Evidence-Based Practice & Research Flashcards

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?

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

The Iowa Model begins with determining organizational priority — not all problems warrant full EBP projects; alignment with organizational priorities ensures resource support and sustainability.

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?

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

ARR and NNT provide clinically meaningful context that RRR alone obscures — an NNT of 50 means treating 50 patients to prevent one outcome, which must be weighed against cost and burden.

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?

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

Confounding by indication (selection bias) is the primary threat — sicker, higher-fall-risk patients may cluster on units with different staffing due to acuity-based assignments, making staffing appear causative.

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

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

Phenomenology examines lived experience and subjective meaning — the appropriate qualitative methodology for understanding nurses' experiences of a new practice change.

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

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

The I-squared statistic quantifies heterogeneity in meta-analysis: values of 25%, 50%, and 75% represent low, moderate, and high heterogeneity respectively.

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?

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

PARIHS: successful EBP implementation = f(evidence, context, facilitation). Strong evidence with poor context (culture, leadership) or inadequate facilitation explains implementation failure.