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Which research evidence would most influence a group of nurses to change their practice?
- A. Expert committee report of recommendations for practice
- B. Systematic review of randomized controlled trials
- C. Nonexperimental descriptive study
- D. Critical pathway
Correct Answer: B
Rationale: Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed.
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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.
Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will demonstrate what behavior?
- A. Denying suicidal ideation
- B. Reporting a sense of well-being
- C. Taking medications as prescribed
- D. Attending clinic appointments on time
Correct Answer: B
Rationale: Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery.
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.
A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient?
- A. Clinical algorithm
- B. Clinical pathway
- C. Clinical practice guideline
- D. International Statistical Classification of Diseases and Related Health Problems (ICD)
Correct Answer: A
Rationale: A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patient's needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases.
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the website's address most alerts the nurse that the site may have biased and prejudiced information?
- A. Address ends in '.org.'
- B. Address ends in '.com.'
- C. Address ends in '.gov.'
- D. Address ends in '.net.'
Correct Answer: B
Rationale: Financial influences on a site are a clue that the information may be biased. '.com' at the end of the address indicates that the site is a commercial one. '.gov' indicates that the site is maintained by a government entity. '.org' indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. '.net' can have multiple meanings.