The most important step in Evidence-Based Nursing (EBN) is to correctly identify a problem through patient assessment or practice assessment, processes that require reflection by the nurse on clinical practice, in conjunction with a knowledge of the patient's present circumstances. The information below describes how to frame the question once the patient or practice assessment and the resulting problem identification have occurred.
Background vs. Foreground
Background questions ask for general knowledge and do not normally arise from the need to make a clinical decision.
Background questions usually have two essential components:
A question root (who, what, when, etc.) with a verb
A disorder, treatment, test, or other aspect of healthcare
e.g. What causes obesity? When should children be introduced to sexual education? Who is most susceptible to nursing burn out?
Background information can be found in:
reference book entries
textbooks, chapters, appendices
drug monographs, guides to diagnostic tests
Foreground questions ask for specific knowledge to inform clinical decisions or actions.
Foreground questions usually have 3 or 4 essential components, from the PICO format:
Patient/population characteristics, problem
Interventions or Exposures
Types of Questions
Clinical questions typically fall into one of four main categories:
Etiology (or harm/risk factors): What causes the problem?
Diagnosis: Does this patient have this problem?
Therapy: What is the best treatment for this problem?
Prognosis: What will the outcome of the problem be?
* Knowing the type of clinical question is important later in the EBN process--once the nurse goes to look for studies that will answer his/her question.
Nursing Practice Questions
In nursing, many other questions about practice will also arise, with some of the questions resulting from the nursing principle of working with rather than on the patient. These questions can be quantitative or qualitative in nature. Examples include:
What other, validated instruments for measuring this condition or phenomenon (e.g. pain) exist and how do they compare to the one we currently use?
Should a nurse deliver patient education on the patient's disease/condition near the beginning or the end of an appointment or consultation?
How do caregivers of patients with [x] cope with the burden of care and how can nurses assess the level of caregiver burden and/or support the caregivers?