements in a research article: This study explores changes in coping and emotion that occur between the preoperative and the postoperative period. Further, the relationships between coping and emotion preoperatively and postoperatively are evaluated. Finally, the influence of preoperative coping and emotion on postoperative emotion is documented. This section represents which part of a research study? a. Results b. Methods c. Purpose d. Hypothesis

ANS: C

Feedback A No results were described in the passage. B Although methods are implied, the passage does not include the specific methodology. C The statements describe the aims or goals that the investigator hoped to achieve with the research and thus reflect the purpose of the study. D The passage does not state the hypothesis of the study.

PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 32

1. A nurse states the purpose of a research study as, “This study will compare the effect of warm and cold applications on the resolution of intravenous (IV) infiltrations in hospitalized older-adult patients in the early postoperative period.” In this statement, what constitutes the independent variable(s)? a. Postoperative older adult patients b. Early postoperative period c. Warm and cold applications d. Resolution of IV infiltrations

ANS: C

Feedback A Postoperative older adult patients represent the population to be studied. B Early postoperative period indicates the timing of the intervention. C Warm and cold applications represent the independent variables, which will be manipulated and influence the dependent (outcome) variable resolution of IV infiltrations. D Resolution of IV infiltrations represents the dependent (outcome) variable of the study.

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