The whole point of Evidence-Based Practice is to guide practice (the P in EBP), that is, to determine how best to deal with a clinical situation or problem.
But clinical problems don't often arise or present as nicely formulated questions: they can be complex and have many different aspects. But without a clear question it can be difficult to find the information needed to guide practice. (If you don't have a question, it might be difficult to get an answer!)
So the first step in EBP is to convert the issue or problem into a relevant, structured, and answerable question, that is actually going to help determine what, as a clinician, you will do. It's an important precursor to the process of searching and locating the best evidence.
Structuring the question is important. Vague, or broad, or poorly-framed questions can result in wasted time and a lack of success in finding useful evidence. By comparison, asking a specific and focussed question can help you identify important keywords, search terms, and search strategies. In this way it leads in to the next step in EBP, acquiring the evidence.
Above all, the question should be such that the answer will actually guide the clinician in what he/she should do.
Most clinical problems can be broken down into three of four components that describe the population, patient, or problem (or a combination); the intervention or treatment; the comparison or alternative intervention; and the desired outcome. This is called the PICO method - Population, Intervention, Comparison, Outcome - and it's a tool that's widely used by health professionals and researchers to arrive at an answerable question and to help with research. Once you have identified the PICO elements you need to bring them together, firstly to create a well-formulated question, and secondly to help identify keywords and search terms.
PICO is one of many such tools that help with determining the clinical question. It is especially useful in answering therapy-type questions. For more information on PICO, and on other similar tools, see the PICO and SPIDER page in the Library's Evidence-Based Practice guide.
Scenario: It is common practice in a small rural hospital for Panadol to be used to treat children who present to the Emergency Department with fever and/or pain. But one of the nurses has heard that ibuprofen is more effective in reducing pain and fever in children, and wants to find out if this proposition is supported by evidence.
The PICO would be:
Population - children with pain or fever
Intervention - ibuprofen
Comparison - paracetamol
Outcome - reduced levels of pain/fever.
And the question would be: In children with pain and/or fever, is ibuprofen more effective than paracetamol in reducing pain and fever?
NOTE: We might then identify the keywords/search - children, pain, fever, ibuprofen, paracetamol
And what about the search strategy? - child* AND (pain* OR fever*) AND ibuprofen AND (paracetamol OR panadol)
There are numerous online resources available to assist with this process of asking a well-formulated question. You could try:
- part of an excellent interactive tutorial on Evidence-Based Practice. It's part of Module 2: Ask the Question
- part of a guide on Evidence-Based Practice from the University of South Australia Library
- part of a guide on Evidence-Based Practice from the Library at the WA Government North Metropolitan Health Service
- from the University of Hawaii at Manoa Library.
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