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Chapter 01: Integrating Research, Evidence-Based Practice, and Quality Improvement Processes LoBiondo-Wood & Haber: Nursing Research: Methods abirb.com/test and Critical Appraisal for Evidence-Based Practice, 9th Edition abirb.com/test
MULTIPLE CHOICE 1. Nursing research is significant to the profession of nursing because it promotes: abirb.com/test 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. abirb.com/test ANS: C
A
B C
D
Feedback abirb.com/test 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. abirb.com/test 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. Nursing research generates a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet constantly shifting challenges of abirb.com/test health care delivery to multiple populations. It provides a foundation for evidence-based nursing care and quality improvement activities. Although research can document nursing accountability, each state’s Nurse abirb.com/test Practice Act defines the scope of nursing practice for that state.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
2. 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: abirb.com/test a. professional accountability. b. standards of care. c. legal scope of practice. d. advanced practice nursing activities. abirb.com/test ANS: A
A B
C D
Feedback abirb.com/test Scientific investigation promotes accountability, a hallmark of the nursing profession and a fundamental concept of the ANA’s Code for Nurses. Standards of care are defined by ANA, as well as specialty nursing organizations. abirb.com/test The Code for Nurses states that nurses should conform to standards, but standards per se are not part of the Code. Legal scope of practice is defined by each state’s Nurse Practice Act and abirb.com/test elaborated in its rules and regulations. The ANA Code applies to nursing practice in general, not advanced practice. abirb.com/test
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DIF: Cognitive Level: Remembering (Knowledge) abirb.com/test
3. 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 researchabirb.com/test 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
A B C D
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Feedback Subject identification is determined by the nurse researcher. abirb.com/test Data collectors need to understand their role in the study; they do not need to understand the entire research process. Subject recruitment is the responsibility of the nurse researcher. abirb.com/test 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. abirb.com/test
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DIF: Cognitive Level: Understanding (Comprehension)
abirb.com/test 4. 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. abirb.com/test d. implementing an intervention found to be effective in one clinical case study.
ANS: C abirb.com/test
A B C D
Feedback A consumer uses and applies research to practice but is not responsible for designing a study. abirb.com/test A consumer does not conduct data analysis of a study; the study’s primary investigator analyzes data. A consumer of nursing research needs to understand the research process to abirb.com/test determine the merit and relevance of evidence presented in research studies. A consumer would not implement an intervention on the basis of a single case study. abirb.com/test
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DIF: Cognitive Level: Understanding (Comprehension)
5. Members of the nursing staff are to participate in a unit-based clinical research study. Which abirb.com/test
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 inabirb.com/test which clinical services are
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delivered c. Developing research methods to monitor and evaluate the quality of nursing abirb.com/test practice in the clinical setting d. Providing leadership in the application of scientific knowledge to nursing practice ANS: A abirb.com/test
A B
C D
Feedback A baccalaureate-prepared nurse should be able to use skills of critical appraisal to both understand and appraise the steps of the researchabirb.com/test process. Nurses prepared at the baccalaureate level in nursing are at the bedside implementing protocols, whereas expert consultation is generally reserved for nurses prepared at the master’s or higher-degree level (advanced education). Developing research methods is generally reserved forabirb.com/test nurses with advanced education. Providing leadership in research application is generally reserved for nurses with advanced education. abirb.com/test
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
6. Which statement describes the role of the nurse in research? a. Nurses must be prepared at the baccalaureate or higher level of education to have
any role in nursing research.
