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
• I - Intervention or treatment
• C - Comparison intervention or treatment
• O - Outcome

Reminders:

• Must be an answerable question
• Must be managable

References
Nollan, R., Fineout-Overholt, E., & Stephenson, P. (2005). Asking compelling clinical questions. In: B. M. Melnyk & E. Fineout Overholt (Eds.), Evidence-based practice in nursing & healthcare: a guide to best practice (pp. 25-37). Philadelphia: Lippincott Williams & Wilkins. (UH Manoa Hamilton RT42 .M44 2005)

Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2011). Asking answerable clinical questions. In: Evidence-based medicine: how to practice and teach it (4th ed., pp. 13-27). Edinburgh: Churchill Livingstone/Elsevier. UH Manoa Hamilton Reference R723.7 .E954 2011)

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 some aspect of a disorder. Example: What causes pressure ulcers? What are the complications of pressure ulcers?

Foreground or specific questions ask for specific knowledge about managing patients with a disorder. These questions can be further categorized into the following areas:

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

The resources below are unrestricted.

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