4 The Practice Question 67Trigger Sources of Evidence-Based Practice Problems
Knowledge-
focused
New sources of evidenceChanges in standards or guidelinesNew philosophies of careNew information provided by organizational standards committeesProblems may also be recurring or priority issues within an organization or a
practice that has questionable benefit. Clinical questions can seek to help nurses
understand dissimilar outcomes between two patient populations. Why do
some patients in the intensive care unit (ICU), for example, develop ventilator-
associated pneumonia whereas other ICU patients do not? There may be a
difference in practice among nurses, nursing units, or peers outside of the organi-
zation. The potential for problems to generate practice questions is limitless, and
EBP projects have the potential to result in improvements in health, organization
of systems, or education. Problems that are important are those that can cause
harm, result in an unsatisfactory experience, or diverge or vary from established
standards of care or that are associated with high resource use (e.g., staffing or
costs). With the advent of value-based purchasing, healthcare teams and orga-
nizations are now financially rewarded or penalized for performance on quality
and safety outcomes, preventable adverse conditions, and costs. Thus, it is crucial
that EBP teams, before beginning the EBP project, consider and select problems
that align with identified priorities within their organization. When time and ef-
fort are dedicated to only those questions that are important, potential benefits
accrue to patients, nurses, and organizations, such as:
■■ Increased visibility of nursing leadership and contributions
■■ New levels of support from clinicians and organizational leaders
■■ Tangible quality and safety benefits to patients and families
■■ Values-based organizational outcomes