How do you come up with a question?
Hospital or Unit Goals
Best when your question aligns with these goals because it helps to increase buy-in from others and improves the chances that there will resource support.
Events on the Unit
What are you stressed out about or makes your job more difficult?
Observation of processes on the unit - do you see any variations in practice
Safety Intelligence (SI) Trends (Formally known as PSN's)
Patient Satisfaction Scores and Other Hospital Data Sources
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.
These steps will help you start identifying a need for your question. After consulting with others and searching the literature if it does not yield a definite answer, then you need to proceed with the development of a PICO question to structure your EBP process.
People/Sources to Consult and Questions to Ask:
Is your question addressed by a specific policy/procedure/regulatory agency?
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.
Speak with your nurse manager or nurse clinician about the biggest concerns on the unit.
A conversation about current practice issues on the unit ("Safety Intelligence" trends, learning needs).
Consult the hospital data/ key performance indicators- falls, pressure ulcers, Patient Satisfaction scores.
How does your unit compare, what can be done better?
Seek out experts on your topic within VCU Health System and outside of the organization.
Experts may be aware of the current evidence already in practice. They will be able to help you further refine the need for your question. Some of these individuals will/are stakeholders in the potential EBP project and so referring to the stakeholder analysis tool.
Do a brief search for a practice guideline, meta-analysis or systematic review in order to ensure there is not any high-level evidence that would preclude you from performing your evidence-based practice project.
When beginning to explore your topic, you will need to make sure that you ask a clear focused question. In order to ensure that you do this well, you will need to answer two types of questions. Depending on the question the types of resources consulted will vary.
Background Questions: Focuses on the big picture and provides basic, general knowledge in reference to a specific condition, situation or topic.
Provides general information that enables one to gain a greater understanding and allows one to understand the options or possibilities when it comes to addressing a topic.
Tend to have two components.
A question root (who, what, when, etc.) with a verb
A disorder, test, treatment, or other aspects of healthcare
Background Question Resources: Reference Books, Textbooks, Review Articles
What is the best practice for preventing nosocomial infections?
What types of patients are most at risk for falls in the inpatient setting?
What are the best interventions to encourage sleep in the inpatient setting?
When is the best time to discuss end of life care decisions with terminal patients?
Foreground Questions: a focused question that asks something specific in order to make an informed clinical decision or action.
Specific knowledge about managing a patient with a condition.
Requires a grasp of basic concepts
Foreground Question Resources - Research findings, journal articles, conference proceedings, synthesis of findings
The question can be broken down into parts into parts - PICO
P - (Patient, Population or Problem)
I - (Intervention)
C - (Comparison with other treatments, if applicable)
O - (Outcome)
Is therapeutic touch or guided imagery more effective when treating a patient with fibromyalgia?
In elderly patients requiring wound care, does the use of tap water as compared to normal saline reduce the incidence of infection?