Developing a Clinical Question and Selecting a Framework

Nursing research and evidence-based practice are generated from clinical problems identified in practice, often in search of a solution to the problem. Once a problem is selected, practice in asking and writing the right question about the problem is needed. Distinguishing between a background and a foreground question is the first step in this process.  In general, nurses with less experience begin with a background question, but as experience increases, foreground questions become prominent.  A focused foreground question in a Population, Intervention, Comparison, Outcome and Time (PICOT) framework provides the components of an answerable, searchable question.  The language used in the question represents the purpose of the question.  For example, research questions generally have a directional outcome. (i.e., to reduce or improve); clinical questions gather the evidence related to an outcome (i.e., who, what, and where); and quality improvement questions are focused on processes influencing the outcomes (i.e., why) (Fineout-Overholt & Stillwell, 2019).  Once a clinical question is drafted, a literature search is conducted using key search terms, and a framework or model from which to develop a method for answering the question should follow.

As a doctorally prepared nurse, the ability to understand how to ask the clinical question, search the literature, appraise the information obtained, and organize it is imperative. The purpose of this course module is to practice building the skill for these critical features. This module is an exercise in asking an answerable, searchable question for study, performing a scholarly literature search, appraising the publications selected and creating an organized evidence (evaluation) table for easy reference when drafting the introduction and literature review for a clinical scholarship project.  An evidence-based framework or model will also be selected to guide the draft of the clinical scholarship project.

 Module Objectives

 At the end of this learning module, the student will be able to:

· Identify a clinical problem of interest.

· Create a study question about the clinical problem.

· Perform a literature search to answer the study question.

· Appraise the factors impeding and facilitating the adoption of the evidence.

· Develop an evidence (evaluation) table or matrix highlighting the attributes and limitations of the literature selected from a scholarly literature search.

· Select an evidence-based practice framework or model from which to build a clinical scholarship project.




Literature Search (25 points)

Directions:  Identify a clinical issue or problem.  Develop a study question to answer the question.  Perform a literature search (consider working with a librarian on this).   Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area).

Name (1 point deducted if missing)

Date (1 point deducted if missing)

Clinical Issue or Problem (3 points) (e.g., there is a high number of pediatric needlesticks in an Emergency Department)

Problem Statement (3 points) (e.g., the average number of needlesticks for children in an Emergency Department is 2.2 needlesticks per visit [author & author, 2021)

Study Question (5 points)

· PICO(T) format (e.g., Melnyk & Fineout-Overholt, 2019, Appendix A, pp. 706-7)

Key Search Terms (5 points) (include Boolean operators)

Search Engines Used (3 points) (e.g., PubMed, CINAHL, etc.)

Number of Initial Publications Generated (2 points) (matching the search terms and phrases)

Refined Search:  Inclusion and Exclusion Criteria (2 points)

Number of Publications Generated and Number Selected the Literature Review (2 points)

Literature Appraisal (25 points)

Directions:  Select a research publication (not an evidence-based practice guideline) from the literature search to critically appraise.  Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area).  (adapted from Polit & Beck, 2017, p. 100).


Evidence (Evaluation) Table/Matrix (100 points)

Directions:  The evidence table/matrix should include all studies which will be included in the draft of the introduction and literature review for the clinical scholarship project due at the end of the semester.  At least 10 studies should be included and in alphabetical order according to the author. Complete the following items on the word document (.docx) provided in the module (download the document, complete it, then upload into the assignment area).  (adapted from Melnyk & Fineout-Overholt, 2019, p. 724).  Each section is worth 10 points (10 sections x 10 points = 100 points)

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