CHC Evidence-Based Practice & Research Methods 4 — Questions and Answers
Question 1: A CHC team is evaluating flooring material options to reduce patient fall rates. Which type of evidence would rank HIGHEST on the evidence hierarchy for this decision?
- A manufacturer's white paper on product safety
- Anecdotal reports from nursing staff at one facility
- A systematic review of multiple controlled studies on flooring and fall outcomes (Correct answer)
- A single observational case study from one hospital
Correct answer: A systematic review of multiple controlled studies on flooring and fall outcomes
Systematic reviews of controlled studies sit at the top of the evidence hierarchy, synthesizing the best available research on an intervention's effectiveness.
Question 2: When a healthcare construction standard references 'Level C' evidence, this typically indicates:
- Evidence derived from expert opinion or consensus in the absence of controlled trials (Correct answer)
- The highest quality randomized controlled trial data available
- Data collected from government regulatory agencies only
- Evidence specific to Canadian healthcare facilities
Correct answer: Evidence derived from expert opinion or consensus in the absence of controlled trials
Level C evidence reflects expert consensus or opinion, used when controlled studies are lacking or impractical to conduct.
Question 3: A researcher uses a pre/post design to study the effect of a new nurse station layout on medication errors. The primary limitation of this design is:
- It cannot collect quantitative data
- It lacks a concurrent control group, making it difficult to rule out temporal confounders (Correct answer)
- It requires randomization of patient assignments
- It is not permitted under IRB regulations
Correct answer: It lacks a concurrent control group, making it difficult to rule out temporal confounders
Without a concurrent control group, changes over time (e.g., staff training, seasonal variation) may explain the outcome rather than the layout change.
Question 4: In healthcare facility research, 'inter-rater reliability' is most critical when:
- Calculating a project's construction cost index
- Multiple observers are independently coding or measuring the same environmental variables (Correct answer)
- Reviewing structural drawings for code compliance
- Selecting subcontractors through a bid process
Correct answer: Multiple observers are independently coding or measuring the same environmental variables
Inter-rater reliability ensures that different observers produce consistent measurements, which is essential for the validity of observational data in facility research.
Question 5: The 'Hawthorne effect' in healthcare construction research refers to:
- Changes in participant behavior due to awareness of being observed, potentially confounding results (Correct answer)
- The effect of natural lighting (hawthorne windows) on patient outcomes
- A statistical correction applied to small sample sizes
- A fire-code requirement for corridor widths in older facilities
Correct answer: Changes in participant behavior due to awareness of being observed, potentially confounding results
The Hawthorne effect occurs when subjects modify their behavior because they know they are being studied, which can bias observational research findings.
Question 6: Which of the following is an example of 'translational research' in the context of healthcare construction?
- Converting a research paper from English to Spanish for broader distribution
- Applying laboratory findings on antimicrobial surfaces to actual hospital construction specifications (Correct answer)
- Translating occupancy sensor data into billing codes
- Replacing analog blueprints with digital BIM models
Correct answer: Applying laboratory findings on antimicrobial surfaces to actual hospital construction specifications
Translational research bridges the gap between scientific discovery and real-world application, such as implementing antimicrobial surface research into construction standards.
Question 7: A facility's post-occupancy evaluation reveals that a newly constructed behavioral health unit has higher staff injury rates than the old unit. The most evidence-based next step is to:
- Immediately demolish and rebuild the unit
- Conduct a root cause analysis comparing design features with staff workflow and incident data (Correct answer)
- Dismiss the findings as insufficient sample size without further review
- Replace all staff with those trained in the old facility
Correct answer: Conduct a root cause analysis comparing design features with staff workflow and incident data
A root cause analysis using design and operational data is the evidence-based approach to identifying modifiable factors contributing to the adverse outcome.
CHC Evidence-Based Practice & Research Methods 4
A CHC team is evaluating flooring material options to reduce patient fall rates.
Which type of evidence would rank HIGHEST on the evidence hierarchy for this decision?