Potter: Canadian Fundamentals of Nursing, 6th Edition

Chapter 06: Evidence-Informed Practice

Key Points – Printable
• Evidence-informed decision making is based on knowledge from research, clinical expertise and patient preferences, and values.
• Development of nursing knowledge is essential to the profession of nursing.
• Research literacy is an essential competency for evidence-informed practice.
• Conducting research studies is critical for the development of evidence.
• How a study is conducted (study design) is dependent on the research question being asked.
• When human subjects participate in research, the researcher must obtain their informed consent, must maintain their confidentiality,
and must protect them from undue risk or injury.
• When summarizing data reported in a research study, the nurse should note when, how, where, and by whom the investigation was
conducted, as well as who and what were studied.
• A researchable clinical nursing problem is one that is not satisfactorily resolved by current nursing interventions, occurs frequently in
a particular group, can be measured or observed, and has a possible solution within the realm of nursing practice.
• To determine whether research findings can be used in nursing practice, the nurse considers the scientific worth of the study by
substantiating evidence from other studies, the similarity of the research setting to the nurse’s own clinical practice setting, the status
of current nursing theory, and factors affecting the feasibility of application.

1. Questions
1.ID: 18735299585
You are a nurse researcher interviewing senior oncology nurses, asking them to describe how they deal with the
loss of a patient. The analysis of the interviews yields common themes describing the nurses’ grief. This is an
example of which type of study?
A.  Historical study.
B.  Qualitative study. Correct
A qualitative study involves inductive reasoning to develop generalizations or theories from specific
observations or interviews. Historical research establishes facts and relationships concerning past
events. Correlational research is exploration of the interrelationships among variables of interest
without any intervention by the researcher. An experimental study involves the use of tightly
controlled subject groups, variables, and procedures to eliminate bias and ensure that findings can
be generalized to similar groups of subjects.
C.  Correlational study.
D.  Experimental study.
2.ID: 18735299589
An operating room nurse is talking with colleagues during a meeting. She asks, “I wonder if we would see fewer
wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical patients?
What does the P represent in this example of a PICOT question?
E.  Povidone-iodine use.
F.  Surgical patients. Correct
Surgical patients are the patient population of interest (P) in the PICOT
(patient population, intervention, comparison, outcome, time) question. The intervention is the
cleaning of the skin, and the comparison of interest is between chlorhexidine use and povidone-
iodine use. Operating room nurses are not an element of the PICOT question.
G.  Chlorhexidine use.
H.  Operating room nurses.
3.ID: 18735300202
A nurse researcher is designing an exercise study that involves 100 patients who attend a wellness clinic. As the
patients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or
remain in the traditional program. The nurse plans to measure the patients’ self-report of exercise before and 6
months after the program begins. What factor might influence the results of this study in an unfavourable way?
I.  Bias.
J.  Gender.
K.  Sample size.
L.  Sampling method. Correct
Because the patients at the clinic are allowed their choice of the traditional versus the new exercise
program, the sampling in this study is not random sampling.
4.ID: 18735299596
The foundation of research is which of the following?
M.  Evidence.
N.  Documentation.
O.  Critical thinking.
P.  Scientific method. Correct
The scientific method is the foundation of research and is the most reliable and objective of all
methods of obtaining knowledge. Documentation, critical thinking, and evidence are not the
foundations of research.

5.ID: 18735300214
A researcher gives a subject full and complete information about the purpose of a study. This is an example of
which of the following?
Q.  Bias.
R.  Anonymity.
S.  Confidentiality.
T.  Informed consent. Correct
Informed consent implies that the research subjects are given full and complete information about
the purpose of the study, procedures, data collection, potential harms and benefits, and alternative
methods of treatment. Confidentiality rules guarantee that any information the subject provides will
not be reported to people outside the research team. Bias is any personal opinion or judgement that
may be interjected into the results. Anonymity means that the subject’s name and identifying
information would not be disclosed during the research study.

6.ID: 18735299587
A new nurse on an orthopedic unit is assigned to care for a patient undergoing skeletal traction. The nurse asks a
colleague, “What is the best practice for cleaning pin sites in skeletal traction?” This question is an example of
which of the following?
U.  Testing the hypothesis.
V.  PICOT question.
W.  Problem-focused trigger.
X.  Knowledge-focused trigger. Correct
A knowledge-focused trigger is a question regarding new information available on a topic. A
problem-focused trigger is one faced while the nurse is caring for a patient or noting a trend. The
PICOT (population, intervention, comparison, outcome, time) format is a way to phrase a question
to help clarify the question and the parts. A hypothesis is a prediction about the relationship between
study variables.