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b. Nurses with master’s or higher levels of education are solely responsible for
applying research to clinical practice. c. The research role of nurses prepared at both baccalaureate and master’s levels of abirb.com/test education includes critical appraisal skills. d. Regardless of the nursing education level, only the nurse with the most comprehensive understanding of statistical methods should interpret research findings. abirb.com/test
ANS: C
A B
C
D
Feedback abirb.com/test Having a role in nursing research or implementing findings is not limited to nurses with baccalaureate or higher levels of education. Nurses with master’s or higher levels of education provide leadership to supervise how research findings are applied in the clinical area. abirb.com/test However, all levels of nurses can apply research findings to practice. To use research in evidence-based practice, the nurse must not necessarily be able to conduct research but should be able to understand and appraise the steps of the abirb.com/test research process to read the research literature critically and use it to inform clinical decisions. Data analysis is usually conducted by nurses with master’s or higher levels of abirb.com/test education. However, interpretation of research findings can be performed by any nurse who can critically analyze the research performed.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
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7. What is the primary value of evidence-based nursing practice? a. Implementing the most cost-effective nursing practicesabirb.com/test when providing patient
care b. Incorporating research findings with clinical expertise when individualizing patient care abirb.com/test 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
A B
C
D
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Feedback Cost-effective nursing interventions can occur based on evidence, but it is not the primary value of evidence-based nursing practice. abirb.com/test 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 clinicalabirb.com/test decisions. 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. abirb.com/test 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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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
8. A novice nurse researcher is comparing the processes used in nursing research and in abirb.com/test 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 abirb.com/test 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 abirb.com/test 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. abirb.com/test
ANS: C
A B C
Feedback abirb.com/test The research process and the evidence-based practice process, though similar, have fundamental differences as well. This definition applies to the research process, not the evidence-based practice abirb.com/test process. 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-basedabirb.com/test practice includes a review of completed research studies to identify answers to a clinical question. abirb.com/test
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Both the research process and the evidence-based practice process include critical review of quantitative and qualitative studies. abirb.com/test
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DIF: Cognitive Level: Understanding (Comprehension)
9. A nurse is analyzing a research article. Where in the articleabirb.com/test is the nurse likely to find the
research question and study purpose? a. Introduction b. Data analysis c. Findings d. Data collection
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ANS: A
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A
B C D
Feedback The research question and study purpose is generally found early in the report: in abirb.com/test the abstract, the introduction, or at the end of the literature review or conceptual framework section. The research question and study purpose are defined before the data analysis abirb.com/test section of the research article. The research question and study purpose are defined before the findings section of the research article. The research question and study purpose are defined before the data-collection abirb.com/test section of the research article.
PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test REF: Page 8, Table 1.1 10. 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 abirb.com/test 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 abirb.com/test relationships between variables. c. Quantitative research typically uses a convenience sample, seeking to answer a clinical question about a human experience. abirb.com/test d. Qualitative research collects data from a small number of subjects, allowing for in-depth study of a phenomenon. ANS: D
A B C
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Feedback Qualitative, not quantitative, research is usually conducted in natural settings abirb.com/test using data that are words rather than numbers. Quantitative, not qualitative, research seeks to explain cause-and-effect relationships between variables. Qualitative, not quantitative, research seeks to answerabirb.com/test a question about a human experience. abirb.com/test
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Qualitative research typically collects data from a small number of subjects, thus allowing for in-depth study of a phenomenon while using a subjective approach. abirb.com/test
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DIF: Cognitive Level: Remembering (Knowledge)
abirb.com/test 11. The nurse is analyzing a research article. To determine if an integrative review was performed
as part of the study, the nurse must understand that this type of review is: a. a summary of research studies on a focused topic that used a specific statistical methodology. abirb.com/test b. a synthesis of the research and theoretical literature on a specific area without a statistical analysis. c. a synthesis of qualitative articles on a focused topic using a specific qualitative abirb.com/test methodology. d. a summary of articles in an attempt to develop a clinical practice statement or clinical guidelines. ANS: B
A B
C D
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Feedback Meta-analysis summarizes articles on a focused topic abirb.com/test that used a specific methodology. An integrative review is a synthesis of research or theoretical literature on a specific area that follows specific steps of literature integration without statistical abirb.com/test analysis. Meta-synthesis is a synthesis of qualitative articles on a focused topic using specific qualitative methodology. Clinical guidelines are practice statements designed toabirb.com/test assist clinicians about health care decisions for specific conditions or situations.
