(Test Bank) Burns and Grove's The Practice of Nursing Research - Appraisal, Synthesis & Generation of Evidence

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CHAPTER 1 1.Which of the following groups would be best served by the development of a scientific base for nursing practice? A)Nursing administrators B)Practicing nurses C)Nurses' clients D)Health care policymakers Ans:C Feedback: Nursing research is systematic inquiry designed to develop trustworthy evidence about issues of importance to nurses and their clients. Nurse leaders recognize the need to base specific nursing decisions on evidence indicating that the decisions are clinically appropriate, cost-effective, and result in positive client outcomes. Although all of the people listed would benefit from the development of a scientific base for nursing practice, ultimately it is the clients themselves who would most benefit, as they would then receive the most appropriate and most effective care. 2.An especially important goal for the nursing profession is to do which of the following? A)Conduct research to better understand the context of nursing practice B)Establish a solid base of evidence for practice through disciplined research C)Document the role nursing serves in society D)Establish research priorities Ans:B Feedback: Nurses are increasingly expected to understand and undertake research and to base their practice on evidence from research. Evidence-based practice is the use of the best evidence in making patient care decisions and typically comes from research conducted by nurses and other health-care professionals. All of the other answers are possible goals for the nursing profession, but none is as important as establishing evidence for practice. 3.Which of the following is a fundamental belief of those who hold to the constructivist paradigm? A)A fixed reality exists in nature for humans to understand B)The nature of reality has changed over time C)Reality is multiply constructed and multiply interpreted by humans D)Reality cannot be studied empirically Ans:C Feedback: In the constructivist paradigm, it is assumed that reality is not a fixed entity but is rather a construction of human minds, and thus “truth” is a composite of multiple constructions of reality. However, constructivists do believe that reality can be studied empirically. Belief in a fixed reality that exists in nature for humans to understand would be an example of a positivist belief, not a constructivist one. The constructivist belief does not hold so much that the nature of reality has changed over time as that it has always been constructed by human minds. Page 14.Which of the following is a fundamental belief of those who hold to the positivist paradigm? A)The researcher is objective and independent of those being studied B)The researcher cannot interact with those being studied C)The researcher instructs those being studied to be objective in providing information D)The distance between the researcher and those being researched is minimized to enhance the interactive process Ans:A Feedback: In the positivist paradigm, it is assumed that there is an objective reality and that natural phenomena are regular and orderly. In the constructivist paradigm, it is assumed that reality is not a fixed entity but is rather a construction of human minds, and thus “truth” is a composite of multiple constructions of reality. 5.Which of the following attributes is least characteristic of the traditional scientific method? A)Control over external factors B)Systematic measurement and observation of natural phenomena C)Testing of hunches deduced from theory or prior research D)Emphasis on a holistic view of a phenomenon, studied in a rich context Ans:D Feedback: Quantitative research (associated with positivism) involves the collection and analysis of numeric information. Quantitative research is typically conducted within the traditional scientific method, which is systematic and controlled. Quantitative researchers base their findings on empirical evidence (evidence collected by way of the human senses) and strive for generalizability beyond a single setting or situation. Constructivist researchers emphasize understanding human experience as it is lived through the collection and analysis of subjective, narrative materials using flexible procedures; this paradigm is associated with qualitative research. 6.Empiricism refers to which of the following? A)Making generalizations from specific observations B)Articulating a study purpose in terms of an appropriate classification system C)Gathering evidence about real-world phenomena through the senses D)Verifying the assumptions on which the study was based Ans:C Page 2Feedback: Empiricism is gathering and analyzing evidence through their senses. Quantitative research involves the collection and analysis of numeric information. Quantitative research is typically conducted within the traditional scientific method, which is systematic and controlled. Quantitative researchers base their findings on empirical evidence and strive for generalizability beyond a single setting or situation. Constructivist researchers emphasize understanding human experience as it is lived through the collection and analysis of subjective, narrative materials using flexible procedures; this paradigm is associated with qualitative research. 7.Which of the following is a hallmark of the scientific method? A)Rigorous B)Holistic C)Systematic D)Flexible Ans:C Feedback: Quantitative research is typically conducted within the traditional scientific method, which is systematic and controlled. Quantitative researchers base their findings on empirical evidence and strive for generalizability beyond a single setting or situation. Constructivist researchers emphasize understanding human experience as it is lived through the collection and analysis of subjective, narrative materials using flexible procedures; this paradigm is associated with qualitative research. 8.Which of the following limits the capacity of the scientific method to answer questions about humans? A)The necessity of departing from traditional beliefs B)The difficulty of accurately measuring complex human traits C)The lack of funding for research D)The shortage of theories about human behavior Ans:B Feedback: Nursing research focuses on human beings, who are inherently complicated and diverse. The traditional scientific method typically focuses on a relatively small aspect of human experiences in a single study. Complexities tend to be controlled and, if possible, eliminated rather than studied directly, and this narrowness of focus can sometimes obscure insights. 