After reading chapter two in Melnyk (chapter attached) and reviewing the lectures you submit a 2-3 page paper that explores the background of your issue.  For this paper #1, you will be defining this issue or disease using the literature.  It will end with the PICOT question. The parts of your paper should include: 

– Introduction

– Definition  

– Epidemiology

– Clinical Presentation

– Complications

– Diagnosis

– Conclusion with PICOT Question

T
o fully implement evidence-
based practice (EBP),
nurses need to have both

a spirit of inquiry and a culture
that supports it. Inour first article
in this series (“Igniting a Spirit of
Inquiry:AnEssential Foundation
for Evidence-Based Practice,”
November 2009),we defined a
spirit of inquiry as “an ongoing
curiosity about the best evidence
toguide clinical decisionmaking.”
A spirit of inquiry is the founda-
tionof EBP, andonce nurses pos-
sess it, it’s easier to take the next
step—toask the clinical question.1

Formulating a clinical question
in a systematicwaymakes it pos-
sible to find an answermore
quickly and efficiently, leading to
improved processes and patient
outcomes.
In the last installment,wegave

an overviewof themultistepEBP
process (“The Seven Steps of
Evidence-Based Practice,” Janu-
ary). Thismonthwe’ll discuss
step one, asking the clinical
question. As a context for this
discussionwe’ll use the same

scenariowe used in the previous
articles (see Case Scenario for
EBP: Rapid Response Teams).
In this scenario, a staff nurse,

let’s call herRebeccaR., noted
that patients on hermedical–
surgical unit had a high acuity
level thatmay have led to an in-
crease in cardiac arrests and in the

number of patients transferred
to the ICU.Of thepatientswho
had a cardiac arrest, four died.
Rebecca sharedwith her nurse
manager a recently published
study onhow the use of a rapid
response teamresulted in reduced
in-hospital cardiac arrests andun-
planned admissions to the critical

Asking the Clinical Question: A Key Step in
Evidence-Based Practice

A successful search strategy starts with a well-formulated question.

This is the third article in a series from the Arizona State University College of Nursing and Health Innovation’s Center
for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the
delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and
patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the
highest quality of care and best patient outcomes can be achieved.

The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one
step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward
implementing EBP at your institution. Also, we’ve scheduled “Ask the Authors” call-ins every few months to provide a
direct line to the experts to help you resolve questions. Details about how to participate in the next call will be pub-
lished with May’s Evidence-Based Practice, Step by Step.

Case Scenario for EBP: Rapid Response Teams

You’re a staff nurse on a busy medical–surgical unit. Overthe past three months, you’ve noticed that the pat

R
esearch studies show that
evidence-based practice
(EBP) leads to higher qual-

ity care, improved patient out-
comes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care.1-5 Despite
these favorable findings, many
nurses remain inconsistent in their
implementation of evidence-based
care. Moreover, some nurses,
whose education predates the in-
clusion of EBP in the nursing cur-
riculum, still lack the computer
and Internet search skills neces-
sary to implement these practices.
As a result, misconceptions about
EBP—that it’s too difficult or too
time-consuming—continue to
flourish.

In the first article in this series
(“Igniting a Spirit of Inquiry: An
Essential Foundation for Evidence-
Based Practice,” November 2009),
we described EBP as a problem-
solving approach to the delivery
of health care that integrates the
best evidence from well-designed
studies and patient care data,
and combines it with patient

preferences and values and nurse
expertise. We also addressed the
contribution of EBP to improved
care and patient outcomes, de-
scribed barriers to EBP as well as
factors facilitating its implementa-
tion, and discussed strategies for
igniting a spirit of inquiry in clin-
ical practice, which is the founda-
tion of EBP, referred to as Step
Zero. (Editor’s note: although
EBP has seven steps, they are
numbered zero to six.) In this
article, we offer a brief overview
of the multistep EBP process.
Future articles will elaborate on
each of the EBP steps, using
the context provided by the

Case Scenario for EBP: Rapid
Response Teams.

Step Zero: Cultivate a spirit of
inquiry. If you’ve been following
this series, you may have already
started asking the kinds of ques-
tions that lay the groundwork
for EBP, for example: in patients
with head injuries, how does
supine positioning compared
with elevating the head of the
bed 30 degrees affect intracranial
pressure? Or, in patients with
supraventricular tachycardia,
how does administering the
β-blocker metoprolol (Lopressor,
Toprol-XL) compared with ad-
ministering no medicine affect

By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,

FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.

Williamson, PhD, RN

The Seven Steps of Evidence-Based Practice
Following this progressive, sequential approach will lead
to improved health care and patient outcomes.

This is the second article in a new series from the Arizona State University College of Nursing and Health Innova-
tion’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving
approach to the delivery of health care that integrates the best evidence from studies and patient care data with clini-
cian expertise and patient preferences and values. When delivered in a context of caring and in a supportive organi

Exploring the Literature

Picot Question:

Research Tool Search Tips Search Terms &
Limits

Findings Features

CINAHL
CINAHL is an SSU
subscription-only
resource that offers full
text access to 336
scholarly journals and
indexes over 3,000
journals from the fields of
nursing and allied health.

 Look at the Major
Subject Heading in the
Full Record

 Use the Limits Feature:
o Example:

Publication
Type=Systematic
Review

 Try the CINAHL Heading
search:

Keyword search:

Limits:

CINAHL Heading
search:

Limits:

PubMed
PubMed is a free health
science citation &
abstracts index from the
National Center for
Biotechnology Information
at the U.S. National
Library of Medicine.

 Look at MeSH Terms in
Full Record

 Use the Limits Feature:
o Examples: Article

Type=Meta-
Analysis; Age=All
Adult

 Look for the open
access Free articles!

Keyword search:

Limits:

MESH search:

Limits:

Cochrane Library
Cochrane Library provides
access to the Cochrane
Library of Systematic
Reviews. Full text of
reviews are subscription
only. Index/summaries are
a public resource.

 Use the Simple Search
and the Advance Search
Features

 Allows you to search
with MeSH Terms

 Check out the New
Reviews

Browse reviews by topic

Keyword search:

Limits:

MESH search:

Limits:

National Guidelines
Clearinghouse
The National Guideline
Clearinghouse™ (NGC) is
a public resource for
evidence-based clinical
practice guidelines.

 Detailed search provides
limits and advance
search features

 Browse by
Disease/Condition or
Treatment/Intervention

 Add guidelines to “My
Collection” and select
Compare Guidelines to
view side-by-side
comparisons of
principle data

Keyword search:

Also browse by:

TRIP Database
TRIP is a clinical search
engine to locate publicly
available clinical evidence.

 Limit to:
 Systematic Reviews
 Guidelines-US

Keyword search:

Limits:

Other Databases: