FREE Chapter 2: Evolution of Research in Building Evidence-Based Nursing Practice

Chapter 2: Evolution of Research in Building Evidence-Based Nursing Practice

Test Bank

MULTIPLE CHOICE

1. In which way did Florence Nightingale contribute to evidence-based practice?

a.

She conducted research on outcomes and the power of nursing for change.

b.

She was the first woman elected to the Royal Statistical Society.

c.

She gathered data that changed the care of hospitalized soldiers.

d.

She calculated mortality rates under varying conditions.

ANS: C

Nightingale gathered data on soldier morbidity and mortality rates and the factors influencing them and presented her results in tables and pie charts, a sophisticated type of data presentation for the period. Nightingale’s research enabled her to instigate attitudinal, organizational, and social changes. She changed the attitudes of the military and society toward the care of the sick. The military began to view the sick as having the right to adequate food, suitable quarters, and appropriate medical treatment, which greatly reduced the mortality rate.

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2. If a nurse manager wants to study how well last year’s policies governing implementation of a “bundle” of interventions to prevent cross-contamination of MRSA have been working in her units, which of the following strategies would she use?

a.

Outcomes research

b.

Intervention research

c.

Ethnographic research

d.

Experimental research

ANS: A

Outcomes research emerged as an important methodology for documenting the effectiveness of health care services in the 1980s and 1990s. This type of research evolved from the quality assessment and quality assurance functions that originated with the professional standards review organizations (PSROs) in 1972. During the 1980s, William Roper, the director of the Health Care Finance Administration (HCFA), promoted outcomes research for determining the quality and cost-effectiveness of patient care. Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting. Through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on human behavior and health. Experimental studies have three main characteristics: (1) a controlled manipulation of at least one treatment variable (independent variable), (2) administration of the treatment to some of the subjects in the study (experimental group) and not to others (control group), and (3) random selection of subjects or random assignment of subjects to groups, or both. Experimental studies usually are conducted in highly controlled settings, such as laboratories or research units in clinical agencies.

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3. A researcher publishes a paper describing how faith, pain, adherence to therapy, and meditation interact during the rehabilitation process. The description of the process is based on many interviews the researcher conducted with persons during and following rehabilitation experiences. The methodology is

a.

Ethnography

b.

Phenomenology

c.

Historical research

d.

Grounded theory

ANS: D

Grounded theory methodology emphasizes observation and the development of practice-based intuitive relationships among variables. Throughout the study, the researcher formulates, tests, and redevelops propositions until a theory evolves. The theory developed is “grounded,” or has its roots in, the data from which it was derived.

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4. A panel of researchers conducts several studies, all drawn from an existent hospital and clinic database. The studies focus on quality and effectiveness within that system. The specific studies address mortality rates in elders within a year after hip fracture, functional outcomes six months after admission to a neurosurgical ICU after traumatic brain injury, rate of nurse injuries in an emergency department, and number of patient falls on various floors of the hospital. What type of research is this?

a.

Experimental research

b.

Outcomes research

c.

Ethnographic research

d.

Grounded theory research

ANS: B

The spiraling cost of health care has generated many questions about the quality and effectiveness of health care services and the patient outcomes. Consumers want to know what services they are buying, and whether these services will improve their health. Health care policy makers want to know whether the care is cost-effective and of high quality. These concerns have promoted the development of outcomes research, which examines the results of care and measures the changes in health status of patients. It can also examine costs related to care delivery within a hospital system.

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5. A researcher designs a study. It depends on questionnaires for data, it has a clear purpose statement, it provides its results as a narrative without statistical analysis, and it makes general suggestions for practice. What type of research is this?

a.

Qualitative research

b.

Outcomes research

c.

Intervention research

d.

Quantitative research

ANS: D

Quantitative research is a formal, objective, systematic process in which numerical data are used to obtain information about the world. Qualitative research is also systematic, but it is a holistic, interactive, and subjective approach to describe life experiences and identify their meaning. Both types of research have a purpose statement and can use a survey instrument; however, neither depends on surveys for data. Both can contain suggestions for practice. Qualitative research results are presented as a narrative, without statistical analysis. Outcomes research examines the results of care and measures the changes in health status of patients. Intervention research investigates the effectiveness of a nursing intervention in achieving the desired outcome or outcomes in a natural setting.

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6. A newly employed nurse administrator wants to know more about the employees on the units the administrator supervises. The manager accesses the managerial database and gathers data about all of the current employees on the unit, including work shift, number of years employed, age, gender, educational preparation, certifications, work history, and professional accomplishments. What type of research is this?

a.

Descriptive research

b.

Correlational research

c.

Quasi-experimental research

d.

Experimental research

ANS: A

The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This is a research study, even though it depends upon existent data, collected by another manager. Its purpose is to describe the employees.

