Create a clinical research question related to a clinical experience you have encountered
Create a clinical research question related to a clinical experience you have encountered
Explain the importance of a research question/problem. Create a clinical research question related to a clinical experience you have encountered at work/school. Use the PICOT format to create your question. Select a topic/area of interest to you as this will be your topic you will use for the remaining semester to develop a research protocol.TOPIC OF MY INTEREST WOULD BE PATIENT SAFETY. ( FALL PREVENTION)
Requirements for this post:
Read the PICOT article
Word count: Max 500 words
APA format : please reference from 5 years.
Asking the Clinical Question: A Key Step in
Evidence-Based Practice
A successful search strategy starts with a well-formulated question.
This is the third article in a series from the Arizona State University College of Nursing and Health Innovation’s Center
for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the
delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and
patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the
highest quality of care and best patient outcomes can be achieved.
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one
step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward
implementing EBP at your institution. Also, we’ve scheduled “Ask the Authors” call-ins every few months to provide a
direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May’s Evidence-Based Practice, Step by Step.
Case Scenario for EBP: Rapid Response Teams
You’re a staff nurse on a busy medical–surgical unit. Over
the past three months, you’ve noticed that the patients on
your unit seem to have a higher acuity level than usual, with
at least three cardiac arrests per month, and of those patients
who arrested, four died. Today, you saw a report about a
recently published study in Critical Care Medicine on the use
of rapid response teams to decrease rates of in-hospital cardiac arrests and unplanned ICU admissions. The study found
a significant decrease in both outcomes after implementation
of a rapid response team led by physician assistants with specialized skills.
2 You’re so impressed with these findings that
you bring the report to your nurse manager, believing that a
rapid response team would be a great idea for your hospital.
The nurse manager is excited that you have come to her with
these findings and encourages you to search for more evidence
to support this practice and for research on whether rapid response teams are valid and reliable.
58 AJN ▼ March 2010 ▼ Vol. 110, No. 3 ajnonline.com
care unit.
2 She believed this could
be a great idea for her hospital.
Based on her nurse manager’s
suggestion to search for more evidence to support the use of a rapid response team, Rebecca’s spirit
of inquiry led her to take the next
step in the EBP process: asking
the clinical question. Let’s follow
Rebecca as she meets with Carlos A., one of the expert EBP mentors from the hospital’s EBP and
research council, whose role is to
assist point of care providers in
enhancing their EBP knowledge
and skills.
Types of clinical questions.
Carlos explains to Rebecca that
finding evidence to improve patient outcomes and support a
practice change depends upon
how the question is formulated.
Clinical practice that’s informed
by evidence is based on wellformulated clinical questions
that guide us to search for the
most current literature.
There are two types of clinical
questions: background questions
and foreground questions.
3-5 Foreground questions are specific and
relevant to the clinical issue. Foreground questions must be asked
in order to determine which of
two interventions is the most effective in improving patient outcomes. For example, “In adult
patients undergoing surgery, how
does guided imagery compared
with music therapy affect analgesia use within the first 24 hours
post-op?” is a specific, welldefined question that can only
guides her in formulating a foreground question using PICOT
format.
PICOT is an acronym for the
elements of the clinical question:
patient population (P), intervention or issue of interest (I), comparison intervention or issue of
interest (C), outcome(s) of interest (O), and time it takes for the
intervention to achieve the outcome(s) (T). When Rebecca asks
why the PICOT question is so
important, Carlos explains that
it’s a consistent, systematic way
to identify the components of a
clinical issue. Using the PICOT
format to structure the clinical
question helps to clarify these
components, which will guide the
search for the evidence.
6, 7 A wellbuilt PICOT question increases
the likelihood that the best evidence to inform practice will be
found quickly and efficiently.
5-8
To help Rebecca learn to formulate a PICOT question, Carlos uses the earlier example of a
foreground question: “In adult
patients undergoing surgery, how
does guided imagery compared
be answered by searching the
current literature for studies
comparing these two interventions.
Background questions are
considerably broader and when
answered, provide general knowledge. For example, a background
question such as, “What therapies
reduce postoperative pain?” can
generally be answered by looking
in a textbook. For more information on the two types of clinical
questions, see Comparison of
Background and Foreground
Questions.
4-6
Ask the question in PICOT
format. Now that Rebecca has
an understanding of foreground
and background questions, Carlos
Comparison of Background and Foreground Questions4-6
Question type Description Examples
Background
question
A broad, basic-knowledge question
commonly answered in textbooks.
May begin with what or when.
1)What is the best method to prevent pressure ulcers?
2)What is sepsis?
3)When do the effects of
furosemide peak?
Foreground
question
A specific question that, when
answered, provides evidence for clinical decision making. A foreground
question includes the following elements: population (P), intervention or
issue of interest (I), comparison intervention or issue of interest (C), outcome (O), and, when appropriate,
time (T).
1)In mechanically ventilated patients (P), how does a weaning
protocol (I) compared with no
weaning protocol (C) affect ventilator days (O) during ICU length
of stay (T)?
2)In hospitalized adults (P), how
does hourly rounding (I) compared with no rounding (C) affect
fall rates (O)?
The PICOT question is a consistent,
systematic way to identify the components
of a clinical issue.
By Susan B. Stillwell, DNP, RN, CNE, Ellen Fineout-Overholt, PhD,
RN, FNAP, FAAN, Bernadette Mazurek Melnyk, PhD, RN,
CPNP/PMHNP, FNAP, FAAN, and Kathleen M. Williamson, PhD, RN
ajn@wolterskluwer.com AJN ▼ March 2010 ▼ Vol. 110, No. 3 59
also not always required. But
population, intervention or issue
of interest, and outcome are essential to developing any PICOT
question.
Carlos asks Rebecca to reflect
on the clinical situation on her
unit in order to determine the
unit’s current intervention for addressing acuity. Reflection is a
strategy to help clinicians extract
critical components from the clinical issue to use in formulating
the clinical question.
3 Rebecca
and Carlos revisit aspects of the
clinical issue to see which may become components of the PICOT
question: the high acuity of patients on the unit, the number of
cardiac arrests, the unplanned
ICU admissions, and the research
article on rapid response teams.
Once the issue is clarified, the
PICOT question can be written.
with music therapy affect analgesia use within the first 24 hours
post-op?” In this example, “adult
patients undergoing surgery” is
the population (P), “guided imagery” is the intervention of interest
(I), “music therapy” is the comparison intervention of interest
(C), “pain” is the outcome of interest (O), and “the first 24 hours
post-op” is the time it takes for
the intervention to achieve the
outcome (T). In this example,
music therapy or guided imagery
is expected to affect the amount
of analgesia used by the patient
within the first 24 hours after surgery. Note that a comparison may
not be pertinent in some PICOT
