Chapter 24 Translating Research into Practice
1. The chief nursing officer at a local hospital seeking Magnet® status creates staff
development classes concerning translation of research into practice (TRIP). What best
describes TRIP?
a. Conducting an integrative review of the literature
b. Searching the literature for a systematic review
c. Providing the results of research studies to practitioners
d. Applying strategies that aid in adoption of research in practice
The science of how research is adopted is known as translation science, the science of
translating research into practice (TRIP). The primary aim of research utilization is to
activate the change process to move research findings into practice to improve patient
outcomes.
2. The chief nursing officer at a local hospital seeking Magnet® status creates staff
development classes about incorporating evidence-based practice in nursing. What best
describes evidence-based practice?
a. Applying best research evidence to care of patients
b. Using research-based information to develop practice guidelines
c. Conducting a randomized control trial to determine effectiveness of handwashing
techniques
d. Developing standards for practice
Evidence-based medicine is derived from evidence-based medicine and involves
integration of the best research evidence with clinical expertise and the patient’s unique
values and circumstances in making decisions about the care of individual patients. It is
focused on searching for, appraising, and synthesizing the best evidence to address a
specific clinical practice problem.
3. As a nurse manager, you trial a new pain scale on your unit that is supported by
numerous research studies. You compare the patient outcomes with the new scale
against the existing scale. Feedback from staff suggests that the new scale is too difficult
for patients who have limited language skills and who are already under duress to
understand. The difficulty in implementing the new scale refers to testing:
a. efficacy.
b. effectiveness.
c. practice failure.
d. comparative error.
Comparing the effectiveness of interventions can help to address the needs of clinicians
in determining best practices for their patients. Comparative effectiveness research
(CER) is the “generation and synthesis of evidence that compares the benefits and
harms of alternative methods to prevent, diagnose, treat, and monitor a clinical
condition or to improve the delivery of care” (Institute of Medicine, 2009, p. 29).
Efficacy is testing an intervention or treatment in a traditional randomized clinical trial
under carefully controlled conditions and is used to determine whether an intervention
or treatment works, whereas effectiveness is testing whether the intervention or
treatment works in the real world of practice.
4. The nurse manager wants to use evidence-based recommendations to prevent
ventilator-associated pneumonia. What is the critical first step to effectively gather
evidence for guiding practice?
a. Develop the clinical question.
b. Identify the databases to be used.
c. Appraise the evidence.
d. Integrate available evidence with unit expertise.
Identifying the question may be the most challenging part of the process. Once the
clinical question has been identified, writing it down will help in moving on to the next
step of gathering evidence.
5. A strategic goal for nursing in the facility developed by the chief nursing officer is to
implement an evidence-based practice program. What is an appropriate strategy that
can be used by a nurse manager who is beginning to implement an evidence-based
practice program on the unit?
a. Conducting a review of adverse events and incident reports
b. Soliciting input from staff members
c. Reviewing specialty organization guidelines
d. Identifying patients with extended lengths of stay
Stakeholders need to be involved early, and staff members need to be involved when
initiatives involve direct patient care. Involvement assists in understanding issues and
concerns, motivations, and unmet needs.
6. The nurse manager of an ICU wants to implement the revised policy and procedure
on central line catheter care. What would be the most effective method of getting the
staff nurses to incorporate a new evidence-based practice into their care?
a. Conducting an interactive educational workshop
b. Distributing educational materials on clinical units
c. Sharing the results of a chart audit with staff
d. Providing staff with a short DVD on the topic
Suggestions for effective strategies that promote behavioral change in health
professionals include active involvement strategies such as face-to-face information
sessions in small groups and one-to-one interactions. Other approaches have mixed or
few results.
7. Before implementation of the new policy and procedure on central line catheter care,
the nurse manager uses an appraisal system to evaluate the evidence. What is important
in using an appraisal system to evaluate the evidence gathered in preparation for
development of a new protocol?
a. Limiting the search to randomized clinical trials
b. Matching the appraisal tool to the type of evidence
c. Eliminating qualitative research studies
d. Using only preprocessed evidence
Appraisal tools are specific to the number of studies, as well as to the study design (type
of evidence), type of review, and strategy for determining the applicability of evidence to
your practice.
8. To help staff nurses adjust to using research in practice, what strategy would the
nurse manager use?
a. Attendance at a regional research conference
b. Formal classes in electronic search techniques
c. Establishing a journal club
d. Issuing reports on the adverse consequences of outdated practices
Journal clubs provide opportunities for engagement in reading research and considering
how it might be applied to clinical practice problems, which is considered very effective
in behavioral change.
9. What is a strategy that can be used by a small community hospital with limited
resources to develop an evidence-based nursing practice program?
a. Hiring a nurse researcher
b. Partnering with nurse researchers at a local university
c. Subscribing to journals devoted to evidence-based nursing
d. Including research competencies in managers’ job descriptions
Partnering with nurse researchers assists in providing nurse researcher expertise and
leadership to organizations that do not have the size or the resources to hire nurse
researchers.