9.The classic scientific method has its intellectual roots in which of the following? A)Positivism B)Determinism C)Constructivism D)Empiricism Ans:A Page 3Feedback: In the positivist paradigm, it is assumed that there is an objective reality and that natural phenomena are regular and orderly. The related assumption of determinism refers to the belief that phenomena result from prior causes and are not haphazard. In the constructivist paradigm, it is assumed that reality is not a fixed entity but is rather a construction of human minds, and thus “truth” is a composite of multiple constructions of reality. Although the word empiricism has come to be allied with the classic scientific method, researchers in both traditions gather and analyze evidence empirically, that is, through their senses. 10.Constructivist qualitative research typically does which of the following? A)Involves deductive processes B)Attempts to control the research context to better understand the phenomenon being studied C)Involves gathering narrative, subjective materials D)Focuses on numeric information Ans:C Feedback: In the constructivist paradigm, it is assumed that reality is not a fixed entity but is rather a construction of human minds, and thus “truth” is a composite of multiple constructions of reality. In the positivist paradigm, it is assumed that there is an objective reality and that natural phenomena are regular and orderly. Constructivist researchers emphasize understanding human experience as it is lived through the collection and analysis of subjective, narrative materials using flexible procedures; this paradigm is associated with qualitative research. The other answers are truer of positivist, quantitative research. 11.Quantitative and qualitative research share which of the following features? Select all that apply. A)A desire to understand the true state of human affairs B)An emphasis on formal measurement C)A reliance on external evidence collected through the senses D)Utility to the nursing profession Ans:A, C, D Feedback: Both quantitative and qualitative research share a desire to understand the true state of human affairs, a reliance on external evidence collected through the senses, and utility to the nursing profession. However, quantitative, not qualitative, research emphasizes formal measurement. 12.Which of the following is a descriptive question that a qualitative researcher most likely would ask? A)What is the nature of this phenomenon? B)What is the average intensity of this phenomenon? C)How frequently does this phenomenon occur? D)What is the average duration of this phenomenon? Ans:A Page 4Feedback: Description of phenomena is an important purpose of research. In descriptive studies, researchers count, delineate, and classify. Nurse researchers have described a wide variety of phenomena, such as patients' stress, health beliefs, and so on. Quantitative description focuses on the prevalence, size, and measurable aspects of phenomena. Qualitative researchers describe the nature, dimensions, and salience of phenomena 13.A researcher wants to investigate the effect of patients' body position on blood pressure. The study would most likely be of which type? A)Qualitative B)Quantitative C)Either quantitative or qualitative (researcher preference) D)Insufficient information to determine Ans:B Feedback: Because this study would involve a measurable, numeric outcome, blood pressure, it should most likely be a quantitative study. 14.A researcher wants to explore the process by which men make decisions about treatment for prostate cancer. The researcher's paradigm is most likely which of the following? A)Positivism B)Determinism C)Empiricism D)Constructivism Ans:D Feedback: As this study involves gathering subjective, non-measurable data, the researcher's paradigm is most likely constructivism. Positivism is not likely, as there is no emphasis on an objective, orderly reality. Determinism, which refers to the belief that phenomena result from prior causes and are not haphazard, is not pertinent here. Although the research will involve empiricism, or gathering information using the senses, this is not the primary paradigm. 15.Which of the following would be most strongly associated with cause-probing research? A)Identification B)Description C)Exploration D)Explanation Ans:D Page 5Feedback: A fundamental distinction that is especially relevant in quantitative research is between studies whose primary intent is to describe phenomena and those that are cause-probing. Specific purposes on the description/explanation continuum include identification, description, exploration, prediction/control and explanation. Many nursing studies can also be classified in terms of a key EBP aim: therapy/treatment/intervention; diagnosis and assessment; prognosis; etiology and harm; and meaning and process. 16.Nursing has experienced constant change over the past decades as a result of increased research. When determining best practices, nursing decisions should do which of the following? Select all that apply. A)Be based on tradition B)Include holistic approaches C)Be clinically appropriate D)Be cost effective Ans:C, D Feedback: Nurse leaders recognize the need to base specific nursing decisions on evidence indicating that the decisions are clinically appropriate, cost-effective, and result in positive client outcomes. Holistic treatments may be appropriate in some, but not all, circumstances. Tradition alone is an inadequate basis for practice. 17.Evidenced-based nursing primarily uses which of the following to answer clinical questions? A)Consulting an authority B)Using intuition C)Obtaining the newest research D)Relying on experience Ans:C Feedback: Nurses are increasingly expected to understand and undertake research, and to base their practice on evidence from research, that is, to adopt an evidence-based practice (EBP). EBP, broadly defined, is the use of the best evidence in making patient care decisions. Experience, intuition, and authority are not wholly ignored in the EBP process, but research is a priority. 18.The major difference between quantitative and qualitative research is that qualitative research seeks to find answers based on which of the following? A)Solid factual data B)Experiences or descriptions C)Etiology D)Systematic process Ans:B Page 6Feedback: Human experiences, and people's descriptions and interpretations of these experiences, are the main focus of qualitative research. Systematic process, etiology, and factual data are more closely aligned with the quantitative tradition. 19.Which of the following research focuses is qualitative? A)Weekend and night outcomes of patients admitted to a specific hospital system's trauma departments B)Trends in hospitalizations of patients with antibiotic-resistant tuberculosis C)Predicting risks for serious complications with abdominal surgery D)Needs of nursing students living with chronic illness Ans:D Feedback: Constructivist studies are heavily focused on understanding the human experience as it is lived, through the careful collection and analysis of qualitative materials that are narrative and subjective. Human needs, and individuals' perceptions of those needs, are a common focus of qualitative research. Outcomes, risk factors, and treatment modalities are often addressed with quantitative research. 