Week 5 – Evidence-Based Practice (EBP), Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

1. Overview of Evidence-Based Practice (EBP) Evidence-Based Practice (EBP) integrates clinical expertise, patient preferences, and the best available evidence to improve patient outcomes. It involves a systematic approach to clinical problem-solving.

2. Advanced Levels of Clinical Inquiry Clinical inquiry refers to the process of asking questions about clinical practice to improve care. Advanced levels of inquiry involve:

Formulating PICOT Questions:

P – Patient/Population

I – Intervention

C – Comparison

O – Outcome

T – Time Example: In elderly patients with hypertension (P), does daily exercise (I) compared to no exercise (C) reduce blood pressure (O) over 6 months (T)?

Types of Clinical Questions:

Background Questions: General knowledge (e.g., What is diabetes?)

Foreground Questions: Specific knowledge for clinical decision-making (e.g., Is metformin more effective than insulin in controlling blood sugar in adults with type 2 diabetes?)

Levels of Evidence:

Level I: Systematic reviews and meta-analyses of RCTs

Level II: Randomized Controlled Trials (RCTs)

Level III: Controlled trials without randomization

Level IV: Case-control or cohort studies

Level V: Systematic reviews of descriptive/qualitative studies

Level VI: Single descriptive or qualitative study

Level VII: Expert opinion

3. Systematic Reviews Systematic reviews are comprehensive summaries of research on a specific clinical question. They follow a structured methodology to minimize bias.

Steps in Conducting a Systematic Review:

Define a clear research question (often using PICOT)

Develop inclusion and exclusion criteria

Search for relevant studies in databases (e.g., PubMed, CINAHL)

Assess the quality of studies

Extract and synthesize data

Analyze and interpret findings

Report results transparently

Meta-Analysis: A statistical technique used within systematic reviews to combine results from multiple studies.

Importance in EBP: Systematic reviews provide high-level evidence that informs guidelines, policies, and clinical decision-making.

4. Application in Nursing Practice

Nurses use EBP to improve patient care, reduce errors, and enhance outcomes.

Systematic reviews help nurses stay updated with best practices.

Advanced clinical inquiry empowers nurses to question current practices and seek evidence-based improvements.

NURS 6052 Week 5 Quiz: Advanced Levels of Clinical Inquiry and Systematic Reviews

1. What does the ‘P’ in a PICOT question stand for? A. Procedure B. Protocol C. Practice D. Patient/Population Answer: D Explanation: ‘P’ stands for Patient or Population, defining the group targeted by the clinical question.

2. Which level of evidence is considered the highest in the hierarchy? A. Randomized controlled trials B. Expert opinion C. Case-control studies D. Systematic reviews and meta-analyses Answer: D Explanation: Systematic reviews and meta-analyses synthesize data from multiple high-quality studies.

3. What type of clinical question is: “Is metformin more effective than insulin in controlling blood sugar in adults with type 2 diabetes?” A. Descriptive question B. Background question C. Exploratory question D. Foreground question Answer: D Explanation: Foreground questions guide clinical decision-making by comparing interventions and outcomes.

4. Which database is commonly used to search for nursing and healthcare literature? A. ERIC B. Scopus C. Google Scholar D. CINAHL Answer: D Explanation: CINAHL is a key database for nursing and allied health research.

5. What is the primary purpose of a systematic review? A. To develop new theories B. To summarize existing research C. To provide expert opinions D. To conduct new experiments Answer: B Explanation: Systematic reviews summarize and synthesize existing research using a structured methodology.

6. Which component of a systematic review involves combining statistical results from multiple studies? A. Narrative synthesis B. Meta-analysis C. Case study D. Qualitative review Answer: B Explanation: Meta-analysis combines results from multiple studies for a more precise estimate.

7. Which of the following is NOT a step in conducting a systematic review? A. Assessing study quality B. Defining a research question C. Searching databases D. Randomizing participants Answer: D Explanation: Randomizing participants is part of experimental studies, not systematic reviews.

8. What does the ‘O’ in PICOT represent? A. Observation B. Outcome C. Objective D. Operation Answer: B Explanation: ‘O’ stands for Outcome—the expected result or effect of the intervention.

9. Which type of study is considered Level II evidence? A. Case study B. Expert opinion C. Systematic review D. Randomized controlled trial Answer: D Explanation: Level II evidence includes randomized controlled trials (RCTs).

10. Why are inclusion and exclusion criteria important in systematic reviews? A. To increase bias B. To ensure consistency and relevance C. To simplify the analysis D. To reduce the number of studies Answer: B Explanation: These criteria ensure only relevant, high-quality studies are considered.

11. Which of the following best describes a background question? A. Does diet affect cholesterol levels? B. What is the effectiveness of aspirin in stroke prevention? C. Is yoga better than medication for anxiety? D. What causes hypertension? Answer: D Explanation: Background questions seek general knowledge, such as causes or definitions.

12. What is the role of clinical expertise in EBP? A. To ignore patient preferences B. To replace research evidence C. To interpret and apply evidence in practice D. To conduct experiments Answer: C Explanation: Clinical expertise helps interpret and apply evidence to individual patient care.

13. Which of the following is a benefit of using systematic reviews in nursing practice? A. They eliminate the need for patient input B. They reduce the need for clinical judgment C. They provide anecdotal evidence D. They offer high-level evidence for decision-making Answer: D Explanation: Systematic reviews support informed clinical decisions and best practices.

14. What does the ‘T’ in PICOT stand for? A. Time B. Technique C. Treatment D. Trial Answer: A Explanation: ‘T’ refers to the duration over which the outcome is measured.

15. What type of question is “What is diabetes?” A. Foreground question B. Background question C. Comparative question D. Qualitative question Answer: B Explanation: Background questions address general knowledge about conditions or concepts.