10. Tara, the unit manager, is explain to her colleague her recent project, which involves
seeking the most effective approaches to incontinence care, with the intention of
adopting evidence-supported approaches on her dementia care unit. Her colleague
suggests that translation of research into practice is:
a. less important than knowledge-generating research, which is required to advance the
nursing profession.
b. a priority of all healthcare practitioners to improve patient care.
c. characterized by lack of knowledge about how to use evidence to guide practice.
d. so difficult that it is useless to begin the query in the first place.
The National Institutes of Health identified translational research or getting research
into the hands of practitioners to improve patient care, as a priority.
11. After searching the literature, Tara, the unit manager develops a table that outlines
the findings of studies on management of incontinence. She then examines the studies
in terms of risk and whether the findings fit within her practice context and for her
population of moderately to severely cognitively impaired patients. This is which phase
of a research utilization model?
a. Preparatory
b. Validation
c. Evaluation
d. Application
The third phase, comparative evaluation and decision making, involves making a
decision about the applicability of the studies by synthesizing cumulative findings;
evaluating the degree and nature of other criteria, such as risk, feasibility, and readiness
of the finding; and making a recommendation about using the findings of the studies.
12. The clinical guidelines for management of incontinence developed by the Registered
Nurses Association of Ontario (RNAO):
a. reflect practice that is fiscally directed and sound.
b. articulate practice recommendations developed from synthesis and
review of evidence.
c. are intended to increase awareness of issues in incontinence management.
d. reflect a compilation of information from a variety and range of sources related to
incontinence.
The evidence-based practice (EBP) movement has grown exponentially with scientific
publications, establishment of collaboration centers, resources on the Web, and grants
focused specifically on translating of research into practice. A number of evidence-based
nursing centers have been established around the world. These centers have teams of
researchers who critically appraise evidence and then disseminate protocols for the use
of evidence in practice. In this example, clinical guidelines have been developed by a
professional nursing organization on the basis of best possible evidence on incontinence
management. Although issues may be raised in the recommendations, the purpose is to
guide practice for the purposes of better patient care.
13. Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager
to adopt evidence-based recommendations related to family-centered care on the unit.
Marie’s response has been that she rarely has time to provide care to patients, let alone
families, and that there is no good reason to do anything different than what she is
already doing. An approach that may gain Marie’s support of the idea is to:
a. invite Marie to review the studies for herself.
b. suggest that she does not need to provide family-centered care.
c. avoid discussion of the idea with her until she initiates it.
d. secure the support of her closest colleagues on the unit.
As a skeptic, Marie, who is a late majority adopter, needs pressure from colleagues to
move her toward support of the recommendations. The translation of research into
practice requires that nurse leaders and managers understand group dynamics,
individual responses to innovation and change (such as the response of late majority
adopters), and the culture of their healthcare organization.
14. You are excited by evidence supporting the use of workstations on wheels (WOWs) at
the bedside to improve documentation and patient outcomes. You have disseminated
the information through discussions and e-mails and are now ready to begin the process
of considering implementation on the unit. To develop positive attitudes toward the use
and implementation of the technology, you would discuss your ideas with (Rogers’
diffusion of innovations theory):
a. Harvey, RN, a technology guru, who enthusiastically tries on all new software.
b. Berta, RN, who thoughtfully considers evidence and regularly uses it to
try new approaches in her practice.
c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas
about whether or not to try something new.
d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at all.
He says that he will use it when there is no chance of security breaks.
Berta is the one with whom you should now have informed conversations, because she is
an early adopter who is respected for her thoughtful acquisition and critique of
knowledge and application of knowledge to practice. Berta, an early adopter (Rogers’
characteristics of innovation adopters), is more effective in this stage than Harvey, an
innovator who may be seen as open to all new ideas regardless of merit.
15. The implementation of saline flushes for capped angiocatheters across all areas of
practice in the facility is an example of:
a. how multilevel and interprofessional application of a procedure can slow
adoption of EBP.
b. how competition among disciplines can lead to negative patient outcomes.
c. the reluctance of hospital administrators to act on recommendations from EBP.
d. how a safe, well-known practice outweighs the benefits of adopting a newer practice.
The translation of research into practice operates at four levels: The individual
healthcare professional, healthcare groups or teams, organizations, and the larger
healthcare system or environment. The adoption of saline flushes illustrates the
challenges of communicating EBP to other disciplines and organizations and of the
involvement of different levels. This particular innovation needed endorsement by
nurses, physicians, and pharmacists, as well as by administrators who needed evidence
of lost savings to support adoption.
16. Which of the following would be most effective in implementing the findings of a
new clinical treatment for problems associated with bowel motility for the staff nurses?
a. Lecture by a nurse practitioner
b. Workshop for surgical nurses that involves discussion of case studies and
application of evidence
c. Discussion of the findings on the bulletin boards at the workstation
d. Education of unit opinion leaders regarding the evidence presented in the studies
Current research suggests that translation of research into practice is best facilitated
through interactive learning such as workshops. Least effective strategies included
didactic learning and distribution of learning materials.
17. Which of the following is an effective approach in the appraisal of research studies?
a. Accept only studies that use a RCT design.
b. When ranking research studies, choose RCTs over qualitative studies.
c. Select only studies with a large sample size.
d. Evaluate the quality of the research against the standards for that type of
research.
