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

4 The Practice Question 75

Patient, population, or problem

Describe the patient, population, or problem succinctly. Include the type of pa-

tient or population and the setting. Consider patient attributes such as age, gen-

der, symptoms, and diagnosis (patient’s problem) or issues such as effectiveness,

timeliness, efficiency, or safety.

Intervention

The intervention can be a treatment; a clinical, learning, or operational interven-

tion; or a structure or process of care (see definitions and examples in Table 4.3).

Comparison with other intervention(s)

Determine if a comparison intervention exists. Will this intervention be compared

to another? Not all questions have comparisons, particularly if you are asking a

background question. A statement of current practice may be used as a compari-

son.

Outcomes

Define measures that will be used to determine the effect of the intervention on

target population (e.g., readmission, quality of life, hand hygiene, compassion

fatigue. Once the measure(s) is defined, the next step is to describe how it will be

calculated (the metric). A metric is the degree to which a particular subject pos-

sesses the quality that is being measured. Measures can be rate-based or nonrate-

based. Rate-based metrics are calculated using a numerator and denominator. For

example, if the outcome of interest is patient falls, the metric will describe how

falls will be measured. In this example, the metric would be the total number of

falls (numerator) per 1,000 patient days (denominator). Nonrate-based measures

are counts or frequency of occurrence or a process measure such as symptom

experience. Measuring outcomes indicates the level of success in achieving the

desired outcome(s). A measurement plan (see Appendix B) guides teams through

this process.