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PNC IV - Exam 2 Questions and Answers 100% Solved
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Exam of 30 pages for the course PNC 100 at PNC 100 (PNC IV - Exam 2)
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PNC IV - Exam 2Evidence Based Practice - answer integrates best current evidence with clinical
expertise and patient/family preferences and values for delivery of optimal health care
Step of EBP - answerEBP is a systematic approach to rational decision making that
facilitates achievement of best practices (Newhouse and others, 2005). Using a step-by-
step approach ensures that you will obtain the strongest available evidence to apply in
client care. There are five steps of EBP
1. Ask a clinical question
2. Collect the most relevant and best evidence
3. Critically appraise the evidence you gather
4. Integrate all evidence with one's clinical expertise and client preferences and values
in making a practice decision or change
5. Evaluate the practice decision or change
1st Step of EBP - Ask a clinical question - answerAlways think about your practice when
caring for clients. Question what does not make sense to you and question what needs
clarification. Think about a problem or area of interest that is time consuming, costly, or
not logical (Callister and others, 2005). Examples of problem-focused trends include the
increasing number of client falls or incidence of urinary tract infections on a nursing unit.
Such trends lead you to ask, "How can I reduce falls on my unit?" or "What is the best
way to prevent urinary tract infections in postoperative clients?" The questions you ask
will eventually lead you to the evidence for an answer. In your 4th semester you will
develop a question.
2nd Step of EBP - Collect the most relevant and best evidence - answerYou will find the
evidence you need in a variety of sources: agency policy and procedure manuals,
quality improvement data, existing clinical practice guidelines, or computerized
bibliographical databases. Do not hesitate to ask for help to find appropriate evidence.
Your faculty will of course always be a key resource. When you are assigned to a health
care setting, consider using experts such as advanced practice nurses, staff educators,
risk managers, and infection control nurses.
3rd step of EBP - Critically appraise the evidence you gather - answerPerhaps the most
difficult step in the EBP process is critiquing or analyzing the available evidence. The
critiquing of evidence involves its evaluation, which includes determining the value,
feasibility, and utility of evidence for making a practice change (ONS, 2005). When
critiquing evidence, first evaluate the scientific merit and clinical applicability of each
study's findings. Then with a group of studies and expert opinion determine what
findings have a strong enough basis for use in practice.
,4th step of EBP - Integrate all evidence with one's clinical expertise and client
preferences and values in making a practice decision or change - answerOnce you
decide that the evidence is strong and applicable to your clients and clinical situation,
incorporate the recommended evidence into practice. Your first step is to simply apply
the research in your plan of care for a client. Use the evidence you find as a rationale
for an intervention you plan to try. For instance, you learned about an approach to bathe
older adults who are restless and decide to use the technique during your next clinical
assignment. You use the bathing technique with your own assigned clients, or you work
with a group of other students or nurses in revising a policy and procedure or
developing a new clinical protocol.
5th Step of EBP - Evaluate the practice decision or change - answerAfter applying
evidence in your practice, your next step is to evaluate the effect. How does the
intervention work? How effective was the clinical decision for your client or practice
setting? Sometimes your evaluation is as simple as determining if the expected
outcomes you set for an intervention are met.
Two types of EBP questions - answerBackground and Foreground
There are two types of questions to consider: background and foreground questions.
Background questions are those that provide foundational knowledge. An example of a
background question would be "What is scleroderma?" These types of questions can
most easily be answered by a textbook, review article, or a reputable website.
Foreground questions address issues of a more specific nature, such as "Is drug x more
effective that drug y in treating scleroderma?" These questions are best answered by
searching the primary literature, which is found in databases indexing research studies.
Background Questions - answer-Broad, basic knowledge questions
"what is the best method to prevent pressure ulcers?"
considerably broader and when answered, provide general knowledge (can be
answered from a textbook). For example: "What therapies reduce postoperative pain?"
Foreground Questions - answerSpecific question, provides evidence for clinical decision
making (PICO)
"In hospitalized adults (P), how does hourly rounding (I) compared with no rounding (C)
affect fall rates (O)?
specific and relevant to the clinical issue; must be asked in order to determine which of
two interventions is most effective in improving patient outcomes; answered by
searching current literature for studies comparing the two interventions. For example:
"In adult patients undergoing surgery, how does guided imagery compared with music
therapy affect analgesia use within the first 24 hours post-op?" Use the PICO
format....see next slide
, Developing a clinical questions - PICOT - answerP - patient population
I - intervention of interest
C- Comparison intervention
O - Outcome
T - time involved
Develop an answerable question
The first step in finding evidence is determining a question to ask. This may seem
straightforward and obvious, but this step is often a stumbling block for many people.
The reason is that most people start looking for information, or evidence, with only a
vague idea of what they are seeking. It would be similar to looking for someone's house
and only knowing they are in the southeast part of town. One could spend hours or even
days trying to find the exact location with such vague directions—and the person would
probably quit the search without success. To find the most direct route, one must start
with a good map. And a good map begins with the question, "Where do you want to
go?" The best way to find evidence is to be clear about what information is needed. The
question needs to be specific or answerable, without being too vague or so specific that
the probability of finding information about the topic would be unlikely. Entering a search
query such as 'breast cancer' or 'diabetes' would lead to an overwhelming abundance of
information. What particular aspect of breast cancer or diabetes is of interest: treatment;
supportive services; prevention strategies? Before searching for the evidence, define
the question to be answered and map a strategy to get there.
One formula that can be helpful in designing an answerable question is the PICO
formula. The acronym stands for Population, Intervention, Comparison, and Outcome.
Using these elements clarifies the formulation of a question. An example of a PICO
question would be, "For inpatients (P), is turning every 2 hours (I) more effective than air
mattresses (C) for preventing pressure ulcers (O)?"
Note that a comparison may not
How to search for evidence to answer the clinical question - answer1. Identify the type
of PICOT question.
2. Determine the level of evidence that best answers the question.
3. Select relevant databases to search (such as the CDSR, DARE, PubMed, CINAHL).
4. Use keywords from your PICOT question to search the databases.
5. Streamline your search with the following strategies:
• Use database controlled vocabulary
(such as "MeSH terms").
• Combine searches by using the Boolean connector "AND."
• Limit the final search by selecting defining parameters
(such as "humans" or "English").
Why talk about Health Policy? - answerInfluences health and well being of society
Has impact on professional nursing -- this includes things from staffing education
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