While randomized controlled trials (RCTs) are generally considered the gold standard
for research, it is important to assess not only the method but also the quality of the
study and its applicability to the question that is being asked. The quality of all studies
should be appraised against the standards accepted for that type of research.
18. Within a multisite healthcare system, the most appropriate strategy for translation of
research would be:
a. widespread development of protocols using EBP at unit levels.
b. dissemination of EBP and recommendations to individuals, units, and the
organization.
c. development of the skills of individual managers on how to build guidelines based on
EBP.
d. establishment of an interdisciplinary center to guide and lead the
translation of research findings into practice.
At a systems level, the most appropriate approach would be establishing a center that
leads in, guides, and promotes EDP across and at various levels.
19. At an organizational level, which of the following strategies would assist in ensuring
that EBP is incorporated into nursing care?
a. Formation of nursing-only implementation teams
b. Restriction of evidence to RCTs
c. Formation of a network of individuals doing research and/or interested
in research utilization
d. Avoidance of partnership with experienced researchers
Collaboration, partnerships, and consideration of a variety of evidence appropriate to
the clinical questions are important in ensuring translation of evidence into practice.
Collaboration is considered particularly critical and can occur through practice-based
networks.
20. Which of the following is most accurate regarding evidence-based practice?
a. Evidence-based practice replaces continuous quality improvement.
b. Evidence-based practice began with medicine and assists in determining which
medical models can be applied in nursing practice.
c. Effective and efficient care can already be demonstrated, which means that EBP will
soon become redundant.
d. EBP is generally recognized across disciplines and by policymakers as
state-of-the-art clinical practice.
EBP is recognized across nursing and other disciplines as reflective of state-of-the-art
clinical practice, as it is based on best available evidence.
21. Which of the following is a meta-analysis?
a. Review of 35 studies on nurse work satisfaction to determine the
significance of the aggregated research findings
b. Review of multiple chart audits to determine which errors are being reduced through
implementation of evidence-based guidelines
c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of
venipuncture in young children
d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency
room sites
Meta-analysis statistically combines the results of several similar studies to determine
whether aggregate findings are significant.
22. Once evidence related to the use of prompted voiding in patients with cognitive
impairment has been appraised and integrated with practice, it is important to:
a. consider whether patients’ families see this as necessary for the well-
being of family members.
b. search large databases such as CINAHL to amass further evidence.
c. clarify the clinical practice question.
d. solicit input regarding integration with practice.
EBP is the integration of best research evidence with clinical expertise and the patients’
unique values and circumstances. In this situation, the family’s values and preferences
would be considered. Search of databases, clarification of the question, and gaining staff
input would occur in the process.
23. As the unit manager, you are interested in determining whether patient autonomy is
preserved through informed consent in surgical settings. You determine that
participatory action research is the best method to address this question. Which of the
following is consistent with a participatory action research design?
a. You interview 125 patients who have recently undergone surgery and transcribe the
interviews to determine themes. Themes are validated with an expert in informed
consent.
b. You circulate a questionnaire to patients who recently underwent surgery and ask for
their opinions regarding consent. Data is analyzed and the findings distributed to
administration and other groups.
c. An audit is undertaken of signed consents for treatment, to determine if the consent is
properly witnessed and signed. Findings are used to inform changes in policies.
d. You meet with a patient group to determine which questions should be
asked about patient informed consent and what issues might be
encountered and addressed during the research.
In participatory action research (PAR), the members of the community being studied
are integral members of the research team and are involved in identifying the questions
and addressing the issues involved in the implementation of the research project.
24. Volunteers in a study are assigned randomly to groups. Some of the volunteers
receive an herbal supplement that is reputed to control nausea, and some of the
volunteers are assigned to a control group where a placebo is administered. This is an
example of a(n):
a. longitudinal study.
b. RCT.
c. meta-analysis.
d. appraisal tool.
RCTs, or randomized controlled trials, always involve testing of a treatment through the
random assignment of subjects in the study to an experimental or treatment group or to
a control group that receives a placebo.
25. A nurse manager introduces prompted voiding into nursing practice on a unit, which
is supported by clinical guidelines based on evidence-based practice. The nurses on the
unit resist implementation, indicating that the bathroom facilities are too far away for
efficient implementation of the guidelines, and that resources are too few to accomplish
the initial voiding observations. For the nurse manager in this situation, it is important
to have further discussion with the staff regarding: (Select all that apply.)
a. compatibility of this intervention with the values of staff on the unit.
b. advantages of prompted voiding over incontinence products and
catheterizations.
c. usefulness of prompted voiding with the particular population of patients
on the unit.
d. feasibility of the program with respect to unit design.
Various theories related to the translation of evidence into practice point to strategies
for success in introducing innovation and EBP on units, including determination of how
well the innovation fits with the values of the staff; benefits of this practice or innovation
over current practice; appropriateness of the innovation or practice for the target group
for which the practice is intended; and the feasibility of the innovation from a variety of
perspectives, including the physical design or layout of a unit.
