Let’s take a moment to place the practice question in context. A practice question is not a research question. A gap in knowledge guides the PhD researcher in writing a research question that includes making a prediction.
A practice question emerges from the research you read, review, and critically appraise to articulate and support your practice problem. A clear and concise practice question is always supported by research evidence. Alongside the research evidence that lends support to a practice question, the unique practice needs of the local practice setting is reflected in the practice question.
Developing an Answerable Practice Question Exploration
Return to Your Practice Problem
Take this opportunity to review your research evidence. Embedded in the research used to articulate a compelling practice problem is the beginning of your practice question.
Take this opportunity to reflect on your practice problem through the lens of your local practice setting. What does your practice problem look like in daily practice? Reflect on conversations shared with key stakeholders in practice. What is going on in practice related to the identified practice problem?
PICOT is a mnemonic for a formatting tool that serves two purposes. Each purpose is of equal importance to the practice scholar as the practice change project is designed.
Assists with writing a clear, concise, one-sentence practice question.
Assists with searching and retrieving relevant evidence in the robust scientific search engines. The formatting tool PICOT lends itself to the identification of keywords from each segment of the practice question. The ability to break a practice question into keywords is what makes searching for evidence.
P Patient/Population The practice scholar states the relevant patients/individuals. What does the research literature say about the age, gender, specific characteristics, social that would be important in this practice problem? The concise articulation of the population is supported by a synthesis of research evidence.
I Intervention The practice scholar states the research-evidence based intervention to be translated to practice. The research-evidence based intervention is supported by research evidence. The practice scholar translates/transfers the research-evidence based intervention as it was tested and empirically proven across research studies. Note: The practice scholar does not alter the research-evidence based intervention. Implementation fidelity requires no changes be made to the empirically proven research intervention.
C Comparison The practice scholar describes current practice. In a practice change project, the comparison is practice as usual.
The practice scholar’s intention is to learn if the translation of a research-evidence based intervention influences local practice outcomes. Practice change projects are not intended to design or test an intervention, therefore, a prediction is not made as outcomes are identified.
The practice outcome may be singular or several stated outcomes. The practice scholar returns to research studies where the research-evidence based intervention was tested. These studies describe how study outcomes were measured. The practice scholar confirms that identified outcomes in the practice change project are numerical and are captured using reliable and valid measures.
Reliability in statistics and psychometrics is the overall consistency of a measure. A measure is said to have a high reliability if it produces similar results under consistent conditions. For example, measurements of people’s height and weight are often extremely reliable.
Validity in statistics and psychometrics refers to the extent to which an assessment accurately measures what it is intended to measure.
T Timeframe The timeframe for the DNP Practice Change Project is 8–10 weeks.
Fineout-Overholt (2006) developed PICOT templates to assist in the formulation of a focused, answerable question. These templates align with the primary clinical domains, which include intervention/therapy, etiology, diagnosis, prognosis/prediction, and meaning.
Let’s use these PICOT templates to formulate a focused, answerable question to address each clinical domain.
Clinical Domain: Intervention/Therapy
Questions in this domain address the treatment of an illness or disability.
Use the Intervention template to formulate a focused, answerable question addressing an intervention.
In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?
Now compare your answer to a sample question addressing an intervention.
In African-American female adolescents newly diagnosed with Type 2 Diabetes (P), does medical nutrition therapy (I) as compared to a low-carbohydrate diet (C) help achieve and maintain blood glucose levels in the normal range (O) over 8-12 weeks (T)?
Use the therapy template to formulate a focused, answerable question addressing a therapy.
In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?
Now compare your answer to a sample question addressing therapy.In obese adolescents (P), does a personal movement tracker device (I) as compared to not using a movement tracker device (C) influence BMI and quality of life (O) over 8-12 weeks?
Reflect on how these templates addressing intervention and therapy are similar? How are they different?
Clinical Domain: Etiology
Questions in this domain address the causes or origins of disease (i.e., factors that produce or predispose toward a certain disease or disorder).
Use the Etiology template to formulate a focused, answerable question addressing etiology.
Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O)over ________________(T)?
Now compare your answer to a sample question addressing etiology.
Are 30-50 year old women (P), who complete mindfulness based stress reduction (MBSR) training (I) compared with those who do not complete MBSR (C) have blood pressure levels within the normal range (O) over 8-10 weeks (T)?
Clinical Domain: Diagnosis
Questions in this domain address the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.
Use the Diagnosis template to formulate a focused, answerable question addressing a diagnosis.In ____________________(P), are/is ____________________ (I) compared with those without ____________________(C) more accurate in diagnosing _____________________(O) within ___________(T)?
Now compare your answer to a sample question addressing a diagnosis.
In women under age 50 (P) is a yearly mammogram (I) compared with a mammogram every 3 years (C) more effective in detecting breast cancer (O)?
Clinical Domain: Prognosis/Prediction
Questions in this domain address the prediction of the course of a disease.
Use the Prognosis template to formulate a focused, answerable question addressing a diagnosis.In ____________________(P), how does ____________________ (I) compared to ____________________(C) influence _____________________(O) over ___________(T)?
Now compare your answer to sample questions addressing prognosis and prediction.
For individual 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during the flu season (T)?
Clinical Domain: Meaning
Questions in this domain address how one experiences a phenomenon.
Use the Meaning template to formulate a focused, answerable question addressing meaning.How do ____________________(P), with ____________________ (I) compared to ______________(C) perceive _____________________(O) during ___________(T)?
Now compare your answer to a sample question addressing prognosis.
Do women completing a 28-day treatment program for opioid addiction( P), with regular participation in a 12-step problem (I) compared to those with no participation (C) perceive self-efficacy (O) during the first 8-10 weeks of sobriety (T)?
Although writing clear and concise questions may be the most fundamental step of evidence-based practice, it is not always easy to put practice problems into the format of a focused, searchable question. Using these PICOT templates focuses the question and helps to identify and narrow search terms, making the search for relevant evidence less time-consuming and more productive.
Searching for Evidence
After you have a one-sentence practice question (PICOT format), the search for evidence begins with the following steps.
Identify the searchable keywords contained in your practice question and list them on the Questionnaire Development Tool (located in Appendix B of Johns Hopkins Nursing Evidence-Based Practice).
Identify the types of information needed to best answer the question and list the sources where such information can be found. What scientific search engines will you utilize to begin your search?
Develop the search strategy.
Evaluate search results relevant to the practice question.
Revise the search strategy as needed. Keep in mind that this is an iterative process. You will continue this search for evidence throughout the design phase of your practice change project.
Record your search strategy specifics, including search terms used, limits placed on the search, and years searched on the Question Development Tool and save the results.