Model for Improvement
The Model for Improvement begins with three questions designed to clarify the following concepts:
a. Plan, do, act
b. Aims, measures, changes
c. Mission , goal , strategy
d. Will, ideas, execution
Answer : b
b. Aims, measures, changes
The first step of EBP
Answer:
Identifying a problem OR
cultivate a spirit of inquiry OR
question your current practice
The intended effect of evidence based nursing practice is
a. to help consumers provide patient care that is based on the available research
b to help consumers validate the findings of nursing research]
c. to help consumers understand credible data on nursing research practice
d. to help consumers validate traditional practices
Answer: a
a. To help consumers provide patient care that is based on the available research
In research , what is the highest category of evidence
a. case control studies
b. qualitative studies
c. cohort studies
d. meta- analysis
Answer: d.
d. meta analysis
The ethical term " do no harm " refers to
a. beneficence
b.fidelity
c. bioethics
d. non maleficence
Answer: d. non maleficence
d. What is non maleficence
You conduct PDSA cycles every day
True or False
Answer: True
We all test out new ideas constantly. Consider :
"Instead of writing out notes while in class, I tried to type the notes on my laptop. That was a disaster! I missed half the lecture trying to type faster than my skills allowed ".
This model is not a model for EBPP
a. Iowa Model of Evidence-based practice
b. Johns Hopkins Nursing Evidence-based practice
c. Stetler Model of Evidence-based practice
d. Colorado Research for evidence-based practice
Answer d:
d. Colorado Research for evidence- based practice.
As you transition into practice you will experience uncertainty. When you are uncertain , what steps should you take to ensure the use of the best available evidence to guide your practice?
a. "I'll conduct a research study to uncover information"
b. I'll use my organization's QI process to answer questions
c. "I'll review and appraise available evidence to determine the most effective clinical practice"
Answer: c:
c. I'll review and appraise available evidence to determine the most effective clinical practice
Examining and appraising the available evidence is the most effective means of providing nursing care that is necessary to enhance the outcome for the patient.
Conducting a research study and examining your org QI process would not yield timely information to improve outcome.
Your preceptor asks you to check orthostatic VS on your patient. You wonder about several questions, " what's the best practice to do this?, Is it okay to measure using the forearm ? Should I use a manual or automatic cuff?".
With this mind , how would you phrase your clinical practice question?
a. What's the best practice when measuring orthostatic BP in the forearm ?
b. For patients who are obese, is it reliable to measure orthostatic blood pressure in the forearm versus upper arm to obtain accurate readings ? ...
c. For patients who are obese, is it reasonable to measure orthostatic BP in the forearm ?
Answer:b
b. For patients who are obese, is it reliable to measure orthostatic blood pressure in the forearm versus upper arm to obtain accurate readings ? ...
Remember to be as specific as possible when developing clinical questions. ( who, what, where, why, when , how ).
You are a social media contact with Susan, another nurse on your unit. She made a post that you suspect is about Mr. Keller because of the individually identifiable health details she provides, even though she does not use his name.
You ask her about the post and she replies that she asked her social media contact to pray for Mr Kelly and his wife.
Did Susan violate HIPAA?
a. yes
b. no
Answer: a. Yes
a. Your colleague has breached the Keller's privacy by making a social media posting about them without their permission, even though she withheld names. Further, by disclosing individually identifying information about a patient outside of what is allowed by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, she may have violated a federal law.
The acronym PDSA
Answer:
Plan
Study
Do
Act
EBP emphasizes research evidence over all EXCEPT
a. tradition
b. authority
c. trial and error
d. friend's experience
e. best practices
Answer: e.
e. EBP fosters best practices.
You have developed a clinical practice question and now it is time to conduct a literature review. How do you think the literature review you learned in school is different from clinical practice?
a. You will need to conduct a broader literature review to ensure findings to a larger population
b. There wont be any differences
c. The review will be a more targeted review since the clinical question is one that came about during your practice.
Answer : C.
c. The review will be a more targeted review since the clinical question is one that came about during your practice.
You are inserting an NG tube for the first time and you have read the procedure. Your preceptor asks you afterwards if you have any questions about how to insert the tube or check the placement . You reply " last week I saw a nurse check placement by auscultation of an air bolus, is that ok? Your preceptor replies "since we have time, why don't we see what the evidence shows"
What would your clinical practice question be?
a. Should the verification of NG tube occur via chest x-ray, auscultation of air or another method in med-surg patients ?
b. To prevent inadvertent placement in the lungs, what is the most reliable method for verification of placement of NG tube in obese patients ?
c. How can we standardize nursing practice to ensure consistency with the placement of an NG tube for medical- surgical patients ?
