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Lesson 4
What is a Clinical Problem?©
Barbara B. Pieper, PhD, RN
LEARNING OBJECTIVE
The learner will be able to identify a clinical problem amenable to EBP.
Consumers expect you to use the most up-to-date information in your practice. Recall that evidence-based practice (EBP) is a major initiative to bridge the gap between published research or best evidence and its translation into the decision-making process of practice. The beginning of that process begins in the mind of the practitioner, and starts with identifying a clinical problem. Recall in Lesson 2 you read a journal article. Has your thinking changed on that selected topic?
The initial step in forming a clinical problem starts with asking a series of questions. Clinical questions come from a number of places. Some experts suggest scanning databases, or nursing or scientific journals, relevant to your practice, to see what is new or if there are alternative ways of doing something. This helps to get you off “auto-pilot”, and starts to stir your imagination.
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However, more specific strategies are in order to help you navigate the huge amount of information available to clinicians, and help you formulate a searchable clinical question (covered in Lesson 5). To begin, you might ask yourself if you’re achieving good clinical outcomes. Look at areas that are sensitive or responsive to nursing care. For example, what is your fall rate? Medication error or infection rate? Are your patients satisfied with their pain management? Think about what you’d like to achieve, and are you there yet? Look at the interventions you use with patients. Do you know why you’re implementing a particular intervention, a particular way? Is it based on science or is it “just the way we do it”? Is there another way of doing something? Can you do it better? What do you know about the patient’s experience with the illnesses you help to manage? What is it like to recover from breast cancer surgery or what are the coping mechanisms of long term AIDS patients? Do you base your care on knowing that experience? Who is the primary population you work with, elderly, young, a particular ethnic group, etc. and do you understand some of their developmental or cultural needs? Do you have the latest information on these groups? This kind of questioning helps a clinician look at practice with a different set of eyes and is the beginning of forming a clinical question. The terms underlined are categories that will help you form the searchable question and investigate the literature.
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