20.When little is known about a phenomenon or the phenomenon is not clearly identified, the best type of research suited to uncover this is which of the following? A)Exploration B)Description C)Identification D)Prediction Ans:C Feedback: Qualitative researchers sometimes study phenomena about which little is known. In some cases, so little is known that the phenomenon has yet to be clearly identified or named or has been inadequately defined. Identification is thus necessary. Exploration (which addresses causation), predication, and description would likely be subsequent efforts. 21.Consumers of research do which of the following? A)Design studies B)Undertake studies C)Produce research D)Read research Ans:D Page 7Feedback: In the current EBP environment, every nurse is likely to engage in one or more activity along a continuum of research participation. At one end of the continuum are users (consumers) of nursing research, nurses who read research reports to keep up-to-date on findings that may affect their practice. EBP depends on well-informed nursing research consumers. At the other end of the continuum are the producers of nursing research : nurses who actively design and undertake studies. 22.When nurses rely primarily on tradition, they are most likely to do which of the following? A)Produce a precise range of answers B)Increase new knowledge C)Maintain an unbiased perspective D)Undermine effective problem solving Ans:D Feedback: Tradition may undermine effective problem solving. There is growing concern that many nursing actions are based on tradition, custom, and “unit culture” rather than on sound evidence. This prevents the acceptance of new knowledge and increases bias and is unlikely to produce a precise range of answers. 23.A research nurse understands that evidenced-based practice in nursing does which of the following? A)Relies on tradition B)Consults recognized authorities C)Depends primarily on textbooks D)Is based on the latest research Ans:D Feedback: EBP prioritizes research findings, which are found primarily in primary sources, such as journals, rather than in secondary sources, such as textbooks. It is not dependent on tradition or authority. 24.Non-research-based evidence includes which of the following? Select all that apply. A)Unit culture B)Nurse's experience C)Qualitative studies D)Trial and error Ans:C Feedback: Clinical reports, experience and beliefs are non-research based sources of evidence, which are considered to be comparatively weak. Qualitative studies are research-based. CHAPTER 2 Page 81.Research utilization is a process that begins with which of the following? A)A clinical problem that needs to be solved B)A problem-focused trigger C)A knowledge-focused trigger or research finding D)A well-worded clinical question Ans:C Feedback: Research utilization (RU) is the use of findings from disciplined research in a practical application that is unrelated to the original research. Evidence-based practice is broader than RU because it integrates research findings with other factors. Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus (“triggers”) for an EBP endeavor, (1) problem-focused triggers, the identification of a clinical practice problem in need of solution, or (2) knowledge-focused triggers, readings in the research literature. A second catalyst for an EBP project is the research literature, knowledge- focused triggers, which is the origin akin to research utilization. 2.Which of the following is an example of a systematic review? A)An RCT study published in the journal Nursing Research B)A meta-analysis from the Cochrane database C)A synopsis published in Evidence-Based Nursing D)A clinical practice guideline from the National Guideline Clearinghouse Ans:B Feedback: A meta-analysis is a type of systematic review and a technique for integrating quantitative research findings statistically. In essence, meta-analysis treats the findings from a study as one piece of information. The findings from multiple studies on the same topic are combined and then all of the information is analyzed statistically in a manner similar to that in a usual study. Unlike systematic reviews, clinical practice guidelines (which often are based on systematic reviews) give specific recommendations for evidence-based decision-making. Guideline development typically involves the consensus of a group of researchers, experts, and clinicians. A randomized controlled trial (RCT) is an individual study that focuses on the effectiveness of therapies rather than on broader health-care interventions. Synopses, or summaries, of systematic reviews and of single studies are available in evidence-based abstract journals such as Evidence-Based Nursing. 3.Most evidence hierarchies put which of the following at the pinnacle? A)Randomized clinical trials (RCTs) B)Systematic reviews of multiple studies C)Quality improvement projects D)It depends on the research question Ans:B Feedback: In all evidence hierarchies that include randomized clinical trials, quality improvement projects and research questions, systematic reviews are at the pinnacle. Page 94.Which of the following can be used to critically appraise clinical practice guidelines? A)A systematic review from the Cochrane Collaboration B)The Iowa model C)The AGREE instrument D)An evidence hierarchy Ans:C Feedback: Evidence-based clinical practice guidelines distill a body of evidence into a usable form. Unlike systematic reviews, clinical practice guidelines, which often are based on systematic reviews, give specific recommendations for evidence-based decision- making. Several appraisal instruments are available to evaluate clinical practice guidelines, but one with broad support is the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument. The Iowa model is used in selecting a problem for an institutional evidence-based project. An evidence hierarchy is a tool for ranking evidence sources according to the strength of the evidence they provide. 5.Which of the following models was explicitly developed with the idea that individual nurses could engage in RU-type activities? A)Iowa Model B)Johns Hopkins Model C)Cochrane Model D)Stetler Model Ans:D Feedback: Some models focus on the use of research from the perspective of individual clinicians such as the Stetler Model, one of the oldest models that originated as an RU model, but most focus on institutional EBP efforts such as the John Hopkins Nursing EBP Model and the Iowa Model. There is no Cochrane Model; the Cochrane Collaboration is an organization that prepares, maintains, and promotes the accessibility of systematic reviews. 