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7. A human resources employee performs research focusing on the professional lifespan within the institution of nurses, and trying to discover whether their choice of work area is connected with the number of years they work in the institution. What type of research is this?

a.

Descriptive research

b.

Correlational research

c.

Quasi-experimental research

d.

Experimental research

ANS: B

The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This study investigates the connection or association between work area and length of time worked.

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8. In an attempt to assess whether selection of a same-gender psychiatrist leads to better mental health outcomes, clients newly referred for mental health services are told they may choose their mental health physicians. Later, measures of mental health are performed. What type of research is this?

a.

Descriptive research

b.

Correlational research

c.

Quasi-experimental research

d.

Experimental research

ANS: C

The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks control in at least one of three areas, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study is designed to test an intervention but does not include random assignment.

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9. In a rehabilitation unit, patients are randomly assigned to high fiber diets versus ordinary fiber diets, in order to measure the effect on constipation. What type of research is this?

a.

Descriptive research

b.

Correlational research

c.

Quasi-experimental research

d.

Experimental research

ANS: D

The quantitative research methods are classified into four categories: (1) descriptive, which defines the magnitude of a concept and its characteristics, (2) correlational, which determines association between or among variables, (3) quasi-experimental, which tests an intervention and lacks either a control group or random assignment, and (4) experimental, which tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment.

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10. A researcher uses interviews with two or three open-ended questions to study women in the staging phase of breast cancer treatment, in order to understand their experiences and the meanings they attribute to those experiences. What type of research is this?

a.

Phenomenologic research

b.

Grounded theory research

c.

Ethnographic research

d.

Historicism

ANS: A

Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

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11. A researcher uses interviews with eight open-ended questions to study women in a new staging phase of breast cancer treatment, which includes serial biopsies and necessitates weekly closed biopsy, in order to understand more about social factors that impinge upon their experience. What type of research is this?

a.

Phenomenologic research

b.

Grounded theory research

c.

Ethnographic research

d.

Historicism

ANS: B

Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

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12. A researcher conducts many interviews, over a one-year period, with women in the treatment phase of breast cancer, all of whom are attending a breast cancer support group, in order to understand what happens in the support group, how the members are affected by membership, and how the members contribute to the group. The researcher herself is also in treatment for breast cancer and is a member of the group. What type of research is this?

a.

Phenomenologic research

b.

Grounded theory research

c.

Ethnographic research

d.

Historicism

ANS: C

Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

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13. A researcher reviews the twenty years that a breast cancer clinic has been in operation in a small Midwestern city. The researcher interviews many of the women who have been treated in the clinic during this period and reviews the records of the clinic, along with its survival rates and the emergence of several of its innovative support programs for women and their families. The researcher ultimately writes a story of the clinic over those twenty years. What type of research is this?

a.

Phenomenologic research

b.

Grounded theory research

c.

Ethnographic research

d.

Historicism

ANS: D

Phenomenologic research examines the lived experiences of participants and the meanings those experiences hold for them, drawing its results only from the participants’ views. Grounded theory research defines under-researched concepts and explains them within a social framework, building on both observation and the perceptions of the persons who are familiar with the concepts, and sometimes generating theory; it emphasizes interaction, observation, and development of relationships among concepts. Ethnography defines shared characteristics of members of a culture or participants who share in a common characteristic, and explains commonalities, often within a cultural framework, using observation, interview, and other data collection strategies; through the use of ethnographic research, different cultures are described, compared, and contrasted to add to our understanding of the impact of culture on the human experience. Historicism tells the story of past events, reconstructing these from other historical references, interviews, artifacts, art, and other sources that reflect the time of interest.

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MULTIPLE RESPONSE

1. Florence Nightingale researched mortality and morbidity rates in soldiers during the Crimean War and investigated various factors that influenced both, presenting her results as pie charts and graphs. Consequently, it is known that she conducted which types of research? (Select all that apply.)

a.

Phenomenologic research

b.

Causational research

c.

Descriptive research

d.

Correlational research

e.

Ethnographic research

ANS: C, D

Nightingale is noted for her data collection and statistical analyses during the Crimean War. She gathered data on soldier morbidity and mortality rates and the factors influencing them and presented her results in tables and pie charts, a sophisticated type of data presentation for the period. There is no evidence that she designed causational (experimental or quasi-experimental) research or any type of qualitative research.

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2. Which of the following statements about quantitative research is accurate? (Select all that apply.)

a.

The results of quantitative research should be generalized back to the population from which the sample was drawn.

b.

Quantitative research is always easy and straightforward to read and understand.

c.

Quantitative research addresses quantities, connections, and causes.

d.

Quantitative research predominates in the nursing research literature.

e.

Quantitative research is always experimental.

f.

Quantitative research provides answers to “What?” and “Who?” questions.

