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

(^76) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
Table 4.3 Definitions and Examples of Structures, Processes, and
Outcomes of Care
Concept Definition Examples
Structure Attributes of the setting Adequacy of facility, equipment, and staff;
qualifications of staff; availability of resources;
policies
Process Any patient care activity or
intervention
Hand washing, aseptic technique; triage
algorithms in the emergency department;
medication administration
Outcome Effects of care on health
status and populations
Quality of life, patient satisfaction, surgical site
infection
Source: Donabedian, 1988
Table 4.4 provides an example using PICO to create a foreground question. The
question is, For adult surgical inpatients between the ages of 20 and 50 with a
peripheral intravenous catheter, does the use of saline to flush the peripheral IV
maintain IV patency and decrease phlebitis over 48 hours when compared to
heparin flushes?
Table 4.4 PICO Example of a Foreground Question
P—Patient,
population, or problem
Adult surgical inpatients (patients) between the ages of 20 and
50 years old with a peripheral intravenous catheter (population)
I—Intervention Use of saline flushes
C—Comparison Use of heparin flushes for peripheral IV maintenance
O—Outcomes Improvements in IV patency over 48 hours (process) and
decrease in the incidence of phlebitis by 10% (outcome)