7.ID: 18735300206
The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients.
The nurses decide to initiate a quality improvement project with the plan, do, study, act (PDSA) model. Which of
the following is an example of the “do” step of that model?
Y.  Implement a new skin care protocol on all medical units. Correct
The “do” step consists of selecting an intervention on the basis of a data review, implementing the
change, and studying the results of the change. The “plan” step includes reviewing the available
data to understand existing practice conditions or problems to identify the need for change. The
results of the change are evaluated in the “study” step. The “act” step is the incorporation of the
findings into current practice.
Z.  Review the data collected on patients cared for using the new protocol.
AA.  Review the quality improvement reports on the six patients who developed ulcers over the
previous three months.
BB.  Based on findings from patients who developed ulcers, implement an evidence-informed skin
care protocol.
8.ID: 18735299583
The nurse researcher obtains informed consent from participants in a study primarily for which reason?
CC.  To release the researcher from legal liability.
DD.  To control variables that might affect the study.
EE.  To ensure that the study subjects understand their roles in the study. Correct
The conduct of research must meet ethical standards in which the rights of human subjects are
protected. The research participants must be told about the study’s purpose and procedure and their
roles in the study. The researcher is always legally responsible for his or her actions. Control of
variables is related to the study design, not to informed consent. Confidentiality is part of the ethical
nature of research but is not the focus of informed consent.
FF.  To maintain the confidentiality of the researcher and the participants.

9.ID: 18735300200
Which of the following is a priority goal for nursing research?
GG.  Controlling cost for hospitals.
HH.  Improving patient care. Correct
Quality patient care is always the primary focus of nursing practice. Cost control would be a benefit
but is not the primary focus. Research is not about technology; many “old” procedures can be
improved through research. Although research is a professional function of nursing, it is not done to
serve the profession.
II.  Keeping up with technological advances.
JJ.  Maintaining the professional climate in nursing.

10.ID: 18735299591
A clinical nurse develops a better way to secure an intravenous access device in a patient and wants to see
whether it would benefit other patients. Which of the following should be the first step in initiating a study?
KK.  Recruit patients to participate in the study.
LL.  Use the new technique and gather patient feedback.
MM.  Review current literature related to the clinical problem. Correct
Review of the literature is the first step in the orderly research process to determine what is already
known about the problem. Recruiting patients occurs later in the process, after the nurse identifies
the problem, researches the literature, and designs the study. Experimenting with new nursing
procedures that have not been tested or approved is a risk to patients. Surveys are designed to obtain
information from large study populations and would not be a first step in the research process.
NN.  Survey patients regarding their preferences and feelings regarding the procedure.

11.ID: 18735300208
The nurse researcher who obtains new knowledge regarding a procedure can most effectively share the
information with the nursing profession by doing which of the following?
OO.  Duplicating the study with different patients in different settings.
PP.  Communicating the research findings in a professional journal. Correct
Publication of research results provides other nurses with the scientific background of the study
before they apply its findings in practice. Study subjects and setting should be similar in order to
replicate a study. Nurses should not change from accepted to unproven ways of providing care
without careful research and collaboration with colleagues. Experimenting with new nursing
measures is inappropriate and may place a patient at risk.
QQ.  Recruiting patients who are willing to demonstrate the new technique.
RR.  Asking individual nurses to report their experiences related to the new procedure.
12.ID: 18735299598
Nurses who are new to practice can best contribute to nursing research by doing which of the following?
SS.  Assisting with data collection. Correct
A nurse who is new to practice has not developed the experience required for research but can begin
at the less complicated level of data collection. An experienced researcher is more qualified to
identify problems for formal research, although input from all levels of nursing is valuable. Nurses
with doctoral-level training are typically prepared for obtaining financial backing. A Canadian
Nurses Association position paper cites a master’s degree as qualification for preparing nurses to
implement research-based change in nursing practice.
TT.  Identifying clinical problems in nursing.
UU.  Obtaining financial backing and public interest.
VV.  Implementing research-informed change in nursing practice.
13.ID: 18735300212
A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the
following would be appropriate to use?
WW.  Survey methods.
XX.  Grounded theory.
YY.  Evaluation research. Correct
Evaluation research is aimed at finding out how well a program, practice, policy, or procedure is
working. A survey is a study of a large group to identify general information, opinions, attitudes, or
perceptions. A grounded theory is developed through the collection and analysis of qualitative data.
Experimental research involves collecting information about human subjects who are assigned to a
control group and a comparison group.
ZZ.  Experimental research.
14.ID: 18735299593
The nurse involved in scientific research effectively analyzes the information collected and determines a course
of nursing action by doing which of the following?
AAA.  Depending on tradition.
BBB.  Using critical thinking. Correct
Critical thinking involves analyzing the data, learning, and problem solving to come up with a
course of action. Tradition limits the ability to learn new ways and overlooks what research has to
offer. The advice of experienced practitioners may limit research because experience may mean
doing things the same way they have been done for years. Using personal opinion overlooks the
objective data that are available.
CCC.  Seeking the advice of experienced practitioners.
DDD.  Relying on personal perspective or opinion.