6.In the following clinical question, what is the Outcome (O component): What is the effect of relaxation therapy versus biofeedback on the functional ability of patients with rheumatoid arthritis? A)Functional ability B)Rheumatoid arthritis C)Biofeedback D)Relaxation therapy Ans:A Feedback: In the PIO acronym, P stands for the population or patients (rheumatoid arthritis); I stands for the intervention, influence, or exposure (biofeedback or relaxation therapy); and O stands for the outcomes (functional ability). Page 107.In the following clinical question, what is the Intervention/influence/exposure (I component): Does taking antidepressants affect the risk of suicide in cognitively impaired adolescents? A)Adolescence B)Suicide C)Antidepressant use D)Cognitive impairment Ans:C Feedback: In the PIO acronym, P stands for the population or patients (cognitively impaired individuals); I stands for the intervention, influence, or exposure (antidepressants); and O stands for the outcomes (risk of suicide). 8.In the following clinical question, what is the Population (P component): Do stress and depression affect dyspnea in patients with chronic obstructive pulmonary disease (COPD)? A)Patients who are stressed B)Patients who are depressed C)Patients who experience dyspnea D)Patients with COPD Ans:D Feedback: In the PIO acronym, P stands for the population or patients (patients with chronic obstructive pulmonary disease); I stands for the intervention, influence, or exposure (stress and depression); and O stands for the outcomes (dyspnea). 9.In the following clinical question, what is the Comparison (C component): Does chronic stress affect inflammatory responses in older men with atherosclerotic disease? A)Chronic stress B)Inflammatory response C)Atherosclerotic disease D)There is no “C” component Ans:D Feedback: In the PICO acronym, P stands for the population or patients (older men with atherosclerotic disease); I stands for the intervention, influence, or exposure (chronic stress); C stands for the component that is needed (there is no intervention or influence of interest contrasted with a specific alternative); and O stands for the outcomes (inflammatory response). 10.In which of the following clinical questions is fatigue the “I” component? A)Does fatigue affect agitation in cognitively impaired elders? B)Does a physical activity intervention affect fatigue in patients undergoing cardiac rehabilitation? C)What is the meaning of fatigue among patients with sleep apnea? D)Does the level of depression of patients suffering from chronic fatigue improve by Page 11participating in an exercise intervention? Ans:A Feedback: Fatigue is the “I” component ( intervention, influence, or exposure) in the question, “Does fatigue affect agitation in cognitively impaired elders?” In the other answers, fatigue is one of the other components. 11.Which of the following is a question that would be asked as part of the process of appraising research evidence? A)What are the P, I, and O components? B)How rigorous and reliable is the evidence? C)What type of trigger should I use? D)Is a relevant systematic review available? Ans:B Feedback: Individual nurses have opportunities to put research into practice. The five basic steps for individual EBP are: (1) asking an answerable clinical question as evidenced by, “What are the P, I, and O components?” (2) searching for relevant research-based evidence as evidenced by, “Is a relevant systematic review available?” (3) appraising and synthesizing the evidence as evidenced by, “How rigorous and reliable is the evidence?” Triggers for an organizational project include both pressing clinical problems (problem-focused) and existing knowledge ( knowledge-focused ) such as asked by the question, “What type of trigger would I use?” 12.Which of the following activities is part of an organizational -but not an individual- EBP endeavor? A)Asking a good question/identifying a problem B)Searching for evidence C)Assessing implementation potential D)Synthesizing and appraising evidence Ans:C Feedback: EBP in an organizational context involves many of the same steps as individual EBP efforts, but is more formalized and must take organizational factors into account. Triggers for an organizational project include both pressing clinical problems ( problem- focused) and existing knowledge ( knowledge-focused ), such as assessing implementation potential. Individual nurses have opportunities to put research into practice. The five basic steps for individual EBP are: (1) asking an answerable clinical question; (2) searching for relevant research-based evidence; (3) appraising and synthesizing the evidence; (4) Integrating the evidence with your own clinical expertise, patient preferences, and local context; (5) Assessing the effectiveness of the decision, intervention, or advice. 13.Asking a clinical question is the first step in evidence-based practice. What are the four components of a PICO clinical question? A)Population, implication, comparison, outcome Page 12B)Population, intervention, clinical, outcome C)Population, intervention, comparison, outcome D)Population, implication, clinical, outcome Ans:C Feedback: A crucial first step in evidence-based practice (EBP) involves asking relevant clinical questions that reflect uncertainties in clinical practice. Most guidelines for EBP use the acronyms PIO or PICO to help practitioners develop well-worded questions that facilitate a search for evidence. In the acronym PIO, the P stands for population or patients; the I stands for intervention; and the O stands for outcome. The acronym PICO includes these same three components plus a fourth, C, which stands for comparison. 14.Which following level of evidence includes systematic reviews of multiple studies? A)Level IV B)Level III C)Level II D)Level I Ans:D Feedback: Systematic reviews are at the pinnacle of the hierarchy (Level I), because the strongest evidence comes from careful syntheses of multiple studies. The next highest level (Level II) includes individual randomized controlled trials (RCTs). Going down the “rungs” of the evidence hierarchy for Therapy questions results in less reliable evidence, for example, Level III evidence comes from a type of study called quasi-experiment. In- depth qualitative studies are near the bottom, in terms of evidence regarding intervention effectiveness. 15.A nurse in the United States is scheduled to care for a child with an ostomy. Which of the following resource would best assist the nurse with specific guidelines for evidence- based decision making for this patient? A)MEDLINE B)TRIP C)www.guidelines.gov D)www.rnao.org/bestpractices Ans:C Page 13Feedback: Finding clinical practice guidelines can be challenging, because there is no single guideline repository. A standard search in bibliographic databases such as MEDLINE will yield many references, but could yield a mixture of citations to not only the actual guidelines, but also to commentaries, implementation studies, and so on. A recommended approach is to search in guideline databases, or through specialty organizations that have sponsored guideline development. In the United States, nursing and health-care guidelines are maintained by the National Guideline Clearinghouse (www.guideline.gov). In Canada, the Registered Nurses Association of Ontario (RNAO) (www.rnao.org/bestpractices) maintains information about clinical practice guidelines. Two sources in the United Kingdom are the Translating Research into Practice (TRIP) database and the National Institute for Clinical Excellence (NICE). 