N494-M1

JS79

Melnyk_PPT_Chapter_02.ppt

Home >Nursing homework help >N494-M1

Chapter 2

Asking Compelling Clinical Questions

Barriers to Finding the Right Information at the Right Time

Lack of proficiency in using computers
Lack of computer access at point of care
Low comfort level/lack of skill using search techniques
Lack of access to appropriate electronic databases
Lack of time to search for the best evidence

Types of Questions to Develop Prior to Beginning a Literature Search

Background questions

Asks for general information about a clinical issue
Usually has two components:
1. The starting place of the question (e.g., what, where, when, why, and how)
2. The outcome of interest
Broader in scope than a foreground (PICOT) question

Example: “How does the drug acetaminophen work to affect fever?”

Types of Questions to Develop Prior to Beginning a Literature Search—(cont.)

Foreground questions (PICOT format)

Asks for specific scientific evidence about diagnosing, treating, or educating patients
The focus is on specific knowledge
Use of PICOT format is recommended for a focused literature search

Example: “In children aged 3 to 8 years, how does acetaminophen compare with ibuprofen in lowering a fever?”

Question

Is the following statement true or false?

Foreground questions can often be answered by consulting an up-to-date nursing or science textbook.

Answer

False

Rationale: Foreground questions are clinical questions that can only be answered by specific scientific evidence that is usually found in original studies or systematic reviews of original studies (e.g., RCTs). This type of evidence is not available in textbooks, which are more appropriate for answering background questions.

Types of Questions to Develop Prior to Beginning a Literature Search—(cont.)

Types of foreground questions

Intervention questions (What intervention most effectively leads to an outcome?)
Prognosis/prediction questions (What indicators are most predictive of an outcome?)
Diagnosis questions (What test most accurately diagnoses an outcome?)
Etiology questions (To what extent is a factor associated with an outcome?)
Meaning questions (How does an experience influence an outcome?)

Question

Is the following statement true or false?

A well-formulated PICOT question should specify the measurable patient outcomes that need to addressed.

Answer

True

Rationale: A PICOT question should always specify the outcome that is expected from the clinical question. It is important that the outcome be measurable in some way so that the effectiveness of the change can be evaluated.

Asking Foreground Questions Using the PICOT Format

P: Population of interest
I: Intervention or issue of interest
C: Comparison of interest
O: Outcome expected
T: Time needed for the intervention to achieve the outcome or the time in the course of the disease/symptom that the intervention is applied

PICOT Format: Intervention Template

In ________________(P) how does___________(I)

compared to __________(C) affect ___________(O)

within (T)____________?

PICOT Format: Prognosis Template

In ________________(P) how does___________(I)

compared to _____(C) influence/predict _______(O)

over (T)____________?

PICOT Format: Diagnosis Template

In ________________(P) is ___________(I)

compared to _____(C) more accurate in diagnosing

(O) ____________?

PICOT Format: Etiology Template

Are ________________(P) who have _________(I)

compared to those without _________________(C)

at ______________ risk for/of ___________ (O)

over ____________(T)?

PICOT Format: Meaning Template

How do ________________(P) with _________(I)

perceive _________________(O)

during ____________(T)?

Question

Which of the following components of a PICOT question is absent from the following clinical question?

“Among patients with dementia, how does the use of reorientation therapy compared with regular, supervised mobility affect patient agitation?”

P (Population)
I (Intervention)
O (Outcome)
T (Time)

Answer

d. T (Time)

Rationale: This question specifies the patient population (patients with dementia), the intervention (reorientation therapy), the comparison (regular, supervised mobility), and the relevant outcome (patient agitation), but does not provide the time frame for an expected outcome.