ANS: A, C, D, F

The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. Quantitative research requires the use of structured interviews, questionnaires, or observations, scales, or physiological measures that generate numerical data. Statistical analyses are conducted to reduce and organize data, describe variables, examine relationships, and determine differences among groups. Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized. Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

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3. Which of the following statements about qualitative research is accurate? (Select all that apply.)

a.

Qualitative research deals exclusively with humans.

b.

Qualitative research’s principal purpose is to inform the reader.

c.

Qualitative research yields data that are not numbers-based, such as audiotapes, videotapes, and field notes.

d.

Qualitative research is not systematic.

e.

Qualitative research does not contain or imply a research question.

f.

Qualitative research is ill-defined and vague.

g.

Qualitative research has no practical use.

ANS: B, C

Qualitative researchers use observations, interviews, and focus groups to gather data. The interactions are guided but not controlled in the way that quantitative data collection is controlled. For example, the researcher may ask subjects to share their experiences of powerlessness in the health care system. Qualitative researchers would begin interpreting the subjective data during data collection, recognizing that their interpretation is influenced by their own perceptions and beliefs. Qualitative data take the form of words and are analyzed according to the qualitative approach that is being used. The intent of the analysis is to organize the data into a meaningful, individualized interpretation, framework, or theory that describes the phenomenon studied. The findings from a qualitative study are unique to that study, and it is not the researcher’s intent to generalize the findings to a larger population. Qualitative researchers are encouraged to question generalizations and to interpret meaning based on individual study participants’ perceptions and realities.

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4. Which is true of quantitative research? (Select all that apply.)

a.

It addresses human responses by measuring or counting them.

b.

It presents information by clustering it or counting it.

c.

It yields a data set that can be analyzed by statistics.

d.

It operates systematically.

e.

It states or implies a research question.

f.

It operates in a concrete realm.

g.

It can always be generalized.

ANS: A, B, C, D, E, F

The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. Quantitative research requires the use of structured interviews, questionnaires, or observations, scales, or physiological measures that generate numerical data. Statistical analyses are conducted to reduce and organize data, describe variables, examine relationships, and determine differences among groups. Control, instruments, and statistical analyses are used to ensure that the research findings accurately reflect reality so that the study findings can be generalized. Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

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5. Ethnographic research might focus upon which of the following topics? (Select all that apply.)

a.

Bacterial cultures

b.

Cultural beliefs of the ancient Romans

c.

How children in Alaska play during the winter

d.

Twenty-year abstinence members of Alcoholics Anonymous

e.

The mentoring process in a labor-delivery unit

f.

Conversational Spanish

ANS: C, D, E

Ethnographic research was developed by anthropologists to investigate cultures through an in-depth study of the members of the culture. The culture may be an actual culture, a loosely connected group of people who share a common characteristic, or a work or recreational group. The ethnographic research process is the systematic collection, description, and analysis of data to develop a description of cultural behavior. The researcher (ethnographer) actually lives in or becomes a part of the cultural setting to gather the data.

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6. A researcher is operating from the point of view of logical positivism. Which of the following research methods would the logical positivist use? (Select all that apply.)

a.

Grounded theory research

b.

Correlational research

c.

Historical research

d.

Quasi-experimental research

e.

Quantitative descriptive research

f.

Exploratory descriptive qualitative research

ANS: B, D, E

The quantitative approach to scientific inquiry emerged from a branch of philosophy called logical positivism, which operates on strict rules of logic, truth, laws, axioms, and predictions. The quantitative research methods are classified into four categories: (1) descriptive, (2) correlational, (3) quasi-experimental, and (4) experimental. The qualitative research methods included in this textbook are (1) phenomenological research, (2) grounded theory research, (3) ethnographic research, (4) exploratory-descriptive qualitative research, and (5) historical research.

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7. Which of the follow potential studies would fall within the Agency for Healthcare Research and Quality’s future research goals? (Select all that apply.)

a.

Performing a synthesis of research evidence regarding skin-to-skin contact of mothers and newborns

b.

Enacting a quantitative research project measuring bacterial count on nurses’ uniforms at the beginning and the end of 12-hour work shifts

c.

Performing a qualitative research project to explain sources of student nurses’ stress

d.

Enacting a public education Internet commercial encouraging smokers to read the statistics regarding sequelae of cigarette smoking

e.

Trialing clean-and-sober support groups that are based in community shopping centers

ANS: A, D, E

The Agency for Healthcare Research and Quality partners with public and private sectors to improve the quality and safety of patient care by promoting the use of the best research evidence available in practice. Its three future goals are focused on the following: “Safety and quality: Reduce the risk of harm by promoting delivery of the best possible health care; Effectiveness: Improve healthcare outcomes by encouraging the use of evidence to make informed healthcare decisions; and Efficiency: Transform research into practice to facilitate wider access to effective healthcare services and reduce unnecessary costs.”