16.Which of following study types is a systematic review used for integration of statistical quantitative research findings? A)Meta-synthesis B)Meta-analysis C)Randomized controlled trial D)Quasi-experiment Ans:B Feedback: Systematic reviews can take various forms. One form is a narrative (qualitative) integration that merges and synthesizes findings, much like a rigorous literature review. For integrating evidence from quantitative studies, narrative reviews increasingly are being replaced by a type of systematic review known as a meta-analysis. Meta-analysis is a technique for integrating quantitative research findings statistically. For qualitative studies, integration may take the form of a meta-synthesis. A meta-synthesis, however, is distinct from a quantitative meta-analysis: a meta-synthesis is less about reducing information and more about interpreting it. Randomized controlled trials and quasi- experiments are not types of systematic reviews. 17.The best-known early research utilization (RU) project sought to bridge the gap between research and practice. Which following is the name of that well-known project? A)Cochrane Collaboration B)Stetler Model of Research Utilization C)Conduct and Utilization of Research in Nursing (CURN) Project D)Promoting Action on Research Implementation in Health Services Ans:C Feedback: Recognition of the gap between research and practice led to formal attempts to bridge the gap. The best-known of several early RU projects is the Conduct and Utilization of Research in Nursing (CURN) Project , which was awarded to the Michigan Nurses' Association by the Division of Nursing in the 1970s. The Stetler Model of Research Utilization and Promoting Action on Research Implementation in Health Services are evidence-based practice models, not projects. One keystone of the EBP movement is the Cochrane Collaboration, which was founded in the United Kingdom based on work by British epidemiologist Archie Cochrane. It is not a research utilization project. Page 1418.The Iowa Model identifies problem-focused triggers for implementing an EBP project. Which of the following is a problem-focused trigger in the Iowa Model? A)A finding published recently in a nursing journal B)A new clinical guideline issued by a federal agency C)An increase in latex allergy among emergency room nurses D)Questions from hospital committee Ans:C Feedback: Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus (“triggers”) for an EBP endeavor, (1) problem-focused triggers, the identification of a clinical practice problem in need of solution, or (2) knowledge- focused triggers, readings in the research literature. A second catalyst for an EBP project is the research literature, knowledge-focused triggers, which is the origin akin to research utilization. The catalyst might be a new clinical guideline or a research article discussed in a journal club. 19.As a nurse, you must understand the difference between research utilization and evidence-based nursing practice. Which of the following best defines evidence-based practice? A)Begins with research itself, clinical expertise, and patient preference B)Uses new evidence and translates research findings into real-world applications C)Uses findings from disciplined research in practical application unrelated to original research D)Integrates best research evidence, with clinical expertise, patient preference, and a particular clinical situation Ans:D Feedback: Advocates of EBP do not minimize the importance of clinical expertise. Rather, they argue that evidence-based decision-making should integrate best research evidence with clinical expertise, patient preferences, and local circumstances. Research utilization (RU) is the use of findings from disciplined research in a practical application that is unrelated to the original research. In research utilization, the emphasis is on translating research findings into real-world applications. The starting point in RU is new evidence or a research-based innovation. EBP is broader than RU because it integrates research findings with other factors. Whereas RU begins with the research itself (how can I put this innovation to good use in my clinical setting?), EBP starts with a clinical question (what does the evidence say is the best approach to solving this problem?). 20.Some EBP models recommend a formal assessment of organizational “fit”, known as implementation potential, when an organization is considering undertaking an EBP project. Which following issue is of particular importance to address to determine the implementation potential of the EBP project for the organization? A)Effectiveness of the innovation B)Nurses' attitude toward the innovation C)Patient benefit of the innovation D)Transferability of the innovation Page 15Ans:D Feedback: Some EBP models recommend a formal assessment of organizational “fit,” often called implementation potential (or, environmental readiness ). In determining the implementation potential of an innovation in a particular setting, several issues should be considered, particularly the transferability of the innovation (i.e., the extent to which the innovation might be appropriate in new settings), the feasibility of implementing it, and its cost-benefit ratio. 21.A nurse is observing how the time of feeding impacts an inpatient's gastric reflux. In which of the following steps of the EBP process would the nurse determine whether a specific feeding time alleviated the patient's gastric reflux symptoms? A)Searching for and collecting evidence that addresses the question B)Appraising and synthesizing the evidence C)Integrating the evidence with own clinical expertise, patient preferences, and local context D)Assessing the effectiveness of the decision, intervention, or advice Ans:D Feedback: It would be during step 5 of the EBP process, assessing the effectiveness of the decision, intervention, or advice, that the nurse would determine whether a specific feeding time (an intervention) is effective in alleviating the patient's gastric reflux symptoms. 22.After an institutional project has been developed, the next step is to conduct a pilot study (a trial study). Based on the Iowa Model, which step would identify the success or failure of a pilot study? A)Developing an evaluation plan B)Measuring client outcomes prior to implementation C)Training relevant staff in the use of the new guideline D)Evaluating the project in terms of both the process and the outcomes Ans:D Feedback: The success or failure of the pilot study would be assessed in the evaluation of the study, which is the last step. The other answers refer to earlier steps in the implementation of the study. 