Clinical Nurse Specialist Evidence-Based Practice & Research

Question 1

A CNS wants to implement a new evidence-based practice change on a unit. Using the Iowa Model of Evidence-Based Practice, what is the first step when the CNS identifies a problem-focused trigger?

Accepted Answer

Determine if the topic is a priority for the organization before investing resources in an EBP project

Answer

Immediately gather evidence from literature and implement the strongest recommendation

Answer

Form an interprofessional team to appraise the evidence

Answer

Pilot the change on one unit before spreading organization-wide

Question 2

A CNS is critically appraising a randomized controlled trial studying a new wound care dressing. The trial reports a relative risk reduction (RRR) of 50% but the absolute risk reduction (ARR) is 2%. How should the CNS interpret these findings for clinical decision-making?

Accepted Answer

ARR of 2% means 50 patients need treatment to prevent one additional wound healing failure — NNT should guide clinical and economic decisions

Answer

RRR of 50% confirms the dressing is highly clinically significant and should be adopted immediately

Answer

Both RRR and ARR support implementation since both are statistically significant

Answer

A 2% ARR is always too small to be clinically meaningful and the dressing should not be adopted

Question 3

A CNS is leading a journal club and asks staff to evaluate the internal validity of a cohort study examining the association between nurse staffing ratios and patient falls. Which threat to internal validity is most relevant to this study design?

Accepted Answer

Selection bias — patients with higher fall risk may be preferentially cared for on lower-staffed units

Answer

Publication bias — negative studies are less likely to be published

Answer

Hawthorne effect — staff know they are being observed and change behavior

Answer

Reporting bias — falls may be under-documented on some units

Question 4

A CNS wants to understand nurses' lived experience of implementing a rapid response system. Which research methodology is most appropriate?

Accepted Answer

Phenomenological qualitative study to explore nurses' lived experiences of RRS implementation

Answer

Randomized controlled trial to measure RRS impact on patient outcomes

Answer

Retrospective cohort study comparing outcomes before and after RRS implementation

Answer

Systematic review of RRS implementation literature across multiple institutions

Question 5

When appraising a systematic review and meta-analysis, which statistical measure quantifies the heterogeneity across included studies?

Accepted Answer

I-squared statistic — quantifies the proportion of variation across studies due to heterogeneity rather than chance

Answer

Odds ratio (OR) — measures strength of association across studies

Answer

Number needed to treat (NNT) — synthesizes treatment effects across studies

Answer

Confidence interval width — indicates precision of the pooled estimate

Question 6

A CNS is implementing EBP using the PARIHS framework (Promoting Action on Research Implementation in Health Services). The evidence is strong, but implementation is failing. According to PARIHS, which other factors should the CNS assess?

Accepted Answer

Context (organizational culture, leadership, evaluation processes) and facilitation (support for implementation process) as determinants of success

Answer

Patient acuity and unit census as barriers to implementation

Answer

The strength of the research design and statistical power of the evidence

Answer

Staff nurse educational level and years of experience