Evidence Based Nursing

Intro to EBN

EBN TOOLS

EBN in Practice

EBN Resources
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Front Page

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EBN IN PRACTICE

Step 1 - ASK:

Defining the Question. Issues or questions can arise in a variety of situations.  The use of the evidence based process is not limited to the clinical situation, but can also be useful in the management environment. With such an overwhelming (and rapidly growing) amount of medical information, but a limited amount of time available to search, this step can be one of the most important ones. The creation of a focused and clearly defined question can make efficient use of your time to find a manageable amount of literature to address the information need.

There are generally four parts to question building:  the situation, the intervention, the comparison and the outcome. 

The situation is the patient or problem being addressed. This can be a single patient or group of patients with a particular condition or healthcare problem. For example, you may have a patient with cervical pain was interested in methods to ease pain and improve sleep. The situtation may also be concerned with more managerial aspects of organizing services.  For example, you may be a nursing administrator responsible for cutting the personnel budget with the least amount of impact on patient care.

The intervention stage states what may address the situational need to effect the outcome, or the result that you are interested in seeing form a patient or managerial perspective. In the clinical situation mentioned above, the patient with benign cervical pain (situation) is interested in the use of water-based pillows (intervention) to reduce pain and improve sleep (outcome). Sometimes you may want to consider an alternative or comparison to the intervention. Would using a standard pillow or a cervical roll also reduce pain and improve sleep? In summary, the question for the clinical situation might be: does the use of water-based pillows by patients with benign cervical pain lead to improved sleeping and reduced pain?  To read more information about the clinical situation described, please see the citation below.

Monaghan HM. Water based pillows reduced pain and improved sleep and disability in patients with cervical pain.
Evidence Based Nursing 1998 Jan;1: 17.
http://ebn.bmjjournals.com/cgi/content/full/1/1/17

In the managerial situation mentioned above, the personnel budget needs to be cut (situation). The nursing administrator wants to do this with the least impact on patient care (outcome), and considers decreasing the number of RNs(intervention). As an alternative (comparison) the administrator considers cutting unlicensed assistive personnel . The resulting question might be: will decreasing the number of RNs (versus UAPs) have a low impact on patient care?  We will continue moving through the evidence based steps (5 A's) using the managerial situation example.

Go to Next Step: (2) AQUIRE: 

Further Reading:
Some situations and steps described in this page were taken from the following reading:
Flemming K. Asking answerable questions [editorial].
Evidence-Based Nursing 1998 Apr;1:36-7.
http://ebn.bmjjournals.com/cgi/content/full/1/2/36