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DIF: Cognitive Level: Remembering (Knowledge) abirb.com/test
12. When assessing the strength of a body of evidence used in a research study for consistency, abirb.com/test the nurse should determine: a. extent to which the study’s design, implementation, and analysis minimize bias. b. number of studies that have evaluated the research question, including overall sample size across studies. abirb.com/test c. degree to which studies with similar and different designs investigated the same research questions and report similar findings. d. significance of the findings based on the statistical methods used for data analysis. abirb.com/test
ANS: C
A B C
Feedback abirb.com/test Quality refers to the extent to which the study’s design, implementation, and analysis minimize bias. Quantity refers to the number of studies that have evaluated the research question, including overall sample size across studies. abirb.com/test Consistency is the degree to which studies that had similar and different designs abirb.com/test
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(but investigate the same research question) reported similar findings. Quantity refers to the strength of the findings in the statistical analyses. abirb.com/test
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DIF: Cognitive Level: Remembering (Knowledge) abirb.com/test
13. 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 abirb.com/test c. Discussion or implications d. Abstract or introduction ANS: A
A B C D
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Feedback Legal-ethical issues are typically discussed in the article’s data-collection or abirb.com/test procedures section, usually when discussing the sample. The research results are typically found in the findings or results sections. Recommendations are typically found in the discussion or implications sections. The research question and study purpose are typicallyabirb.com/test found in the abstract or introduction.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) abirb.com/test REF: Page 8, Table 1.1 14. 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? abirb.com/test a. Procedures b. Methods c. Sample abirb.com/test d. Results ANS: D abirb.com/test
A B C D
Feedback Data analysis is typically included in the data analysis or procedures section. Instruments and their validity and reliability are included in the methods or abirb.com/test instruments sections. The research sample and legal-ethical issues are included in the sample or subjects section. The discussion of the findings will be located in the results or discussion section. abirb.com/test
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 8, Table 1.1 abirb.com/test
15. 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 typeabirb.com/test of understanding? a. Preliminary abirb.com/test
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b. Comprehensive c. Analysis d. Synthesis
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ANS: B
A B C D
abirb.com/test Feedback Strategies for preliminary understanding include activities such as using a dictionary and identifying key variables of the study. Strategies for comprehensive understanding include restating the main idea or abirb.com/test theme of the article in one’s own words. Strategies for analysis understanding include using criteria to critique the steps of the research process used in the study. Strategies for synthesis understanding include writingabirb.com/test a summary of the strengths and weaknesses of the study.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
16. The nurse is using the critical reading process to analyze a research article. The nurse is using abirb.com/test 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 abirb.com/test c. Analysis d. Synthesis
ANS: C
A B C D
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Feedback Strategies for preliminary understanding include activities such as highlighting or underlining identified steps of the research process. abirb.com/test Strategies for comprehensive understanding include restating the main idea or theme of the article in one’s own words. Strategies for analysis understanding include using criteria to critique the steps of abirb.com/test the research process used in the study. Strategies for synthesis understanding include writing a summary of the strengths and weaknesses of the study. abirb.com/test
PTS: 1 REF: Page 10
DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
17. 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
abirb.com/test
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Feedback Quality improvement includes identifying specific, immediate goals, not abirb.com/test long-range goals. The quality improvement process includes identifying practices that pose problems, rather than identifying successful practices. Quality improvement includes testing practice changesabirb.com/test rapidly, not slowly. The goal of quality improvement activities is to bring about changes in practice that will make a positive difference in patient care. Therefore, adopting a practice change is a critical step in the process. abirb.com/test
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DIF: Cognitive Level: Remembering (Knowledge) abirb.com/test
MULTIPLE RESPONSE 1. Which statements describe the actions of the baccalaureate nurse graduate as a participant in abirb.com/test
the nursing research process? (Select all that apply.) a. Administering care at the bedside according to a research protocol b. Providing leadership by helping others apply scientific knowledge to practice c. Sharing with nursing colleagues research findings thatabirb.com/test are pertinent to practice d. Designing and conducting nursing research studies e. Functioning as a primary investigator for a research study abirb.com/test
ANS: A, C Feedback Correct
Incorrect
Following a research protocol at the bedside is an activity consistent with abirb.com/test the practice of a nurse prepared at the baccalaureate level. Sharing research evidence with colleagues is an activity consistent with the practice of a nurse prepared at the baccalaureate level. Leadership related to scientific investigation isabirb.com/test more appropriate for a nurse prepared at the master’s or higher-degree level. Designing and conducting research studies are activities more appropriate for a nurse with doctoral preparation. abirb.com/test Functioning as a primary investigator is an activity appropriate for a nurse with doctoral preparation.
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2. Which aspects of the nursing research process are common to nurses at all educational levels? abirb.com/test (Select all that apply.) a. Disseminating research findings in research reports b. Maintaining the protection of patients who are subjects in a study c. Using one’s expertise to develop theoretical explanations for findings abirb.com/test d. Knowing the relationship between research and nursing practice e. Being a member of a collaborative team that applies research to practice
ANS: B, D, E
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Feedback Correct
Incorrect
All nurses are responsible for protecting the rights of patients. All nurses should be aware that research is related to practice. abirb.com/test All nurses can be a part of a clinical team that applies research to practice. Disseminating research in scientific reports is an activity generally performed by nurses with master’s or higher educational preparation. abirb.com/test Developing theoretical explanations for findings is an activity generally performed by nurses with master’s or higher educational preparation.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
3. For the baccalaureate nursing student, education in nursing research should result in: (Select abirb.com/test 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. abirb.com/test d. developing skill as a primary investigator in research. e. becoming a knowledgeable consumer of nursing research.