15.ID: 18735300204
A nurse manager is researching the effects of staff shortages on job satisfaction among new graduates. Which of
the following would be the most effective way to gather data?
EEE.  By directly observing the nursing behaviours on the unit.
FFF.  By interviewing staff nurses on the unit regarding their perceptions. Correct
A qualitative research study can be carried out effectively, in this case, in order to explore and
describe the perceptions of staff nurses about staff shortages and their job satisfaction. Through
narrative interviews, the participants’ perceptions can be compared, and common characteristics can
be discovered. It is difficult to collect data about perceptions or feelings without talking to those
involved. Quantitative survey and experimental research involves precise measurements and would
not be of use in this study of perceptions. Although obtaining suggestions for possible solutions
could be useful, it does not help to identify the problems on this specific unit. The data must be
collected first.
GGG.  By setting up an experimental group and a control group for the study.
HHH.  By calling on other nurses in the facility to suggest ways of handling the problem.
16.ID: 18735300210
Which of the following could be a barrier to nursing research?
III.  Presence of teams in nursing.
JJJ.  Pressure from the administration. 
KKK.  Staff wishing to change a policy.
LLL.  Shortage of professional nursing staff. Correct
Shortage of staff could mean less time and personnel to conduct and participate in research. Nursing
teams that have teamwork skills can aid research. The desire to change is an incentive for research.
Pressure from higher levels in the organization is also an incentive for research.

Chapter 11: Nursing Leadership, Management, and Collaborative Practice

Key Points – Printable

• A leader must set a vision or philosophy for a work unit, ensure appropriate staffing, mobilize staff and institutional resources to
achieve objectives, motivate staff members to carry out their work, set standards of performance, and make the right decisions to
achieve objectives.
• Leadership theories and perspectives are evolving and informed by nursing research.
• Nursing’s ethics and relational competencies constitute the foundation of leadership.
• Management and leadership are related processes; both are essential in nursing practice and health care delivery.
• Healthy practice environments are essential for quality nurse and patient care outcomes.
• Transformational leadership that emphasizes relationships, trust, and vision plays a key role in ensuring healthy practice
environments.
• An empowered nursing staff has decision-making authority to change how they practise.
• Models of nursing care delivery vary according to the responsibility of the registered nurse in coordinating care delivery and the roles
that other staff members play in assisting with care.
• Continuity of nursing care can be compromised in total patient care delivery, functional nursing practice, and team nursing.
• Best practice guidelines are evidence informed and contain recommendations for developing and sustaining collaborative practice
models and leadership.
• For decentralized decision making to succeed, staff members must be aware that they have the responsibility, authority, autonomy,
and accountability for the care they give and the decisions they make.
• A nurse manager can foster decentralized decision making by establishing nursing practice committees, supporting collaborative
practice, implementing quality improvement plans, and maintaining timely staff communication.
• Clinical care coordination involves accurate clinical decision making, establishing priorities, efficient organizational skills,
appropriate use of resources and time management skills, and an ongoing evaluation of care activities.
• To promote an enriching professional environment, each member of a nursing work team is responsible for open, professional
communication.
• Delegation involves transferring responsibility for performing an activity while retaining accountability for the outcome.
• When accomplished correctly, delegation can improve job efficiency and job enrichment.
• An important responsibility for the nurse who delegates nursing care is evaluation of the staff member’s performance and patient
outcomes.
• In a quality improvement–oriented environment, every staff member becomes involved in finding ways to improve or change work
processes so as to promote patient safety and quality care outcomes.
• Nurses’ career development involves planning and opportunities for mentorship.