23.A narrative integrated review of qualitative studies focuses on interpretation of the studies. Which of the following study types would be considered an systematic integrated review of qualitative studies? A)Meta-synthesis B)Meta-analysis C)Randomized controlled trial D)Quasi-experiment Ans:A Page 16Feedback: Systematic reviews can take various forms. One form is a narrative (qualitative) integration that merges and synthesizes findings, much like a rigorous literature review. For integrating evidence from quantitative studies, narrative reviews increasingly are being replaced by a type of systematic review known as a meta-analysis. Meta-analysis is a technique for integrating quantitative research findings statistically. For qualitative studies, integration may take the form of a meta-synthesis. A meta-synthesis, however, is distinct from a quantitative meta-analysis: a meta-synthesis is less about reducing information and more about interpreting it. Randomized controlled trials and quasi- experiments are not types of systematic reviews. 24.The Iowa Model identifies several knowledge-focused triggers for implementing an EBP project. Which following statement is considered a knowledge-focused trigger in the Iowa Model? A)A report in the New England Journal of Medicine regarding a potential flu epidemic B)Readmission rate of heart failure patients C)Poor patient survey results D)Increase in pediatric falls Ans:A Feedback: Several models of EBP, such as the Iowa Model, have distinguished two types of stimulus (“triggers”) for an EBP endeavor, (1) problem-focused triggers, the identification of a clinical practice problem in need of solution, or (2) knowledge- focused triggers, readings in the research literature. A report in a medical journal regarding a potential flu epidemic is an example of a reading in a research literature, and thus would be a knowledge-focused trigger. The other answers are examples of problem-focused triggers. 25.Which of the following is the best resource to use when beginning the search for evidence necessary for an individual EBP project? A)Hayat, M. (2010). Understanding statistical significance. Nursing Research, 59(3), 219-223. B)Durbin, C. R., Fish, A. F., Bachman, J. A., & Smith, K. V . (2010). Systematic review of education intervention for improving advanced directive completion. Journal of Nursing Scholarship, 42, 234-241. C)Polit, D. R., & Beck, C. T. (2014). Essentials of Nursing Research : Appraising Evidence for Nursing Practice ( 8th ed.). Philadelphia: Wolters Kluwer| Lippincott Williams & Wilkins. D)Aggarwal, B., Liao, M., & Mosca, L. (2010). Predictors of physical activity at 1 year in a randomized controlled trial of family members of patients with cardiovascular disease. Journal of Cardiovascular Nursing, 29 (6), 444-449. Ans:B Page 17Feedback: For an individual EBP endeavor, the best place to begin is by searching for evidence in a systematic review, clinical practice guideline, or other preprocessed source because this approach leads to a quicker answer, and, if your methodologic skills are limited, potentially a superior answer as well. Of the answers, only Durbin et al is a systematic review. The study by Aggarwal et al is an individual randomized controlled trial, not a systematic review. The article by Hayat provides general information on statistical significance and does not appear to be primary research. Polit and Beck is the textbook you are using, which is a secondary source, not primary research. CHAPTER 3 1.Which of the following terms would likely be used only by qualitative researchers, as opposed to quantitative researchers, to refer to people who participate in a study? A)Informants B)Study participants C)Subjects D)Investigators Ans:A Feedback: The people who provide information to the researchers in a study are referred to as subjects or study participants in quantitative research, or study participants or informants in qualitative research; collectively they comprise the sample. The person who conducts the research is the researcher or investigator. 2.Which of the following terms is used by both qualitative and quantitative researchers to refer to the abstractions under study? A)Concept B)Theory C)Phenomenon D)Variable Ans:A Feedback: Researchers investigate concepts and phenomena, which are abstractions inferred from people's behavior or characteristics. In quantitative studies, concepts are called variables. A variable is a characteristic or quality that takes on different values. The term phenomena is also more associated with qualitative studies than with quantitative studies, whereas concept is used for both. A theory is an explanation of some aspect of reality, not an abstraction inferred from people's behavior or characteristics. 3.Which of the following would be most likely called a construct? A)Gender B)Body temperature C)Self-care D)Blood type Ans:C Page 18Feedback: Researchers sometimes use the term construct, which also refers to an abstraction, but often one that is deliberately invented (or constructed). For example, self-care in Orem's model of health maintenance is a construct. A variable is a characteristic or quality that takes on different values such as body temperature and blood type. Gender can be coded in a quantitative study. 4."Male" is which of the following? A)Not a variable B)An independent variable C)A dependent variable D)An outcome variable Ans:A Feedback: A variable is a characteristic or quality that takes on different values (i.e., varies from one person or object to another). The dependent (or outcome) variable is the behavior, characteristic, or outcome the researcher is interested in explaining, predicting, or affecting (the “O” in the PICO scheme). The independent variable is the presumed cause of or influence on the dependent variable. The independent variable corresponds to the “I” and the “C” components in the PICO scheme. Thus, “male” is not a variable, but a constant. 5.The dependent (outcome) variable in the research question, "Is the quality of life of nursing home residents affected by their functional ability or hearing acuity?” is which of the following? A)Quality of life B)Functional ability C)Hearing acuity D)Residence in a nursing home Ans:A Feedback: The dependent (or outcome) variable is the behavior, characteristic, or outcome the researcher is interested in explaining, predicting, or affecting (the “O” in the PICO scheme). Quality of life is the dependent variable. The independent variable is the presumed cause of or influence on the dependent variable. Independent variables are nursing home residents, functional ability, and hearing acuity. The independent variable corresponds to the “I” and the “C” components in the PICO scheme. 