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8. Early nursing research by Nightingale focused on improving patient outcomes. What were the principal topics for the next wave of nursing research, in the first half of the 20th century? (Select all that apply.)

a.

Evidence-based practice

b.

Primary nursing’s advantages in hospitals

c.

Nursing education, as opposed to nurse training

d.

The nursing process and nursing diagnosis

e.

Staffing, patient assignments, and type of care

ANS: C, E

From 1900 to 1950, research activities in nursing were limited, but a few studies advanced nursing education. Based on recommendations of the Goldmark Report, more schools of nursing were established in university settings. A research trend that started in the 1940s and continued in the 1950s focused on the organization and delivery of nursing services. Studies were conducted on the numbers and kinds of nursing personnel, staffing patterns, patient classification systems, patient and nurse satisfaction, and unit arrangement. Types of care such as comprehensive care, home care, and progressive patient care were evaluated. In the 1970s, the nursing process became the focus of many studies, with the investigations of assessment techniques, nursing diagnoses classification, goal-setting methods, and specific nursing interventions. Primary nursing care, which involves the delivery of patient care predominantly by registered nurses (RNs), was the trend for the 1970s. The vision for nursing research in the twenty-first century includes conducting quality studies using a variety of methodologies, synthesizing the study findings into the best research evidence, and using this research evidence to guide practice. The focus on EBP has become stronger over the last decade.

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9. Which of the following is true of the Cochrane Center and Cochrane Collaboration, begun in the 1970s by Professor Archie Cochrane? (Select all that apply.)

a.

It was originally called the Walter Reed Army Institute of Research.

b.

It developed the original master’s degrees in nursing practice.

c.

It serves as a repository for evidence-based practice guidelines.

d.

It was the first association to publish a nursing research journal.

e.

It is the online library resource for research literature reviews.

ANS: C, E

Cochrane advocated the provision of health care based on research to improve the quality of care and patient outcomes. To facilitate the use of research evidence in practice, the Cochrane Center was established in 1992 and the Cochrane Collaboration in 1993. The Cochrane Collaboration and Library house numerous resources to promote EBP, such as systematic reviews of research and evidence-based guidelines for practice.

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10. How does quantitative research contribute to evidence-based practice? (Select all that apply.)

a.

It provides facts that nurses can add to their knowledge base. This makes practice more objective and quantifiable.

b.

It provides scientific support for policies already in place. More evidence makes an existent policy more defensible.

c.

It provides evidence opposing policies already in place. Evidence in opposition to policies may result in new policies.

d.

It allows the nurse to understand the personal experience of illness and the meaning the client attaches to it. This engenders compassion.

e.

It contributes evidence that will make nursing practice almost completely evidence-based, eliminating different styles of nursing practice.

ANS: B, C

Quantitative research is a formal, objective, systematic process in which numerical data are used to obtain information about the world. This research method is used to describe variables, examine relationships among variables, and determine cause-and-effect interactions between variables. The qualitative research method of phenomenology allows understanding of the lived experience and the meaning it engenders. The aim of phenomenology is to explore an experience as it is lived by the study participants and interpreted by the researcher. Evidence-based practice is the conscientious integration of best research evidence with clinical expertise and patient values and needs in the delivery of quality, cost-effective health care. It provides the basis for policy decisions and for voluntary change in individual nursing practice. Nursing style is a matter of personal choice.

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11. What does appropriate generalization require? (Select all that apply.)

a.

Any type of sample, whether or not it is representative

b.

Application of findings to the population from which the sample was drawn

c.

More than one research study using the same research questions and variables

d.

Statistically significant findings

e.

Non-significant findings that are supported by several related studies

ANS: B, C, D

Generalization involves the application of trends or general tendencies (which are identified by studying a sample) to the population from which the research sample was drawn. Researchers must be cautious in making generalizations, because a sound generalization requires the support of many studies with a variety of samples.

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12. What best characterizes the contribution of qualitative nursing research to evidence-based practice? (Select all that apply.)

a.

It presents collective common evidence of health care clients’ experiences, which may provide inspirations for individual practice.

b.

It provides stories of how health care clients feel. This lets nurses know what people in similar circumstances can be expected to experience.

c.

It provides evidence that determines how nurses should interact with various cultures. This mandates action.

d.

It generates and tests theory.

e.

It reveals participants’ experiences and individual viewpoints, feelings, and interpretations. These can provide guidelines for client-centered care.

ANS: A, E

Qualitative research is a systematic, interactive, subjective approach used to describe life experiences from the research participants’ point of view. This type of research is conducted to explore, describe, and promote understanding of human experiences, events, and cultures over time. It is holistic and describes the human in context.

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