Questions
1.ID: 18735310070 The nurse needs to complete all of the following tasks. Which task does the nurse perform first?
A.  Have the patient who had surgery yesterday cough and breathe deeply.
B.  Make a referral to the home care nurse for a patient who is being discharged in two days.
C.  Provide instruction on wound care to a patient with a wound drain who is being discharged later today.
D.  Notify the health care provider of the decreased level of consciousness of the patient who had a stroke
yesterday. Correct
Priority is always given to a health challenge that could indicate a life-threatening or life-changing incident.
The second-order priority here would be to get the patient being discharged today to cough and breathe
deeply. The third-order priority would be the teaching because this patient is being discharged today. The
lowest priority is the home care referral because the patient’s discharge is two days in the future.
2.ID: 18735310079
The charge nurse on a surgical unit is doing staff assignments for the 3:00 to 11:00 shift. Which of the following patients should the
charge nurse assign to the licensed practical nurse?
A.  The patient who had a mastectomy this morning.
B.  The patient who had a total laryngectomy yesterday.
C.  The patient who had a vaginal hysterectomy two days ago. Correct
The patient who had a vaginal hysterectomy should be the most stable of these patients and should require the least
amount of nursing assessment. A registered nurse (RN) should be responsible for the patient being discharged,
especially if teaching needs to be done. An RN should also care for the patient who had a laryngectomy because the
procedure was done fairly recently and life-threatening complications can arise, as well as for the patient who
underwent mastectomy because the surgery occurred only this morning.
D.  The patient being discharged this evening after total colectomy.

3.ID: 18735310081
Which type of care management approach entails coordination of health care services for patients and their families while streamlining
costs and maintaining quality?
A.  Team nursing.
B.  Primary nursing.
C.  Total patient care.
D.  Case management. Correct
Case management is the management approach that coordinates health care services for patients and their families
while streamlining costs and maintaining quality. Total patient care is the original care model in which an RN directs
all care for a patient. In team nursing, an RN leads a team of nurses and technicians to provide care. In primary
nursing, an RN directs implementation of the care plan for each patient.

4.ID: 18735310087
While administering medications, the nurse realizes he has given the wrong dose of medication to a patient. The nurse acts by completing
an incident report and notifying the patient’s physician. The nurse is exercising which of the following?
A.  Authority.
B.  Responsibility. 
C.  Accountability. Correct
Accountability is to the answerability of individuals for their actions. Authority is the legitimate power to give
command and make final decisions. Responsibility is concerned with the duties and actions that an individual is
employed to perform. Decision making is the process of critically appraising information and generating a conclusion.

