Evidence-Based Practice: Ask

The evidence-based practice process begins when events trigger an awareness in health care professionals that information is needed to care for a particular patient or that a practice change is needed.

Knowledge-Based Triggers

• New research or other literature
• New practice guidelines or standards for agencies or organizations
• Philosophies of care
• Questions from institutional standards committee

Problem-Based Triggers

• Clinical problems
• Risk management issue
• Benchmarking data
• Financial data
• Process improvement data

References
Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, C. L. Q., ... Goode, C. J. (2001). The Iowa Model of Evidence-Based Practice to promote quality care. Critical Care Nursing Clinics Of North America, 13(4), 497-509. (PMID: 11778337)

Once a question is triggered, use the PICO acronym to help formulate foreground or specific questions that will direct the rest of the EBP process:

• P - Patient, population, or problem of interest
  • Examples: Diseases and conditions
• I - Intervention or issue of interest
  • Examples: Exposures, diagnostic tests, prognostic factors, and treatments
• C - Comparison intervention or issue of interest
• O - Outcome expected

Reminders:

• Must be an answerable question
• Must be manageable

References
Fineout-Overholt, E., & Stillwell, S. B. (2015). Asking compelling, clinical questions. In: B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed., pp. 24-39). Wolters Kluwer. (UH Manoa Hamilton RT42 .M44 2015)

Straus, S. E., Glasziou, P., Richardson, W. S., Haynes, R. B., Pattani, R., & Veroniki, A. A. (2019). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier. (UH Manoa Hamilton E-book)

Questions are generated by triggers that occur when encountering a problem that cannot be answered or when you realize that your knowledge base needs to address a practice issue. Triggers generally generate two types of questions.

Background or general questions ask for general knowledge about conditions, tests, treatments, or aspects of health care. Example: What causes pressure ulcers? What are the complications of pressure ulcers?

Foreground or specific questions ask for specific knowledge to inform clinical decisions, actions, or practices. These questions can be further categorized into the following areas:

• Etiology (Harm)
• Diagnosis
• Therapy
• Prognosis
• Qualitative

References
Fineout-Overholt, E., & Stillwell, S. B. (2015). Asking compelling, clinical questions. In: B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed., pp. 24-39). Wolters Kluwer. (UH Manoa Hamilton RT42 .M44 2015)

Straus, S. E., Glasziou, P., Richardson, W. S., Haynes, R. B., Pattani, R., & Veroniki, A. A. (2019). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier. (UH Manoa Hamilton E-book)

The resources below are unrestricted.

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