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JohnsHopkins Nursing Evidence-Based Practice

Appendix B: Question Development Tool

1. What is the problem?

2. Why is the problem important and relevant? What would happen if it were not addressed?

3.

  • What is the current practice?
  • 4.

  • How was the problem identified?
  • (Check all that apply.)

    ❑ Safety and risk-management concerns

    ❑ Quality concerns (efficiency,
    effectiveness, timeliness, equity, patient-
    centeredness)

    ❑ Unsatisfactory patient, staff, or
    organizational outcomes

    ❑ Variations in practice within the setting

    ❑ Variations in practice compared to community
    standard

    ❑ 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)

    6.

  • Initial EBP question
  • ❑ Background ❑ Foreground

    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)

    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 under- standing 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)

    Johns Hopkins Nursing Evidence-Based Practice
    Appendix B: Question Development Tool

    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)

    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.

    Johns Hopkins Nursing Evidence-Based Practice
    Appendix B: Question Development Tool

  • 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.

      Purpose
      What is the problem, and why is it important?
      What is the current practice?
      How was the problem identified?
      What are the PICO components?
      Initial EBP question
      List possible search terms, databases to search, and search strategies.
      What evidence must be gathered?
      Revised EBP question
      Measurement plan

    1.  What are you proposing as the topic for your EBP project?
    For my EBP final project, I am proposing the risk of hospital-acquired infection, also known as healthcare-associated inactions (HAI). How can healthcare workers decrease exposure the patients with immune deficits?
    2.  Why is this topic of interest to you?
    This topic is essential because I had a family member exposed to the hospital with an infection that almost cost his life. The reason he was admitted was dismissed due to clostridium difficile(C.diff) that turned out to be life-threatening for him, and then he was treated in the ICU. As a nurse, I also glimpse an increased number of patients exposed in the hospital in the recovery unit. 

    3.  Would you classify the topic related to service, practice, or patient outcomes?
    This topic is related to quality patient care, safe practice, and patient outcome.

    This is a good topic.  Just to keep your topic narrow as not to create an overwhelming project, could you focus on one infection…maybe C.Diff seeing as you are familiar with this?  Approach it from a nursing perspective… like:  what can nurses do you prevent the spread of C.Diff in the patient care setting.  You will find sufficient evidence to support your topic.

    Evidence-Based Practice Project Analysis

    Now that you have a good idea of what you will be doing for your EBP project in NURS 4130, it is time to apply change strategies to your topic.  At this time, you may not know all of the answers to the questions you are asked to respond to regarding your topic.  That’s okay. This is your first attempt at analyzing important aspects of your topic to help you devise a plan and think about your topic from a “big picture” perspective. Respond to the following questions:

    1. What is the topic for your EBP project?

    2. What is the overall goal you hope to achieve? 

    3. What do you think is best practice? How will you determine what best practice is?

    4. Who are the internal and external stakeholders?  Do you have any pre-conceived ideas about the stakeholders’ positions and whether they would be supportive of a practice change?

    5. How will you determine if your practice change is successful? Are there benchmarks you will use?

    6. What leadership skills and and strategies are required to assure success of the change? 

    This is an informal piece of writing.  A title page is not required. Please be concise in your responses.  Paper is not to exceed 2-3 pages.  References are not required, but if used, would require an in-text citation and reference page in APA format. 

    1. What is the problem?

    2. Why is the problem important and relevant? What would happen if it were not addressed?

    3.

    What is the current practice?

    4.

    How was the problem identified?

    (Check all that apply.)

    · Safety and risk-management concerns

    · Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness)

    · Unsatisfactory patient, staff, or organizational outcomes

    · Variations in practice within the setting

    · Variations in practice compared to community standard

    · 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)

    6.

    Initial EBP question

    ❑ Background ❑ Foreground

    Johns Hopkins Nursing Evidence-Based Practice

    Appendix B: Question Development Tool

    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)

    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?

    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 under- standing 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)

    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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