Developing and refining a clinical question

Developing and refining a clinical question: A consumer’s perspective Practicing nurses, as well as students, are challenged to keep their practice up to date by searching for, retrieving, and critiquing research articles that apply to practice issues that are encountered in their clinical setting (see Chapter 20). Practitioners strive to use the current best evidence from research when making clinical and health care decisions. As research consumers, you are not conducting research studies; however, your search for information from clinical practice is converted into focused, structured clinical questions that are the foundation of evidence-based practice and quality improvement projects. Clinical questions often arise from clinical situations for which there are no ready answers. You have probably had the experience of asking, “What is the most effective treatment for . . . ?” or “Why do we still do it this way?”


Using similar criteria related to framing a research question, focused clinical questions form a basis for searching the literature to identify supporting evidence from research. Clinical questions have four components:

• Population

• Intervention

• Comparison

• Outcome

These components, known as PICO, provide an effective format for helping nurses develop searchable clinical questions. Box 2.2 presents each component of the clinical question. BOX 2.2

C o m p o n e n t s o f a C l i n i c a l Q u e s t i o n U s i n g t h e P I C O F o r m a t Population: The individual patient or group of patients with a particular condition or health care problem (e.g., adolescents age 13–18 with type 1 insulin-dependent diabetes)

Intervention: The particular aspect of health care that is of interest to the nurse or the health team (e.g., a therapeutic [inhaler or nebulizer for treatment of asthma], a preventive [pneumonia vaccine], a diagnostic [measurement of blood pressure], or an organizational [implementation of a bar coding system to reduce medication errors] intervention)

Comparison intervention: Standard care or no intervention (e.g., antibiotic in comparison to ibuprofen for children with otitis media); a comparison of two treatment settings (e.g., rehabilitation center vs. home care)

Outcome: More effective outcome (e.g., improved glycemic control, decreased hospitalizations, decreased medication errors)

The significance of the clinical question becomes obvious as research evidence from the literature is critically appraised. Research evidence is used together with clinical expertise and the patient’s perspective to confirm, develop, or revise nursing standards, protocols, and policies that are used to plan and implement patient care (Cullum, 2000; Sackett et al., 2000; Thompson et al., 2004). Issues or questions can arise from multiple clinical and managerial situations. Using the example of catheter acquired urinary tract infections (CAUTIs), a team of staff nurses working on a medical unit in an acute care setting were reviewing their unit’s quarterly quality improvement data and observed that the number of CAUTIs had increased by 25% over the past 3 months. The nursing staff reviewed the unit’s standard of care and noted that although nurses were able to discontinue an indwelling catheter, according to a set of criteria and without a physician order, catheters were remaining in place for what they thought was too long and potentially contributing to an increase in the prevalence of CAUTIs. To focus the nursing staff’s search of the literature, they developed the following question: Does the use of daily nurse-led catheter rounds in hospitalized older adults with indwelling urinary catheters lead to a decrease in CAUTIs? Sometimes it is helpful for nurses who develop clinical questions from a quality improvement perspective to consider three elements as they frame their focused question: (1) the situation, (2) the intervention, and (3) the outcome.

• The situation is the patient or problem being addressed. This can be a single patient or a group of patients with a particular health problem (e.g., hospitalized adults with indwelling urinary catheters).

• The intervention is the dimension of health care interest, and often asks whether a particular intervention is a useful treatment (e.g., daily nurse-led catheter rounds).

• The outcome addresses the effect of the treatment (e.g., intervention) for this patient or patient population in terms of quality and cost (e.g., decreased CAUTIs). It essentially answers whether the intervention makes a difference for the patient population.


The individual parts of the question are vital pieces of information to remember when it comes to searching for evidence in the literature. One of the easiest ways to do this is to use a table, as illustrated in Table 2.6. Examples of clinical questions are highlighted in Box 2.3. Chapter 3 provides examples of how to effectively search the literature to find answers to questions posed by researchers and research consumers. BOX 2.3

E x a m p l e s o f C l i n i c a l Q u e s t i o n s • Does using a Discharge Bundle combined with Teachback Methodology reduce pediatric

readmissions? (Shermont et al., 2016)

• What is the most effective IV insulin practice guideline for cardiac surgery patients? (Westbrook et al., 2016)

• Does using a structured content and electronic nursing handover reduce patient clinical management errors? (Johnson et al., 2016)

• What is the impact of nursing teamwork on nurse-sensitive quality indicators? (Rahn, 2016)

• Do PCMH access and care coordination measures reflect the contributions of all team members? (Annis et al., 2016)

• Is a patient-family-staff partnership video the most effective approach for preventing falls in hospitalized patients? (Silkworth et al., 2016)

• What is the impact of prompt nutrition care on patient outcomes and health care costs? (Meehan et al., 2016)

PCMH, Patient-centered medical home.

  E V I D E N C E – B A S E D P R A C T I C E T I P You should be formulating clinical questions that arise from your clinical practice. Once you have developed a focused clinical question using the PICO format, you will search the literature for the best available evidence to answer your clinical question.

Get Professional Assignment Help Cheaply

fast coursework help

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason may is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Our essay writers are graduates with diplomas, bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college diploma. When assigning your order, we match the paper subject with the area of specialization of the writer.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

How It Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.


order custom essay paper
Order a unique copy of this paper
(550 words)

Approximate price: $22

Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

We value our customers and so we ensure that what we do is 100% original..
With us you are guaranteed of quality work done by our qualified experts.Your information and everything that you do with us is kept completely confidential.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

The Product ordered is guaranteed to be original. Orders are checked by the most advanced anti-plagiarism software in the market to assure that the Product is 100% original. The Company has a zero tolerance policy for plagiarism.

Read more

Free-revision policy

The Free Revision policy is a courtesy service that the Company provides to help ensure Customer’s total satisfaction with the completed Order. To receive free revision the Company requires that the Customer provide the request within fourteen (14) days from the first completion date and within a period of thirty (30) days for dissertations.

Read more

Privacy policy

The Company is committed to protect the privacy of the Customer and it will never resell or share any of Customer’s personal information, including credit card data, with any third party. All the online transactions are processed through the secure and reliable online payment systems.

Read more

Fair-cooperation guarantee

By placing an order with us, you agree to the service we provide. We will endear to do all that it takes to deliver a comprehensive paper as per your requirements. We also count on your cooperation to ensure that we deliver on this mandate.

Read more

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Open chat
You can contact our live agent via WhatsApp! Via +1 817 953 0426

Feel free to ask questions, clarifications, or discounts available when placing an order.

Order your essay today and save 20% with the discount code VICTORY