6.The independent variable in the research question, "What is the effect of noise levels on postoperative pain and blood pressure fluctuations in ICU patients?" is which of the following? A)Blood pressure B)ICU patients C)Noise levels D)Postoperative pain Ans:C Page 19Feedback: The dependent (or outcome) variable is the behavior, characteristic, or outcome the researcher is interested in explaining, predicting, or affecting (the “O” in the PICO scheme). Postoperative pain, blood pressure, and being a patient in the ICU are the dependent variables. The independent variable is the presumed cause of or influence on the dependent variables. The independent variable is noise levels. The independent variable corresponds to the “I” and the “C” components in the PICO scheme. 7.In the question, "Do Baccalaureate degree-prepared nurses practice more rehabilitative nursing procedures on a client in an ICU than associate degree-prepared nurses?" the independent variable is which of the following? A)Associate degree-prepared nurses B)Baccalaureate degree-prepared nurses C)Rehabilitative nursing measures D)Type of educational background of nurse Ans:D Feedback: The dependent (or outcome) variable is the behavior, characteristic, or outcome the researcher is interested in explaining, predicting, or affecting (the “O” in the PICO scheme). A rehabilitative nursing measure is the dependent variable. The independent variable is the presumed cause of or influence on the dependent variable. The independent variable is type of educational background of nursing, not a particular degree. The independent variable corresponds to the “I” and the “C” components in the PICO scheme. 8.The purpose of an operational definition in a quantitative study is to do which of the following? A)Assign numeric values to variables B)Specify how a variable will be measured C)State the expected relationship between the variables under investigation D)Designate the conceptual underpinnings of the variable Ans:B Feedback: A conceptual definition describes the abstract or theoretical meaning of a concept being studied. An operational definition specifies how the variable will be measured. Data, the information collected during the course of a study, may take the form of narrative information (qualitative data) or numeric values (quantitative data). 9.Which of the following is a datum from a quantitative study of the labor and delivery experiences of women over age 40? A)Length of time in labor B)107 oz C)“I practically slept through the whole thing!” D)Vaginal versus cesarean delivery Ans:B Page 20Feedback: Research data (singular, datum) are the pieces of information gathered in a study. In quantitative studies, researchers identify and define their variables, and then collect relevant data from subjects. The actual values of the study variables constitute the data. Quantitative researchers collect primarily quantitative data, information in numeric form. In this question it is 107 oz. Length of time in labor, “I practically slept through the whole thing,” and vaginal versus cesarean delivery are not documented as numeric values in this example. 10.Which of the following is a datum from a qualitative research study on the labor and delivery experiences of women over age 40? A)14.6 hours in labor B)60-minute interviews one day after delivery C)"It was a nightmare, much more painful than I ever imagined." D)15 women with a vaginal delivery Ans:C Feedback: Quantitative researchers collect primarily quantitative data, information in numeric form. 14.6 hours in labor, 60-minute interviews one day after delivery, and 15 women with a vaginal delivery are examples of quantitative data. In qualitative studies, researchers collect primarily qualitative data, that is, narrative descriptions. Narrative data can be obtained by conversing with participants, by making notes about their behavior in naturalistic settings, or by obtaining narrative records, such as diaries. “It was a nightmare ñ much more painful than I ever imagined,” is an example of datum from a qualitative research study. 11.In quantitative studies, the most basic distinction is between which of the following? A)Grounded theory and phenomenological research B)Empirical and nonempirical research C)Experimental and nonexperimental research D)Population-based and sample-based research Ans:C Feedback: A key distinction in quantitative studies is between experimental research, in which researchers actively intervene to test an intervention or therapy, and nonexperimental (or observational) research, in which researchers make observations of existing phenomena without intervening. Grounded theory seeks to describe and understand key social psychological processes that occur in a social setting. Phenomenology focuses on the lived experiences of humans and is an approach to gaining insight into what the life experiences of people are like and what they mean. In quantitative research, the empirical phase involves collecting data; and preparing data for analysis (e.g., coding data). Population-based and sample-based research are examples of types of research studies. 12.Which of the following is the least likely research tradition to be used by qualitative nurse researchers? A)Experimental Page 21B)Phenomenologic C)Ethnographic D)Grounded theory Ans:A Feedback: Qualitative research often is rooted in research traditions that originate in other disciplines. Three such traditions are grounded theory, phenomenology, and ethnography. Grounded theory seeks to describe and understand key social psychological processes that occur in a social setting. Phenomenology focuses on the lived experiences of humans and is an approach to gaining insight into what the life experiences of people are like and what they mean. Ethnography provides a framework for studying the meanings, patterns, and lifeways of a culture in a holistic fashion. A key distinction in quantitative studies is between experimental research, in which researchers actively intervene to test an intervention or therapy, and nonexperimental (or observational) research, in which researchers make observations of existing phenomena without intervening. 13.The research tradition that focuses on understanding phenomena within a cultural context is which of the following? A)Experimental B)Phenomenologic C)Ethnographic D)Grounded theory Ans:C Feedback: Qualitative research often is rooted in research traditions that originate in other disciplines. Three such traditions are grounded theory, phenomenology, and ethnography. Grounded theory seeks to describe and understand key social psychological processes that occur in a social setting. Phenomenology focuses on the lived experiences of humans and is an approach to gaining insight into what the life experiences of people are like and what they mean. Ethnography provides a framework for studying the meanings, patterns, and lifeways of a culture in a holistic fashion. A key distinction in quantitative studies is between experimental research, in which researchers actively intervene to test an intervention or therapy, and nonexperimental (or observational) research, in which researchers make observations of existing phenomena without intervening. 