13 minute read
Chapter 17: Evidence-Based Practice: Strategies for Nursing Leaders
Huber: Leadership & Nursing Care Management, 6th Edition
Multiple Choice
1. Evidence-based practice includes: a. collaborative practice dynamics between health care professionals. b. documentation of patient care as evidence of nursing practice. c. integration of research with clinical expertise and patient values. d. mutual goal setting and application in the clinical setting.
ANS: C
Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making (Sackett et al., 2000).
DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. Components of a systematic review include: a. publication of study data. b. assessment of a study. c. determination of statistical tests. d. development of research guidelines.
ANS: B
Standard components of a systematic review are processes for (1) initiating, (2) finding and assessing individual studies, (3) synthesizing the body of evidence, and (4) reporting using a standard format (Institute of Medicine, 2011b).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. authoritarian b. autocratic c. transformational d. translational
3. A team has formed to determine which methods have worked best and which factors influence the implementation of an evidence-based practice program. This is known as _____ research.
ANS: D
Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. Opinion leaders are: a. formal leaders who lead evidence-based practice development teams. b. formal leaders who write new evidence-based practice guidelines. c. informal leaders who influence peers by evaluating innovations for use in certain settings and promoting clinicians use of evidence in clinical decision making. d. informal leaders who gather data about nursing practice changes.
ANS: C
Informal leaders who influence peers by evaluating innovations for use in certain settings and promoting clinicians’ use of evidence in clinical decision making are referred to as opinion leaders. Opinion leaders are likeable, trustworthy, informative, and influential (Flodgren et al., 2011).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
5. A clinical nurse specialist is meeting one on one with staff nurses while they are working to discuss data about the evidence-based practice. This is known as: a. academic detailing. b. champion coaching. c. individual instruction. d. professional mentoring.
ANS: A
Academic detailing is a marketing strategy in which a trained individual meets one on one with practitioners in their setting to provide information about the evidence-based practice.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
6. A communication strategy used in the promotion of adopting evidence-based practice recommendations is: a. best practice evaluation. b. knowledge translation. c. shared governance. d. academic detailing.
ANS: D
Academic detailing involves a strategic approach to communication and discussions with clinicians. Clinicians tend to buy into the need for the practice change when there is a strong evidence base, the topic addresses an identified need, data demonstrate an opportunity for practice improvement within the clinical area, and the practice change offers a relative advantage.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control a. Audit and feedback of key indicators. b. Incremental implementation of practice changes. c. Adhering to a strict action plan for implementation. d. The new practice is much different from current practice.
7. Which of the following will positively influence the sustainability of a practice change?
ANS: A
The sustainability step in implementation is one of the most difficult in the EBP process. Audit and feedback of key indicators remains a necessary component of an integration plan (Ivers et al., 2012). Key indicators to monitor are drawn from the pilot data and include process (i.e., knowledge, attitudes, and practices) and outcomes (Bick & Graham, 2010; Parry et al., 2013)
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
8. The chief executive nursing officer has discussed implementation of evidence-based practice at hospital-wide nursing meetings. She is leading a team to incorporate evidence-based practice terminology into the vision and mission of the institution. She also is advising the multidisciplinary leadership team to incorporate evidence-based practice expectations into the performance appraisals of all staff members. The chief executive nursing officer is modeling: a. continuous quality improvement methodology and techniques. b. marketing tactics that will help familiarize the staff with new terminology. c. professional duties for new protocol acceptance throughout the institution. d. strategies for incorporation of evidence-based practice into the infrastructure of the organization.
ANS: D
Strategies for integration of evidence-based practice into the infrastructure of the organization include the following: incorporation of evidence-based practice into the mission, vision, strategic plan, and performance appraisals of staff; integration of work into nursing governance structure; and demonstration of valuing evidence-based practice through the behaviors of leadership.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. A method used to implement the previous practice if the new practice has been found to be detrimental to patient care b. A process used to expand the reach of effective clinical interventions in new settings c. Recruitment of new nurses from different institutions who can help with role modeling and communication of the new practice d. A tactic used to invigorate leaders to continue to communicate better with staff nurses and ancillary personnel
9. Once a new practice has been implemented on a unit, scaling up needs to be evaluated. What is scaling up?
ANS: B
A reinfusion or reinforcement plan is a strategy for ongoing communication about the new practice until it becomes fully integrated into daily care.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
10. The responsibility to articulate the business case for evidence-based practice to senior leadership lies with: a. the staff nurse. b. nursing leadership. c. the governing board. d. the quality improvement committee.