5.ID: 18735310074
Many managers distribute biweekly newsletters describing ongoing unit or health care agency activities and post minutes of committee
meetings in an accessible location for all staff to read. This is an example of which of the following?
A.  Staff communication. Correct
Staff communication occurs through vehicles such as newsletters and practices such as making meeting notes
accessible. Nursing practice councils may or may not communicate with staff. Nurse–physician collaborative practice
is a model, as is interdisciplinary collaboration.
B.  Nursing practice councils.
C.  Interdisciplinary collaboration.
D.  Nurse–physician collaborative practice.
6.ID: 18735310091
During the morning rounds, the nurse assesses the condition of a patient who underwent major open-heart surgery 2 days earlier. The
patient complains of lower leg pain at the site where the vein graft was removed. The nurse finds that the intravenous (IV) infusion is
being delivered at the appropriate rate but that only 100 mL remains in the bag. An order exists for the IV infusion to continue. What is the
nurse’s first-order priority?
A.  Replace the IV bag with a new one.
B.  Instruct the patient about the complications of wound healing.
C.  Administer an analgesic to the patient to treat the leg pain. Correct
Pain is always a first-order priority. If 100 mL of solution remains in the infusion bag, the nurse has a small window
of time to focus on replacing the IV bag, which can be done after the pain medication is administered. The nurse
should verify pharmacy deliveries while obtaining the new IV bag. Wound healing instruction can be instituted after
action has been taken on the higher priority issues.
D.  Determine whether the pharmacy has delivered the IV solutions ordered for the day.
7.ID: 18735310089
A patient is experiencing an anxiety attack. What is the priority of this patient’s nursing need?
A.  Low (third-order) priority.
B.  High (first-order) priority. Correct
High (first-order) priority issues are those that create an immediate threat to a patient’s survival and safety. An anxiety
attack is such a high-priority issue because of the safety aspect. Issues of intermediate (second-order) priority are
those that do not have a potential to cause immediate harm. Issues of low (third-order) priority and nonemergency
priority are those that may or may not be related to the acute phase of the patient’s illness and can wait until other
problems have been addressed.
C.  Intermediate (second-order) priority.
D.  Nonemergency priority.
8.ID: 18735310077
The nurse checks on a patient who was admitted to the hospital with pneumonia. The patient has been coughing profusely and has
required nasotracheal suctioning. The patient is febrile and is receiving an IV infusion of antibiotics. The patient asks the nurse for a bath
because of profuse perspiring. Which task does the nurse delegate to the nursing assistant working with her today?
A.  Assessing vital signs.
B.  Changing the IV dressing.
C.  Performing nasotracheal suctioning.
D.  Administering a bed bath. Correct
The nursing assistant can administer the bed bath and report to the nurse. Nursing assistants cannot assess vital signs
(they can measure them but not assess them) or change IV dressings, and they should not perform nasotracheal
suctioning.
9.ID: 18735310066
Which of the following tasks is appropriate for an RN to delegate to the nursing assistant?
A.  Explaining to the patient about the preparation for an abdominal computed tomographic (CT) scan.
B.  Administering the contrast medium for an abdominal CT scan.
C.  Obtaining the IV solution that is to be started before the CT scanning.
D.  Measuring vital signs for a patient who is having an abdominal CT scan later in the morning. Correct
The nursing assistant can measure vital signs but cannot obtain IV solutions, perform patient education, or administer
medications (including contrast medium).
10.ID: 18735310072
Which of the following team members is essential for empowering a nursing team?
A.  Staff nurse.
B.  Nurse educator.
C.  Nurse executive. Correct
Without the nurse executive’s involvement in the organization, it is unlikely that anyone will advocate for the values
and goals of nursing. The team members named in the other options are important but are not essential for the nursing
team to move forward.
11.ID: 18735310083
In what way is the interprofessional collaborative practice model unique?
A.  It involves one member of the health care team.
B.  It focuses on physician satisfaction with patient care.
C.  It ensures that health care providers can practise to the full potential of their role and competencies. Correct
The interprofessional collaborative practice model is used by nursing teams and other health care providers who are
members of the interprofessional team. The entire health care team, not just one provider, is accountable for the care
delivered to the patient. The focus is on the patient, not on any health care provider.
D.  It requires that direct care be provided to the patient by one individual.

2.ID: 18735310068
A staff nurse has concerns about a procedural aspect of patient care. What is the most effective way for the nurse to ensure that this
concern is addressed?
A.  Complain to the chief nurse executive. 
B.  Discuss concerns with the unit manager. Correct
The nurse should verbalize all concerns about patient care to someone at the next management level and progress up
the chain of authority as necessary. In this situation, the unit manager would be the person who should be informed
first. Discussing concerns with co-workers is not the most effective way to address them. Complaining is not an
effective strategy for problem solving; instead, the nurse should offer possible solutions. It is never appropriate to
share procedural concerns with the patient or the patient’s family. The staff and management appropriately resolve
these issues.
C.  Share the concerns with the patient’s family.
D.  Discuss the concern with co-workers.
.ID: 18735310085
Which of the following statements represents a nurse-sensitive outcome?
A.  The patient ate 50% of lunch. Correct
The patient’s intake is a nurse-sensitive outcome that can be achieved as a result of nursing care. Family visitation
shows a family focus. The inability of a patient to report pain intensity indicates a problem, not an outcome.
Completing patient education indicates the completion of an intervention, not the attainment of an outcome.
B.  The patient’s family visited for thirty minutes. 
C.  The patient is unable to report a pain intensity rating.
D.  Teaching of insulin administration was completed.
14.ID: 18735310095
The five rights of delegation include which of the following?
A.  Right procedure, patient, time, credential, and supervision.
B.  Right task, circumstances, person, communication, and supervision. Correct
The five rights of delegation are right task, right circumstances, right person, right direction or communication, and
right supervision.
C.  Right time, procedure, qualification, agency, and direction.
D.  Right time, patient, procedure, nurse, and documentation
15.ID: 18735310093
The nurse instructs an unregulated care provider (UCP) to change the central line dressing of a patient after the patient finishes lunch. This
is an example of violating which of the five “rights” of delegation? (Select all that apply.)
A.  Task. Correct
B.  Person. Correct
C.  Direction.
D.  Supervision.
E.  Circumstance.
UCPs are not qualified to change central line dressings. This is an inappropriate delegation of a task to this person.