For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the Course Project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice.
Before you begin, review the Course Project Overview document located in this week’s Learning Resources.
Course Project: Part 1—Identifying a Researchable Problem
One of the most challenging aspects of EBP is to actually identify the answerable question.
—Karen Sue Davies
Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.
In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.
Review the article, “Formulating the Evidence Based Practice Question: A Review of the Frameworks,” found in the Learning Resources for this week. Focus on the PICOT model for guiding the development of research questions.
Review the section beginning on page 71 of the course text, titled, “Developing and Refining Research Problems” in the course text, which focuses on analyzing the feasibility of a research problem.
Reflect on an issue or problem that you have noticed in your nursing practice. Consider the significance of this issue or problem.
Generate at least five questions that relate to the issue which you have identified. Use the criteria in your course text to select one question that would be most appropriate in terms of significance, feasibility, and interest. Be prepared to explain your rationale.
Formulate a preliminary PICO question—one that is answerable—based on your analysis. What are the PICO variables (patient/population, intervention/issue, comparison, and outcome) for this question?
Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.
Using the PICOT variables that you determined for your question, develop a list of at least 10 keywords that could be used when conducting a literature search to investigate current research pertaining to the question.
Write a 3- to 4-page paper that includes the following:
A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice
The 5 questions you have generated and a description of how you analyzed them for feasibility
Your preliminary PICOT question and a description of each PICOT variable relevant to your question
At least 10 possible keywords that could be used when conducting a literature search for your PICOT question and a rationale for your selections
Evidence Based Library and Information Practice 2011, 6.2
Evidence Based Library and Information Practice Commentary Formulating the Evidence Based Practice Question: A Review of the Frameworks Karen Sue Davies Assistant Professor, School of Information Studies University of Wisconsin–Milwaukee Milwaukee, Wisconsin, United States of America Email: email@example.com Received: 17 Jan. 2011 Accepted: 04 Apr. 2011
2011 Davies. This is an Open Access article distributed under the terms of the Creative Commons-Attribution- Noncommercial-Share Alike License 2.5 Canada (http://creativecommons.org/licenses/by-nc-sa/2.5/ca/
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed, not used for commercial purposes, and, if transformed, the resulting work is redistributed under the same or similar license to this one.
Introduction Questions are the driving force behind evidence based practice (EBP) (Eldredge, 2000). If there were no questions, EBP would be unnecessary. Evidence based practice questions focus on practical real-world problems and issues. The more urgent the question, the greater the need to place it in an EBP context. One of the most challenging aspects of EBP is to actually identify the answerable question. This ability to identify the question is fundamental to then locating relevant information to answer the question. An unstructured collection of keywords can retrieve irrelevant literature, which wastes time and effort eliminating inappropriate information. Successfully retrieving relevant information begins with a clearly defined, well-structured question. A standardized format or framework for asking questions
helps focus on the key elements. Question generation also enables a period of reflection. Is this the information I am really looking for? Why I am looking for this information? Is there another option to pursue first? This paper introduces the first published framework, PICO (Richardson, Wilson, Nishikawa and Hayward, 1995) and some of its later variations including ECLIPSE (Wildridge and Bell, 2002) and SPICE (Booth, 2004). Sample library and information science (LIS) questions are provided to illustrate the use of these frameworks to answer questions in disciplines other than medicine. Booth (2006) published a broad overview of developing answerable research questions which also considered whether variations to the original PICO framework were justifiable and worthwhile. This paper will expand on that work.
Evidence Based Library and Information Practice 2011, 6.2
Question Frameworks in Practice PICO The concept of PICO was introduced in 1995 by Richardson et al. to break down clinical questions into searchable keywords. This mnemonic helps address these questions: P – Patient or Problem: Who is the patient? What are the most important characteristics of the patient? What is the primary problem, disease, or co-existing condition? I – Intervention: What is the main intervention being considered? C – Comparison: What is the main comparison intervention? O – Outcome: What are the anticipated measures, improvements, or affects? Medical Scenario and Question: An overweight woman in her forties has never travelled by airplane before. She is planning an anniversary holiday with her husband including several long flights. She is concerned about the risk of deep vein thrombosis. She would like to know if compression stockings are effective in preventing this condition or whether a few exercises during the flight would be enough. P – Patient / Problem: Female, middle-aged, overweight I – Intervention: Compression stockings C – Comparison: In-flight exercises O – Outcome: Prevent deep vein thrombosis The PICO framework and its variations were developed to answer health-related questions. With a slight modification, this framework can structure questions related to LIS. The P in PICO refers to patient, but substituting population for patient provides a question format for all areas of librarianship. The population may be children, teens, seniors, those from a specific ethnic group, those with a common goal (e.g., job-seekers), or those with a common interest (such as a gardening club). The intervention is the new concept being considered, such as longer opening hours, a reading club, after-school activity, resources in a particular language, or the introduction of wi-fi.
LIS Scenario and Question: Art history master’s students submit theses with more bibliography errors than those from students of other faculties. The Dean of art history raised this issue with the head librarian. The head librarian suggested that database training could help. P – Population: Art History master’s students I – Intervention: database searching training C – Comparison: students with no training or students from other Faculties O – Outcome: Improved bibliographic quality Table 1 illustrates the different components introduced in several PICO framework variations. Fineout-Overholt and Johnson (2005) considered the questioning behavior of nurses. They suggested a five-component scheme for evidence based practice questions using the acronym PICOT, with T representing timeframe. This refers to one or more time-related variables such as the length of time the treatment should be prescribed or the point at which the outcome is measured. A PICOT question in the LIS field is: In a specialist library, does posting the monthly library bulletin on the Website instead of only having printed newsletters available result in increased usage of the library and the new resources mentioned in the bulletin? In this question, the timeframe refers to a month. Petticrew and Roberts (2005) suggested PICOC as an alternative ending to PICOT, with C representing context. For example, what is the context for intervention delivery? In LIS, context could be a public library, academic library, or health library. A variation similar to PICOT is PICOTT. In this instance, neither T relates to timeframe. The Ts refer to the type of question and the best type of study design to answer that particular question (Schardt, Adams, Owens, Keitz, and Fontelo, 2007). An example LIS question is: In a specialist library, does instant messaging or e-mail messaging result in the greatest customer satisfaction with a virtual reference service? This type of question is user analysis, and a relevant type of study design is
Evidence Based Library and Information Practice 2011, 6.2
a questionnaire. The PICOTT framework may be too restrictive when searching. If you are searching for effective Websites then transaction log analysis would be a reasonable type of study design. By limiting to that study type you would miss user observation studies, focus groups, and controlled experiments. These frameworks should focus the search strategy, while not excluding potentially useful and relevant information. Specifically developed for building and adapting oncology guidelines is PIPOH (ADAPTE Collaboration, 2009). The second P refers to professionals (to whom the guideline will be targeted) and H stands for health care
setting and context (in which the adapted guideline will be used). An example of this in the LIS setting would be: What is appropriate training for fieldwork students working on the library’s issue or circulation desk? P – Population: Library users I – Intervention: Training P – Professionals: Fieldwork students O – Outcome: S – Setting: Issue or circulation desk Dawes et al. (2007) developed PECODR and undertook a pilot study to determine whether this structure existed in medical journal abstracts. E refers to exposure, replacing
Table 1 Components of the Different PICO-based Frameworks
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