ANS: B
Nursing leaders have a responsibility to clearly articulate EBP work in a way that will be heard by decision makers. Sharing results with senior leaders helps them recognize great work while reporting the business case for evidence-based care to governing boards (Aarons et al., 2014).
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
11. The responsibility of developing the unit culture for evidence-based practice belongs to the: a. staff nurses. b. unit manager. c. medical director. d. chief executive officer.
ANS: B
Nurse leaders are in key positions responsible for developing and sustaining an organizational infrastructure and creating an environment that affects adoption of EBPs and improves patient outcomes.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
12. The role of the project director is to: a. take meeting minutes. b. maintain the action plan. c. set the expectations for the unit. d. report project progress to the governing body.
ANS: B
The project director is responsible for establishing meeting schedules and time lines with the group, running the meetings, maintaining the action plan, delegating work assignments, and overseeing the process and progress. The focus of the project director must always be on moving the project forward, despite challenges, as a key strategy for success. The project director may orchestrate discussions for identifying potential challenges, addressing those that cannot be avoided but continuing to move forward despite distractions.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Stark b. HIPAA c. HITECH d. Anti-kickback
13. The _____ Act provides incentives for adoption and implementation of electronic health records (EHRs) while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use.
ANS: C
The HITECH Act provides incentives for adoption and implementation of EHRs while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Multiple Response
1. A rigorous scientific process used to combine findings from research (usually randomized controlled trials) into a powerful and clinically useful report to guide practice is known as a systematic review. Standard components of a systematic review to consider are: (Select all that apply.)
a. process for initiating.
b. standard reporting format.
c. reliability and validity of data.
d. process for synthesizing the body of evidence.
e. process for finding and assessing individual studies.
ANS: A, B, D, E
Standard components of a systematic review to consider are: (1) process for initiating; (2) process for finding and assessing individual studies; (3) process for synthesizing the body of evidence; and (4) standard reporting format. Rigor used in development varies considerably among reports.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. there is a strong evidence base. b. the topic addresses an identified need. c. the practice change offers a relative advantage. d. the practice change is endorsed by organizational executive leadership. e. data demonstrate an opportunity for practice improvement within the clinical area.
2. Clinicians tend to buy into the need for practice change when: (Select all that apply.)
ANS: A, B, C, E
Clinicians tend to buy into the need for the practice change when there is a strong evidence base, the topic addresses an identified need, data demonstrate an opportunity for practice improvement within the clinical area, and the practice change offers a relative advantage. Localizing or adapting practice recommendations to fit the local setting and culture is an essential step in the process, often using the role of the opinion leader and team of local experts.
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. report results. b. perform research. c. critique and synthesize evidence. d. statistically analyze quality improvement. e. develop an implementation and evaluation plan.
3. The cardiac care unit is putting together a shared governance committee. To develop expertise in evidence-based practice processes, the members of the committee should have skills that include the ability to: (Select all that apply.)
ANS: A, C, D, E
Critical skills for shared governance committee members who supplement point-of-care clinical experts include appraisal and synthesis of the evidence, development of an implementation and evaluation plan, statistical analysis for quality improvement, and reporting of results (Cullen et al., 2010, 2012).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. recognize and reward the work. b. adopt an evidence-based practice model. c. provide education about evidence-based practice. d. discourage nurses from questioning their practice. e. recruit nurses with interest in evidence-based practice.
4. To promote an organizational culture that embraces evidence-based practice, an organization must: (Select all that apply.)
ANS: A, B, C, E
An organizational culture that promotes use of evidence values nurses questioning their practice, provides education about evidence-based practice, adopts an evidence-based practice model, and recognizes and rewards the work. Recruiting and hiring nurses with interest in EBP will help build the desired culture and capacity.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. linking quality improvement and patient safety. b. periodically evaluate the infrastructure and context for EBP in their organization. c. development of a mission, vision, and strategic plan inclusive of EBP language. d. inclusion of EBP components in performance appraisals across all job classifications. e. incorporating evidence-based practice into organizational information systems.
5. Strategies for building a strong organizational context of evidence-based practice include: (Select all that apply.)
ANS: B, C, D, E
When working to sustain evidence-based practice, strategies are needed to hardwire the work into the organizational system. Nurse leaders should periodically evaluate the infrastructure and context for EBP in their organization. Linking quality improvement and EBP is another strategy for building a strong organizational context. Development of a mission, vision, and strategic plan inclusive of EBP language provides a sturdy foundation for this work at all levels of the organization and begins the process of building a culture in which evidence-based health care is the expected norm (Stetler et al., 2014). Inclusion of EBP components in performance appraisals across all job classifications from top executives to all levels throughout the system promotes positive reinforcement and priority setting in the busy work environment. Organizational information systems must be designed to incorporate EBPs into clinical work flow if adoption is to occur and best outcomes achieved (Piscotty et al., 2015).
