Module Components

• Learning Activities

Topics

• National Initiatives and Major Health Problems
• Clinical Problems
• Developing Focused Questions
• Problem Generation
• Module 6:
  Self-Review

NRSG 790 - Methods for Research and Evidence-Based Practice

Module 6: Problem Generation

CLINICAL PROBLEMS

In Chapter 1, Melnyk & Fineout-Overholt (2019) define evidence-based practice (EBP) as the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making in response to a specific clinical problem. Before a PICOT question can be properly framed, one must clearly define the clinical problem and describe the problem’s magnitude and significance. Clinical problems are those that occur in the course of providing healthcare. The nurse clinician wants to provide the best care and interventions possible and thus must be aware of recommendations based on evidence. Significant clinical problems are those that affect many people and/or qualitatively impact the health and well-being of some group(s) of clients receiving healthcare. Significant problems thus receive more attention. If a problem is not very significant, then few people will be interested in solving such a problem.

An example of a significant clinical problem that affects many people in the United States is pediatric obesity. Review the Centers for Disease Control and Prevention (CDC) description of the problem of pediatric obesity http://www.cdc.gov/obesity/data/childhood.html. A relevant PICOT question might explore interventions to reduce obesity among children, either in the context of the family or the community, and in the primary care and/or the school setting.

• What types of interventions have been tried, and which interventions have been successful?
• What studies of such interventions have been published?
• Does other evidence exist?
• According to the CDC, “Childhood obesity among preschoolers is more prevalent among those from lower income families.” Another relevant PICOT question might explore how to address this health disparity.

The graduate nurse must do some preliminary investigation of the background of what is known about a clinical problem by searching the relevant literature and credible websites prior to developing the PICOT question. Often the CDC’s National Center for Health Statistics (http://www.cdc.gov/nchs/index.htm) or other federal, state or local government websites can provide statistics to quantify the magnitude of specific clinical problems. Problems that affect many people, problems that have the potential to cause mortality, and problems that impact life expectancy, disability and/or quality of life are significant problems suitable as a foundation for developing a PICOT question.