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Evidence Based Nursing: Practice Question

Scope of the Practice Problem

 

Determining the scope of the problem is important to the EBP process because it helps the team identify important factors influencing and influenced by the problem. 

To determine the scope of the practice problem, consider these questions: 

Who does this problem effect?
  • individual,
  • population,
  • system/organization
Where does the problem happen? 
  • clinical
  • educational
  • administrative
When does the problem happen? 
  • clinical
  • educational
  • administrative

*Dearholt & Dang, 2012

Defining the Practice Problem

Practice problems emerge from Problem-focused triggers and Knowledge-focused triggers. Regular duties like monitoring quality and risk are problem-focused triggers. Comparatively, knowledge-focused triggers are those that are recognized by reading published reports, attending a professional conference or meeting (Dearholt & Dang, 59). 

 

Problem Focused

Knowledge focused

Financial concerns

Evidence for current practice questioned

Quality Concern

Safety or risk management concerns

New sources of evidence

Changes in standards or guidelines

New philosophies of care

New information provided by organizational standards committees

Tips for Defining the Practice Problem

Differentiate the knowledge gap of the problem from the suggested solution of the problem. 

Allows yourself and others to consider other factors as possibilities for solving the problem

Precisely describe the gap between present and future expectations. 

Allows team to assess how current practice is benchmarked. 

Avoid blaming the problem on external factors. 

Allows team to consider factors other than physician error when considering the problem. 

Challenge Assumptions. 

 

Allows team to consider factors that may have been otherwise taken for granted. In this case, clinician prescribed opioid use among teens who are characterized as least likely to misuse prescription drugs is linked to adult misuse. 

(Dearholt and Dang p. 61-62) 

Defining the Question Type

Type of Question Def. Study PICO Template PICO example
Therapy Deciding if a treatment's pros outweigh the cons. Systematic Review/Meta-analysis → RCT → Case Control → Case Series "In _P_ do/does _I_ result in _O_ when compared with _C_ over _T_?" In Healthy Full-term newborns who are undergoing a painful procedure , does sucrose combined with radiant warmth result in lessened pain during a painful procedure when compared with using only sucrose?
Diagnoses How to evaluate and analyze diagnostic tests. Cross-Sectional → Prospective, Blind comparison to Gold Standard Is/are _I_ performed on_P_ more effective than _C_ over _T_in _O_? "Are self-reporting interviews and parent reports performed on children aged 5-10 more effective than parent reports alone over a four-week consultation process in diagnosing depression?"
Etiology How to determine a cause for disease. Systematic Review/Meta-analysis → RCT → Cohort Study → Case Control → Case Report Are _P_ with _I_ over _T_ more likely to _O_ when compared with _C_ ? In early chilhood, does  Hand dishwashing result in fewer or More Allergic Disease developments when compared with Machine Dishwashing in Children aged 7-8 years?
Prognosis How to estimate and anticipate a patient's likely course of disease or treatment, excluding intervention factors named in PICO. Cohort Study → Case Control → Case Series Do/does _I_ performed on _P_ lead to _O_ over _T_compared with _C_?

does location of suture fusion  in school aged children with single- suture-craniosynostosis lead to developmental delays when compared with unaffected children or children with different suture locations?

Prevention How to anticipate and correct barries to a patient's health. RCT → Cohort Study → Case Control In _P_, do/does _I_ result in _O_ when compared with _C_ over _T_? "In emergency room visitors, do hand sanitizing stations result in fewer in-hospital infections when compared with no hand sanitizing stations over a year-long pilot period?"