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An experienced nurse says to a new graduate, 'When you've practiced as long as I have, you will instantly know how to take care of psychotic patients.' What is the new graduate's best analysis of this comment?
- A. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice.
- B. New research findings must be continually integrated into a nurse's practice to provide the most effective care.
- C. Experience provides mental health nurses with the tools and skills needed for effective professional practice.
- D. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error.
- E. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs.
Correct Answer: A,B
Rationale: Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.
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A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
- A. Advocacy
- B. Attending
- C. Recovery
- D. Evidence-based practice
Correct Answer: A
Rationale: An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for him or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.
A team of nurses wants to integrate evidence-based practice into a facility's clinical pathways. Which step should the team implement first?
- A. Acquire findings from published literature.
- B. Apply the research findings to clinical practice.
- C. Assess the outcomes of using new research findings.
- D. Ask questions to identify clinical problems that should be changed.
Correct Answer: D
Rationale: Integrating evidence-based practice is a multistep process rather than a single change event. The first step is to identify clinical problems that should be changed. Each step must proceed in order when integrated into a clinical environment.
Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, 'Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.' Select the best response by the student interested in psychiatric nursing.
- A. Psychiatric nurses' practice in safer environments than other specialties and nurse-to-patient ratios are better because of the nature of patients' problems.
- B. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations.
- C. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.
- D. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses. That appeals to me.
Correct Answer: B
Rationale: The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.
A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction reported by a patient indicates this nurse is most effective?
- A. Feeling less distrustful of others
- B. Sensing a connection with others
- C. Experiencing only minimal uneasiness about the future
- D. Being somewhat encouraged with efforts to improve
Correct Answer: B
Rationale: A patient is likely to respond most to caring with a sense of connectedness with others. The absence of caring can make patients feel some degree of distrustful, disconnection, unease, and discouragement.
A nurse says, 'When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name.' Which statement is the best appraisal of this nurse's comment?
- A. One descriptive research study rarely provides enough evidence to change practice.
- B. Staff nurses apply new research findings only with the help from clinical nurse specialists.
- C. New research findings should be incorporated into clinical algorithms before using them in practice.
- D. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
Correct Answer: A
Rationale: Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flowcharts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change.