ANS: B, C, E
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Feedback Correct
Incorrect
The student should gain an initial understanding of the importance of abirb.com/test 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 abirb.com/test in decisions about applying research findings in nursing practice. Mastery of research protocol development is generally attained at the master’s or higher-degree level of education. abirb.com/test Developing skill as a primary investigator is generally attained at the doctoral level of education.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
4. Developing nurse researchers at a younger age is a priority for the future in the nursing abirb.com/test 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. abirb.com/test d. promote mentoring opportunities for novice researchers. e. increase nursing’s role in pharmaceutical research.
ANS: A, B, D
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Feedback Correct
Developing young researchers increases the number of researchers contributing to the science of the discipline. abirb.com/test Introducing nurses to research at a younger age allows them sufficient abirb.com/test
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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 abirb.com/test opportunity to be mentored by experienced researchers, as well as to learn to become mentors themselves. Younger researchers do not guarantee research monies. Pharmaceutical studies are medical research and are not considered abirb.com/test nursing research studies.
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DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
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Chapter 02: Research Questions, Hypotheses, and Clinical Questions LoBiondo-Wood & Haber: Nursing Research: Methods and Critical Appraisal for abirb.com/test Evidence-Based Practice, 9th Edition MULTIPLE CHOICE
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1. The difference between a research question and a hypothesis is: a. a research question is practice based, and a hypothesis is theory based. b. a hypothesis attempts to answer the question posed by abirb.com/test the research problem. c. a research problem defines clinical research and a hypothesis defines basic
research. d. there is no difference between a research problem and a hypothesis. abirb.com/test ANS: B
A
B C D
Feedback abirb.com/test Although a hypothesis is sometimes theory based, sometimes it is not. Similarly, research questions are not always practice based. Sometimes they originate in educational theory that relates to nursing education research, and sometimes they abirb.com/test originate in basic, rather than applied, research. A hypothesis attempts to answer the research question. Research problems are present in all types of research, and a hypothesis may be present in basic or applied research. abirb.com/test Hypotheses and research questions are not identical. Hypotheses flow from research questions and suggest the ways the questions can be investigated.
PTS: 1 REF: Page 24
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2. How is a hypothesis related to a theory? abirb.com/test a. Hypotheses can be developed in the absence of a theoretical framework. b. Hypotheses must be consistent with an existing theoretical framework. c. A theory can determine the validity of a hypothesis. abirb.com/test d. A theory can be used to evaluate the merit of a hypothesis. ANS: B
A B C D
abirb.com/test Feedback A hypothesis is a bridge between a theoretical framework and the real world of empirical testing. Therefore, a theoretical framework is required. A sound hypothesis is consistent with an existing body of theory and research abirb.com/test findings. When tested, a hypothesis can help determine the validity of a theory’s assumptions—the reverse of option C. abirb.com/test When tested, a hypothesis can help evaluate a theory’s merit—the opposite of option D.
PTS: 1 REF: Page 24
DIF: Cognitive Level: Understanding (Comprehension) abirb.com/test
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3. A nurse makes these statements. Which one has the greatest potential as an area of nursing
research? abirb.com/test 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.” abirb.com/test d. “The personnel on the nightshift are not attending promptly to the needs of our patients.” ANS: C
A B
C D
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Feedback This statement is broad and not specific to patient care. It would need to be abirb.com/test defined in much more detail to have potential for nursing research. 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. abirb.com/test This statement identifies a specific, important patient problem. Its exploration has potential to contribute to the body of nursing knowledge. This is a broad subjective observation that does not suggest any approach for investigation or potential for contributing to the bodyabirb.com/test of nursing knowledge.
PTS: 1 DIF: Cognitive Level: Applying (Application) REF: Page 25, Table 2.1 abirb.com/test 4. The nurse has identified a clinical problem as a potential research question. The next step
should be: abirb.com/test a. identify the variables. b. formulate the research hypothesis. c. perform a literature review. d. determine financial resources for the research project. abirb.com/test ANS: C
A B
C
D
Feedback abirb.com/test It is too early to identify variables. They will be confirmed by the literature review. Although the researcher may have a preliminary hunch about the hypothesis, it abirb.com/test cannot be formulated until the research question is formalized after the literature review is completed. The literature review helps to further define the research question by identifying gaps in the literature, the need for replication of priorabirb.com/test 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. The financial resources needed for the project cannot be determined until the abirb.com/test study’s design and methodology are finalized.
PTS: 1 DIF: Cognitive Level: Remembering (Knowledge) REF: Page 25, Table 2.1, page 26 abirb.com/test
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