Evidence-Based Practice & Research Flashcards

A CNS is conducting a literature search for evidence on preventing ventilator-associated pneumonia (VAP). Which database is most appropriate as the PRIMARY source for peer-reviewed nursing and medical research?

Answer: PubMed/MEDLINE — the primary biomedical and nursing research database maintained by the National Library of Medicine

PubMed/MEDLINE is the primary peer-reviewed biomedical literature database — comprehensive, free, with MeSH (Medical Subject Headings) for precise searching.

A CNS is conducting a quality improvement project on sepsis recognition. To measure the reliability of the nursing sepsis screening tool, which statistical test measures interrater reliability between two nurses using the same tool on the same patients?

Answer: Cohen's kappa — measures agreement between two raters beyond chance for categorical assessments

Cohen's kappa measures interrater reliability (agreement between two raters) for categorical assessments, correcting for chance agreement — the appropriate statistic for a binary screening tool.

A CNS is reviewing the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework for rating evidence quality. Which scenario describes evidence that should be DOWNGRADED from high to moderate quality?

Answer: A large RCT with significant risk of bias due to lack of blinding in a subjective outcome study (e.g., pain scale)

GRADE downgrades evidence for risk of bias — lack of blinding in studies with subjective outcomes (pain, quality of life) can significantly bias results toward the intervention.

A CNS completes an EBP project that reduces CLABSI rates. Before disseminating findings, which step is most important to ensure the quality improvement data can be meaningfully shared?

Answer: Determine whether the project constitutes 'research' or 'quality improvement' — if QI, IRB exemption or waiver may apply; then select appropriate dissemination venue

Distinguishing QI from research determines IRB requirements — most EBP/QI projects qualify for exemption or expedited review; the CNS must clarify this before dissemination.

A CNS is implementing a new EBP guideline for delirium prevention using the ABCDE bundle. Six months after implementation, compliance is 40%. Using Everett Rogers' Diffusion of Innovations theory, which adopter category best describes the majority of nurses who have not yet adopted the practice?

Answer: Late majority — they are skeptical and adopt only after most peers have, requiring social norms to shift

At 40% adoption (with 60% not yet adopting), the non-adopters are likely in the early-to-late majority who require social proof and peer validation before committing to the change.

A CNS is asked to evaluate the implementation fidelity of a new SBAR handoff tool that has been in place for 3 months. Which evaluation approach best measures whether the tool is being used as intended?

Answer: Conduct structured direct observation of handoffs with a fidelity checklist measuring adherence to each SBAR component

Implementation fidelity measurement requires direct observation with a structured checklist — self-report and documentation audits do not capture real-time adherence to the intended process.