Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^24) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
The universal intellectual standards cited earlier in this chapter can assist the
team in determining the quality of reasoning about a problem, an issue, or a situ-
ation (Paul & Elder, 1996) and can help refine the practice question by making it
clear, accurate, precise, and relevant. If the question that is posed is unclear or is
based on false assumptions, it may not be truly reflective of the issue of concern.
If the question is nonspecific, it may not contain sufficient detail to be answer-
able. If the question is irrelevant to the concern, it could lead to evidence that
does not help provide an appropriate answer. The practice question should have
enough depth and breadth to reflect the complexities of care but not be so broad
that the search for evidence becomes too difficult to manage. Finally, the question
needs to make sense and contain no contradictory elements.
Schlosser, Koul, and Costello (2007) proposed identifying and formalizing the
process of asking well-built questions to distinguish them from poorly stated
questions. The JHNEBP model uses a Question Development Tool (see Appendix
B) to serve as a guide for generating useful questions and defining the scope of
the problem. Components of this tool as they relate to critical thinking standards
are outlined in Table 2.3. The Patient, Intervention, Comparison, and Outcome
(PICO) organizing template (Richardson, Wilson, Nishikawa, & Hayward, 1995)
can be used to structure question development and is discussed in more detail in
Chapter 4.
Table 2.3 Practice Question Development and Critical Thinking Standards
Practice Question Components Critical Thinking Standards and Questions
What is the practice issue?
What is the current practice?
Clarity: Is the issue clear? Can we give an
example?
How was the practice issue identified? Accuracy: Is it true because we believe it, we
want to believe it, we have always believed it, or
it is in our best interest to believe it?