LUC Congestive Heart Failure Nursing Evidence Based Practice Paper e: This form is used to develop an answerable question and to guide the team in the evid

LUC Congestive Heart Failure Nursing Evidence Based Practice Paper e: This form is used to develop an answerable question and to guide the team in
the evidence search process. The question, search terms and strategy, and
sources of evidence can be revised as the EBP team refines the EBP project
focus.
What is the problem and why is it important? Indicate why the project was
undertaken. What led the team to seek evidence? Make sure the problem
statement defines the actual problem and does not include a solution statement.
What is the current practice? Define the current practice as it relates to the problem.
What is the focus of the problem? Is the problem a clinical concern (e.g., preventing
blood stream infections); an educational concern (e.g., discharge teaching for
patients); or an administrative concern (e.g., safety of 12-hour nursing shifts)?
How was the problem identified? Check the statements that describe how the
problem was identified.
What is the scope of the problem? Does the problem look at an individual (e.g.,
clinician, patient, family member); a population (e.g., adult cardiac patients,
recovery room nurses); or an institution/system (e.g., patient transportation, patient
or staff satisfaction)?
What are the PICO components?
 P (patient, population, problem) e.g., age, sex, setting, ethnicity, condition,
disease, type of patient, or population
 I (intervention) e.g., treatment, medications, education, diagnostic tests or best
practice(s)
 C (comparison with other interventions or current practice) may not be applicable
if your question is looking for best practice.
 O (outcome) stated in measurable terms, expected outcomes based on the
intervention identified, e.g., decrease in fall rate, decrease in length of stay,
increase in patient satisfaction.
Initial EBP Question. A starting question that can be refined and adjusted as the team
searches through the literature.
List possible search terms. Using PICO components and the initial EBP question, list
relevant terms to begin the evidence search. Terms can be added or adjusted as
the evidence search continues. Document the search terms, strategy, and
databases searched in sufficient detail for replication. Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
1. What is the problem?
CHF is a major consumer of health care resources that leads to the creation of substantial strain on health
care systems
2. Why is the problem important and relevant? What would happen if it were not
addressed?
The problem is important and relevant because it effects nearly more than half the population and many of the cases
are due to lack of education and awareness of the diagnosis and its symptoms along with the side effects. If
education and classes are not provided and available to all with easy access then the rates of deaths will increase
dramatically.
3. What is the current practice?
4. How was the problem identified? (Check all that apply)
❑
Safety and risk-management concerns
❑
Variations in practice within the setting
❑
Quality concerns (efficiency, effectiveness,
timeliness, equity, patient-centeredness)
❑
Variations in practice compared to community
standard
❑
Unsatisfactory patient, staff, or organizational
outcomes
❑
Current practice that has not been validated
❑
Financial concerns
5. What are the PICO components?
P – (Patient, population, or problem)
I – (Intervention)
C – (Comparison with other interventions, if foreground question)
O – (Outcomes are qualitative or quantitative measures to determine the success of change)
PICO question
How does the use of in-home monitoring for CHF impact re-hospitalization rates?
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Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
P- What is the current percentage of patient readmission for heart failure condition?
I- What Impact does in-home monitoring have towards the re-admission of a patient?
C- Which method is more compatible with the betterment of recovery of a heart failure patient?
O- What measures should be put in place to ensure less re-hospitalization of patients suffering from heart
failure?
6. Initial EBP question ❑ Background ❑ Foreground
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Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
7. List possible search terms, databases to search, and search strategies.
8. What evidence must be gathered? (Check all that apply)
❑
Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase)
❑
Standards (regulatory, professional, community)
❑
Guidelines
❑
Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences)
❑
Position statements
9. Revised EBP question
(Revisions in the EBP question may not be evident until after the initial evidence review; the revision
can be in the background question or a change from the background to a foreground question)
10. Outcome measurement plan
What will we
measure?
(structure,
process,
outcome
measure)
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How will we
measure it?
(metrics are
expressed as rate
or percent)
How often will
we measure it?
(frequency)
Where will we
obtain the
data?
Who will
collect the
data?
To whom will
we report the
data?
Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
Directions for Use of the Question Development Tool
Purpose
This form is used to develop an answerable EBP question and to guide the team in the evidence
search process. The question, search terms, search strategy, and sources of evidence can be revised
as the EBP team refines the EBP question.
What is the problem, and why is it important?
Indicate why the project was undertaken. What led the team to seek evidence? Ensure that the
problem statement defines the actual problem and does not include a solution. Whenever
possible, quantify the extent of the problem. Validate the final problem description with practicing
staff. It is important for the inter-professional team to take the time together to reflect, gather
information, observe current practice, listen to clinicians, visualize how the process can be different
or improved, and probe the problem description in order to develop a shared understanding of the
problem.
What is the current practice?
Define the current practice as it relates to the problem. Think about current policies and
procedures. Observe practices. What do you see?
How was the problem identified?
Check all the statements that apply.
What are the PICO components?
P (patient, population, problem) e.g., age, sex, setting, ethnicity, condition, disease,
type of patient, or population
I (intervention) e.g., treatment, medication, education, diagnostic test, or best practice(s)
C (comparison with other interventions or current practice for foreground questions; is not
applicable for background questions, which identify best practice)
O (outcomes) stated in measurable terms; may be a structure, a process, or an outcome
measure based on the desired change (e.g., decrease in falls, decrease in length of stay,
increase in patient satisfaction)
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Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
Initial EBP question
A starting question (usually a background question) that is often refined and adjusted as the
team searches through the literature:
• Background questions are broad and are used when the team has little knowledge,
experience, or expertise in the area of interest. Background questions are often used to
identify best practices.
• Foreground questions are focused, with specific comparisons of two or more ideas or
interventions. Foreground questions provide specific bodies of evidence related to the EBP
question. Foreground questions often flow from an initial background question and
literature review.
List possible search terms, databases to search, and search strategies.
Using PICO components and the initial EBP question, list search terms. Terms can be added or
adjusted throughout the evidence search. Document the search terms, search strategy, and
databases queried in sufficient detail for replication.
What evidence must be gathered?
Check the types of evidence the team will gather based on the PICO and initial EBP question.
Revised EBP question
Often, the question that you start with may not be the final EBP question. Back- ground
questions can be refined or changed to a foreground question based on the evidence review.
Foreground questions are focused questions that include specific comparisons and produce a
narrower range of evidence.
Measurement plan
Measures can be added or changed as the review of the literature is completed and the
translation planning begins:
• A measure is an amount or a degree of something, such as number of falls with injury. Each
measure must be converted to a metric, which is calculated before and after implementing
the change.
• Metrics let you know whether the change was successful. They have a numerator and a
denominator and are typically expressed as rates or percent. For example, a metric for the
measure falls-with-injury would be the number of falls with injury (numerator) divided by
1,000 patient days (denominator). Other examples of metrics include the number of direct
care RNs (numerator) on a unit divided by the total number of direct care staff
(denominator); the number of medication errors divided by 1,000 orders.
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