Addressing a clinical problem through evidence-based practice (EBP) involves asking the right questions in the right way, finding the best available evidence, and assessing what practice change may be needed. A core factor in the EBP journey is the development of nurses who possess a spirit of inquiry within a culture that supports a systematic process for asking clinical questions.
As step 0 of the EBP process, a spirit of inquiry refers to an ongoing curiosity about the best evidence to guide clinical decision making. Maybe you’ve read an article that causes reflection about a clinical procedure. Perhaps you’ve wondered if an intervention is really necessary, why you do it, what evidence supports it, if it benefits patients, or if another way to do it is better. When nurses ponder and collaboratively improve clinical problems using clinical reasoning and judgement, a spirit of inquiry exists and the first step of the EBP process can begin.
Step 1 of the EBP process takes a priority clinical problem and asks a searchable and answerable question about it. Remember, EBP does not seek to generate new knowledge through conducting research. Instead, EBP uses existing evidence to assess the need for practice change.
Formulating a solid researchable question equips the clinician with terms to search for the most relevant evidence. Many established EBP programs use the PICOT format to develop focused clinical questions (see sidebar).
When formulating a clinical question, C and T are not always necessary or appropriate. However, P, I, and O are essential and always included. PICOT templates can be used to frame questions and are guided by the intent of the clinical inquiry. The various types of clinical inquiries may seek to explore or compare:
- An intervention or therapy to determine best outcomes.
- A prognosis or prediction related to disease progression or complications.
- A diagnosis or diagnostic test to determine accuracy.
- An etiology to determine risk factors or causes.
- The meaning or significance of an experience in a particular group.
A key point is that the PICOT question is meant to initially guide the search process. As you dive into the literature, more appropriate or additional search terms may be found than those originally included in a PICOT question. When this happens, you may be tempted to change the original PICOT components when planning dissemination of the project. This is not necessary! If the original PICOT question fulfills the quest for relevant evidence, why change it?
Oncology nurses routinely face situations that could benefit from clinical inquiry. Embracing the EBP process and taking accountability for practice change starts with a spirit of inquiry.