Skip to Main Content
Today's Hours

The Clinical Inquiry Process Resource Guide

The goal of this guide is to provide nurses a resource to understand and carryout the steps of performing an evidence-based practice (EBP) project.

Where do questions come from?

 

Sources of Potential Clinical Questions

When it comes to clinical inquiry, the question is the key, as it provides the initiative or project with direction, helps to tell the story, and will ultimately bring focus to your searches. Now, there is not just one source for questions; a question can arise from many different places in the healthcare environment. Below is a diagram listing some of those sources for questions.  Keep in mind when it comes to questions that it does not have to come from a single source, but in fact could come from a combination of sources.

 

Sources:

  • Hospital or Unit Goals: 

    These goals are established because they address areas or issues identified by the organization. This could be due to metrics/benchmarks not being met or through other means.

    Aligning any clinical question with these goals/priorities is advisable, as it enhances the likelihood of obtaining buy-in from other stakeholders and securing resource support.                
 VCU Health FY 2023: Quality, Safety and Service Priorities 

Old Goals - Need to Change 

  •  
  • Improving Throughput / Length of Stay
    • Capacity Management
  • Reducing Admissions / Care Transitions 
  • Reducing Hospital-Acquired Conditions 
    • CAUTI, CLASI, C.Diff. , MRSA, Accidental Falls
  • Improving Patient Experience / Service Excellence 
  • Increasing Access to Care  - Ambulatory, Transforming Practice 
  • Safety:  Reducing Harm and Mortality 
    • Includes:  Sepsis Care, Mortality Review Process, Handoffs and Reducing Harm Events
  • Team Member Engagement 
  • Nursing Quality Indicators and Other Hospital Data Sources

The quality of healthcare and nursing care is determined through metrics that enable organizations to benchmark or compare themselves with others. If the data indicates that certain aspects of patient care or the organization are not meeting identified benchmarks, it is a clear indication that action needs to be taken. These are the areas where benchmarks are not being met.

If you are unsure about the indicators of nursing quality, they are listed below:

Nursing Quality Indicator
 
 
 
Your comprehensive guide to the press ganey national database of nursing quality indicators(Ndnqi). (2023, January 12). https://info.pressganey.com/press-ganey-blog-healthcare-experience-insights/your-comprehensive-guide-to-the-press-ganey-national-database-of-nursing-quality-indicators-ndnqi
  • Events on the Unit

Has there been a situation in your unit related to patient care that was not as safe as needed? Alternatively, are you observing any other issues in the work environment that make it less than ideal?

  • What are you stressed out about or makes your job more difficult?

Is there anything on the unit that is making patient care more challenging or increasing stress? 

  • Observation of processes on the unit - Do you see any variations in practice?

Is everyone on your unit, as well as on other units, following the same procedures with the same patient populations or groups? If not, the variations in practice present an opportunity for some form of clinical inquiry, grounded in evidence.

  • Safety Intelligence (SI) Trends (Formally known as PSN's)

While conducting chart reviews, are you noticing any recurring issues related to patient care?

  • Professional Literature 

Are you discovering any new, evidence-based interventions in the literature that could help address an issue you are currently facing on your unit?

 

It may be easier to discuss these questions as part of a group to facilitate ideas. Can bring to your unit's shared governance committee or discuss during unit staff meetings.  

 

Determine if your question is a valid EBP Question and Refine It

Clinical Questions:  Determining Validity and Feasibility

Once you have identified a problem or issue to be explored, the next step in the process is to begin formulating your clinical question. To ensure that the question is both valid and falls within the scope of nursing practice, you should refer to hospital and unit resources. It's important to remember that clinical inquiry and clinical care are collaborative efforts. Therefore, consulting both unit and hospital resources is crucial to ensure the question's validity and feasibility.

Not all questions arising in clinical practice necessarily will lead to projects/initiatives, but they can still contribute to enhanced patient care and a more positive work environment.

Considering the following topics/questions as you work towards a focused question will help to determine how successful your clinical inquiry may be if it turns into a initiative/project.   These are not considered in any particular order but are things to consider as you are talking with others about your concern and ideas on how to make things better. 

Questions and Resources to Consult When Determining Feasibility/Validity 

  • Is there an evidence-based approach that has been established for addressing this problem?

There may be an existing evidence-based guideline, hospital protocol, or other guidance that supports the process or procedure being carried out.  Best to check before moving forward.

 

Find a Practice Guideline or Unit Protocol? 

Just because you have found something that provides guidance related to care, it does not mean that your work is done. It is only considered complete when you are able to answer the following questions, which demonstrate that the publication is evidence-based and current. If not, it may be appropriate to proceed at least to ensure that the stated plan of care is evidence-based and current, and that the sources supporting the guidance are documented.

Questions to Consider

  • When was it written? -  If 5 years or more it may be time to update the policy could be selected as a project. 

  • What is the supporting evidence? -  If there are no supporting citations the policy needs to be updated.
  • Is the problem/issue/topic within the scope of nursing practice?  
    • If the answer is no, you will need to team up with those who are part of the clinical practice. If unable, it is best to find another topic to pursue if attempting to launch an EBP project/initiative. 
  • What does the Patient or Patients Family Want or Value When it Comes to Care?
    • Remember no two patients are the same and what the patient wants when it comes to care is important. 
  • Time  
    • How much time do you think is needed to explore this topic through implementation?
    • Do you and your team have the time to devote to exploring this topic and following through on implementation? •
    • Is there a hospital resource or team that you could partner with to maximize your time? 
  • Resources
    • Does the organization have the tests, equipment, and other resources needed to implement this intervention? 
  • Cost / Return on Investment (ROI)
    • What do you expect the costs of the practice change to be, and what are the potential cost savings for the organization? 
  • Data Collection & Protection of Patient Health Information  
    • What data will need to be collected to measure the effect of the intervention?  
    • Who in the organization may need to assist in obtaining this data?  
    • Are steps being taken to protect patient health information? 
  • Team Identified  
    • Have you assembled a group of individuals to support your initiative/project?
    • Does this group include representatives from multiple disciplines if your topic has interdisciplinary implications? 
    • Make sure to confirm that those identified are willing to contribute.        

 

References

OHSU Clinical Inquiry Council. (2015). Oregon health & science university - evidence-based practice toolkit for nursing. Retrieved from http://libguides.ohsu.edu/ebptoolkit