14.The research tradition that is an approach to understanding people's experiences as they are lived is which of the following? A)Experimental B)Phenomenologic C)Ethnographic D)Grounded theory Ans:B Page 22Feedback: Qualitative research often is rooted in research traditions that originate in other disciplines. Three such traditions are grounded theory, phenomenology, and ethnography. Grounded theory seeks to describe and understand key social psychological processes that occur in a social setting. Phenomenology focuses on the lived experiences of humans and is an approach to gaining insight into what the life experiences of people are like and what they mean. Ethnography provides a framework for studying the meanings, patterns, and lifeways of a culture in a holistic fashion. A key distinction in quantitative studies is between experimental research, in which researchers actively intervene to test an intervention or therapy, and nonexperimental (or observational) research, in which researchers make observations of existing phenomena without intervening. 15.A researcher's expectations about the relationships between variables in a quantitative study are generally formulated as which of the following? A)Hypotheses B)Frameworks C)Research questions D)Conceptual definitions Ans:A Feedback: Hypotheses state researchers' deductively derived expectations about relationships between study variables. To answer research questions and test hypotheses, researchers analyze their data in an orderly fashion. When quantitative research is performed within the context of a theoretical framework, the findings may have broader significance and utility. Even when the research question is not embedded in a theory, researchers should have a conceptual definition rationale and a clear vision of the concepts under study. 16.The overall plan for answering a research question “the architectural backbone of a study” is called which of the following? A)Sampling plan B)Proposal C)Hypothesis D)Research design Ans:D Feedback: The research design is the overall plan for obtaining answers to the research questions and for handling challenges that can undermine the study evidence. The researcher's sampling plan specifies how the sample will be selected and how many subjects there will be. Researchers seeking financial support submit a proposal to a funding source, and reviewers usually suggest improvements. Hypotheses state researchers' deductively derived expectations about relationships between study variables. 17.The aggregate of those to whom a researcher wishes to generalize study results is which of the following? A)Gatekeepers Page 23B)Population C)Sample D)Sampling plan Ans:B Feedback: A population is all the individuals or objects with common, defining characteristics (the “P” component in PICO questions). Gaining entrée to a research site for a particular population typically involves negotiations with gatekeepers who have the authority to permit entry into their world. Researchers typically collect data from a sample, which is a subset of the population. Using samples is more practical than collecting data from an entire population, but the risk is that the sample might not adequately reflect the population's traits. The researcher's sampling plan specifies how the sample will be selected and how many subjects there will be. 18.Gaining entrée in a qualitative project usually requires negotiation with one or more of which of the following? A)Gatekeeper B)Researcher C)Informant D)Consultant Ans:A Feedback: Gaining entrée typically involves negotiations with gatekeepers who have the authority to permit entry into their world. Researchers are the ones who conduct the research study. The people who provide information to the researchers in a study are referred to as subjects or study participants in quantitative research, or study participants or informants in qualitative research; collectively they comprise the sample. A consultant would be an expert in some field who would provide guidance for some aspect of the study. 19.Research design in qualitative studies is often described as: A)Experimental B)Narrative C)Interpretive D)Emergent Ans:D Feedback: The flow of activities in a qualitative study is more flexible and less linear. Qualitative studies typically involve an emergent design that evolves during data collection. A key distinction in quantitative studies is between experimental research, in which researchers actively intervene to test an intervention or therapy. Narrative data can be obtained by conversing with participants, by making notes about their behavior in naturalistic settings, or by obtaining narrative records, such as diaries. There is no interpretive research design in qualitative studies. Page 2420.At what point does a qualitative researcher typically make a lot of decisions about data collection and sampling? A)While reviewing the literature B)During the development of a research report C)While the study is in progress in the field D)After developing an intervention protocol Ans:C Feedback: In qualitative studies, the tasks of sampling, data collection, data analysis, and interpretation typically take place repeatedly while the study is in progress. Qualitative researchers begin by talking with or observing people with first-hand experience with the phenomenon under study. The discussions and observations are loosely structured, allowing participants to express a full range of beliefs, feelings, and behaviors. Analysis and interpretation are ongoing, concurrent activities that guide choices about the kinds of people to question next and the types of question to ask or observations to make. Reviewing the literature, developing a research report, and developing an intervention protocol are steps in quantitative research. 21.In a qualitative study, the people cooperating in the study are called which of the following? A)Subjects B)Investigators C)Researchers D)Informants Ans:D Feedback: In a qualitative study, the people cooperating in the study are called study participants or informants. In a quantitative study, the people being studied are called subjects or study participants. The person who conducts the research is the researcher or investigator. 22.In qualitative research, theory is which of the following? A)A method to test hypotheses B)A tool to direct the research project C)A product of the research D)A way to test relationships between two different groups Ans:C Feedback: A theory is an explanation of some aspect of the study. In qualitative studies, theory often is the product of the research. It is not used to test hypotheses, to direct the research project, or to test relationships between two different groups. 23.The dependent variable in the research question, “Is the quality of life of nursing home residents affected by their functional ability or hearing acuity?” is which of the following? A)Quality of life B)Functional ability Page 25