Answer: b.
b. To prevent inadvertent placement in the lungs, what is the most reliable method for verification of placement of NG tube in obese patients ?
This question covers a clearly identified patient population, a clinical intervention or issue, a baseline or comparison point, and a measurable outcome.
You are the nurse for Mr. Hunter who is a post op patient. Before Mr Hunter's evening meal, his blood glucose level is 185 mg/dL. You explain that the doctor has ordered a weight-based corrective dose of insulin before meals and at the hour of sleep. Mr. Hunter states:
"Hold on a second. I don't want to take insulin. I just take a pill at home." How should you respond :
a. Your doctor ordered insulin, not oral medication, to manage your blood glucose in the hospital
b. We give insulin to all our diabetic patients after surgery
c. In the hospital, insulin is better to control blood glucose levels ,lower your risk of infection, and promote healing. Please tell me more about your concerns.
Answer: c
c. A simple explanation should help Mr. Hunter understand the importance of and make an informed decision about using insulin for glucose control after surgery. Telling Mr. Hunter that his doctor has ordered insulin without an explanation or that insulin is used perioperatively for all patients does not provide education about the new medication.
There are five steps to the Model of Improvement. What step do you utilize the PDSA cycle
a. Set an aim
b. Establish measures
c. Identify changes
d. Test changes
e. Implement changes
Answer: d.
d. The "Test change" step is where the PDSA cycle comes in. By planning a test of change, trying the plan, observing the results, and acting on what you learn, you will make progress towards your aim.
PICOT stands for
P-Population
I- intervention
C- comparison
O- outcome
T- time
The provider is making rounds and mentions he will order placement of an NG tube on Ms Lewis . Because this is your first time inserting an NG tube you go to your VDT and log into ..... to view the steps beforehand
Answer: Lippincott Procedures
Which statement reflects safe delegation for assisting a postoperative patient to ambulate?
a. After the initial RN assessment at transfer, routine, direct patient care activities for postoperative patients can be delegated to nursing assistants.
b. After verifying training and competency, a registered nurse (RN) can always delegate ambulation assistance to a nursing assistant.
c. Before asking an unlicensed assistive personnel (UAP) to assist a patient in ambulation, the RN must assess the patient's gait.
d. After confirming with the nursing assistant that she is able to ambulate the patient , the nurse can always delegate ambulation assistance to a nursing assistant.
Answer c:
c. Before asking an unlicensed assistive personnel (UAP) to assist a patient in ambulation, the RN must assess the patient's gait
Rationale: Delegation is not based only upon the training and competency of the delegate.
Various medications are used to treat pain and may work at different stages of the pain pathway. Which medication isn't used to treat pain?
a. Analgesic (such as acetaminophen )
b. NSAIDS ( such as toradol )
c. Antidepressants
d. Amphetamine
e. Anticonvulsants such as Neurontin
Answer: d. Amphetamine
d. Amphetamines are stimulants used to treat ADHD, narcolepsy, or obesity.
The first step in the Model for Improvement is setting an aim statement. An aim statement needs a S.M.A.R.T goal. What does the acronym S.M.A.R.T stand for ?
S-specific
M-measureable
A-attainable
R- realistic
T-Timely
An example: Decrease the infection rate in the NICU from 11 infections per 1000 catheter days to fewer than 5 infection in nine months.
Two barriers of EBP are
time , lack of knowledge or confidence
skills , non supportive environment
incentive
attitude
resources
Your preceptor reminds you to search for reliable sources of information to ensure that you find the most relevant evidence . With this in mind, name 3 databases you have used to conduct your research.
Answer: Any 3 of the following
Medline, PubMed, Cochrane Library , UptoDate
Some organizations will have you review the "rights of delegation" before assigning an activity. The current NCSBN approach to delegation incorporates these "rights,". Name 4 of the rights of delegation.
Answer: Any 4 of 5
Right task
Right circumstances
Right person
Right directions and communication
Right supervision and evaluation
What assumption about generational issues typically lead to conflict ?
a. expecting to find that different generations will have different life experiences
b. Expecting to find common characteristics among the specific generations
c. Expecting that everyone shares that same point of view
d. Expecting that all generations communicate the same
Answer c:
c. Expecting that everyone shares that same point of view.