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

(^68) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
A robust problem statement provides a comprehensive understanding of the
population of interest (e.g., patients, nurses, families, and their characteristics)
and how they are affected (e.g., of 24 surgical patients that were in the supine
position for more than 4 hours, five developed pressure ulcers on their heels).
Precise descriptions clarify the scope and magnitude of the problem related to the
outcome of interest. Discussion of the problem enables the interprofessional team
to reflect, gather information, observe current practice, listen to clinicians, visual-
ize how the process can be different or improved, and probe the description—
together fostering a shared understanding. Proceeding without a clear problem
statement results in:
■■ EBP questions that do not address the problem
■■ Searches that are too broad and lead the team to review more evidence
than is needed to answer the question
■■ Missing evidence that is important to answer the question, because spe-
cific and sensitive search terms were not used
■■ Team frustration with the effectiveness of the EBP process
A number of strategies can be used to help define problems. For example, phras-
ing the problem statement in terms of the knowledge gap rather than the solution
or asking clarifying questions (e.g., where, why, when, how) allows the team to
probe deeper into the nature or root cause of the problem. Table 4.2 provides
specific strategies for defining the problem and shows an example of each one.
Time spent defining the problem clearly and concisely facilitates the construction
of a good EBP question.