Chapter 15: Evidence-Based Practice (Stanhope: Public Health Nursing, 8th Ed)

Evidence-based public health is:

a. An integration of the best available nursing expertise
b. Derived from community principles to fit the area where it is practiced
c. A health endeavor that makes informed use of evidence
d. Comprised of only public health records

ANS: C
Evidence-based public health is a health endeavor that makes informed use of evidence.
A nurse makes clinical judgments based upon trial and error and past clinical experiences. What problem can result from using these data sources in clinical decision making?

a. Not all sources of information are reliable.
b. Authority always leads to faulty decision making.
c. Ethical knowledge is not taken into account.
d. Trial and error has lead to poor outcomes.

ANS: A
Using the sources of knowledge listed in the other options does not consistently produce desired outcomes.
A nurse uses clinical experience and client preference to guide clinical decision making when using:

a. Evidence-based practice
b. Internal evidence
c. Research utilization
d. External evidence

ANS: B
Internal evidence refers to the use of the nurses clinical experiences and the clients preferences.
The term evidence-based was first used in:

a. Canada
b. Great Britain
c. The United States
d. Australia

ANS: A
The term evidence-based was first attributed to Gordon Gyatt, a Canadian physician at McMaster University in 1992.
A nurse providing care in the 1970s would have used which process as the guide for making clinical decisions?

a. Evidence-based nursing practice
b. The science of medicine
c. Evidenced-based medicine
d. Research utilization

ANS: D
Research utilization projects in the 1970s provided a guide to clinical practice.
A summary of the research evidence that relates to a specific question and to the effects of an intervention is:

a. Evidence-based practice
b. Action research
c. Systematic review
d. Best practices

ANS: C
A systematic review is a summary of the research evidence that relates to a specific question and to the effects of an intervention.
Which type of research is defined as the gold standard of evidence in evidence-based practice?

a. Clinical expertise
b. Randomized controlled trials
c. Case studies
d. Systematic review

ANS: B
The double blind randomized controlled trial generally provides the highest level of evidence followed by other randomized controlled trials.
A nurse is grading the strength of evidence when critiquing a research study. Which domains will the nurse need to consider?

a. Randomness, sample size, and blinding
b. Selection, variables, and description
c. Nursing, medicine, and physiology
d. Quality, quantity, and consistency

ANS: D
Quality, quantity, and consistency are the three domains for evaluating systems.
It would be important for a nurse researcher to use blinding when:

a. The sample size is small
b. The outcomes must be accurately measured
c. Using a control group
d. Studying the attrition rate

ANS: C
Blinding refers to a procedure where the researcher or evaluator does not know which participants are in the experimental or control group.
What information will a nurse find when reading a systematic review?

a. Results of randomized controlled trials
b. A description of the methods used to search for evidence
c. Data compiled on a particular question
d. An in-depth review of the literature completed by one person

ANS: B
A systematic review is usually done by more than one person and describes the methods used to search for the evidence. It is a method of identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research relevant to a particular research question.
A nurse working in a community setting should apply evidence-based practice methods that are described by:

a. Randomized clinical trials
b. Qualitative studies
c. Quantitative studies
d. Multiple research methods

ANS: D
Evidence from multiple research methods has the potential to enrich the application of evidence and improve nursing practice.
A public health nurse would like to incorporate evidence-based practice into the clinical practice at the health department. According to Melnyk and Fineout-Overholt et al., the first step in this process is:

a. Integrating the evidence with clinical expertise
b. Cultivating a spirit of inquiry
c. Asking clinical questions
d. Searching for the best evidence

ANS: B
According to Melnyk and Fineout-Overholt et al., the first step is step 0: cultivating a spirit of inquiry.
When looking at evidence-based practice to support the methods used to facilitate smoking cessation, which type of evidence would be the best for the nurse to examine?

a. Scientific literature found in systematic reviews
b. Double-blind randomized controlled trial
c. Quasi-experimental studies
d. Expert opinion

ANS: A
Because it is difficult to find or perform randomized controlled trials in the community, other types of evidence have been highlighted as the best evidence in public health literature upon which to base evidence-based public health (EBPH) practice; scientific literature found in systematic reviews is one type that is recommended. Although randomized controlled trials are the highest level of evidence, it would not be possible to implement this type of study when studying smoking cessation.
A public health nurse uses a published systematic review to determine which exercises should be incorporated into a newly developed older adult exercise program. Which resource would most likely contain this information?

a. Evidence-Based Practice for Public Health Project
b. PubMed
c. Cochrane Public Health Group (PHRG)
d. Task Force on Community Preventive Services

ANS: C
The PHRG works with contributors to produce and publish Cochrane reviews of the effects of population-level public health interventions. The PHRG undertakes systematic reviews of the effects of public health interventions to improve health and other outcomes at the population level, not those targeted at individuals.
Which are barriers to implementation of evidence-based practice? Select all that apply.

a. Lack of available time
b. Inferior quality of available research
c. Unwillingness of organizations to fund research
d. Inability to understand the evidence

ANS: A, B, C, D
All of these are barriers to evidence-based practice.
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