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Evidence-Based Practice: Ask

Question Triggers

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

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)

PICO Model

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


  • Must be an answerable question
  • Must be managable

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)

Types of Questions

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

Web Resources

The resources below are unrestricted.

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