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. reporting of patient safety events. b. reporting of anticipated outcomes. c. reporting only projects that have cost savings. d. functional responsibility of committees within the organizational and nursing infrastructure. e. reporting the linkages between evidence-based practice and the organization’s mission, values, and strategic plan.
6. When articulating the business case for evidence-based practice to governing boards, key messages to share with board members include: (Select all that apply.)
ANS: B, D, E
Key messages to share with board members include reporting the linkages between evidence-based practice and the organization’s mission, values, strategic plan, and committee’s functional responsibility within the organizational and nursing infrastructure. Reporting of project results is essential to garner continued support and recognition for the program. Reports will best capture attention when addressing three to five key talking points or takeaway messages with clear links to organizational priorities and infrastructure. Reporting anticipated outcomes can be helpful early in the process. Cost savings or cost avoidance may not be achieved with every project but should be calculated whenever possible.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. set the staffing schedule. b. allocate resources as needed. c. set the expectations for the unit. d. promote staff questioning practice. e. encourage and respond to new ideas.
7. Nurse managers are responsible for developing the unit culture supporting innovation and evidence-based care. The nurse manager can facilitate and support EBP work by: (Select all that apply.)
ANS: B, C, D, E
Nurse managers are responsible, parallel to the nurse executive, for developing the unit culture supporting innovation and evidence-based care (Aarons et al., 2015; Cullen, 2015; Huis et al., 2013; Ubbink et al., 2013). Nurse managers can facilitate and support EBP work in the following ways: set unit expectations, discuss importance of EBP with unit nurses and inter-professional team members, encourage and respond to new ideas, promote staff questioning practice, support the team with project work time, promote the project’s importance, track progress, facilitate movement of the project through the institutional shared governance approval process, and allocate resources (Paparone, 2015; RNAO, 2013).
DIF: Cognitive Level: Remember (Knowledge)
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. She can facilitate meetings. b. She can function as team leader. c. She can assist with problem solving. d. She can identify potential roadblocks. e. She can increase her patient load.
8. Jenny is an advanced practice nurse on the telemetry unit. How might Jenny’s skills be used to contribute to a culture of evidence-based practice? (Select all that apply.)
ANS: A, B, C, D
Advanced practice registered nurses can function as opinion leaders and facilitators. They have the ability to take on the most challenging steps in the process by leading a team, identifying potential roadblocks, facilitating problem solving during implementation and evaluation, reporting results, and providing expertise throughout the evidence-based practice process. Critique and synthesis of the evidence, development of an evaluation plan, and analysis of results are steps that utilize this expertise. Strong skills are needed for the facilitator to keep a team focused and moving forward. Increasing patient load does not contribute to a culture of evidence-based practice.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. functioning as change champions. b. facilitating adoption of practice change. c. facilitating use of research findings in practice. d. overseeing the process and progress of projects as project director. e. identifying important and clinically relevant topics to develop into evidence-based practice improvements.
9. The functions of staff nurses in a culture of evidence-based practice include: (Select all that apply.)
ANS: A, B, D, E
Staff nurses are ideally positioned to identify important and clinically relevant topics to develop into evidence-based practice improvements. Staff nurses are expert clinicians who have the skills to collaborate and problem solve, finding many creative solutions. They are critical to providing quality care through implementation of evidence-based practices. Staff nurses can function as change champions and core group members within their current functions. With appropriate coaching and support staff, nurses also can function as an opinion leader or even project director. Advanced practice nurses usually have the responsibility of facilitating use of research findings in practice.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
Other
1. The CNO at Mercy Hospital is implementing a new evidence-based practice for fall prevention. List the steps in order she should take to advance stakeholders (both people and systems) through the process of diffusion.
a. Integrating and sustaining use b. Creating awareness and interest c. Promoting action and adaptation d. Building knowledge and commitment
ANS:
B, D, C, A
The evidence-based practice implementation guide was developed to assist nurse leaders with planning and use of effective implementation strategies that advance stakeholders (both people and systems) through a process of diffusion creating awareness and interest, building knowledge and commitment, promoting action and adaptation, and integrating and sustaining use.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
