Question Development Tool
Appendix B
© 2022 Johns Hopkins Health System/Johns H
Question Development Tool
Appendix B
© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing P a g e | 2
P
I
C
O
What are preliminary inclusion and exclusion criteria (e.g., date, population, setting, other)?
Inclusion: Exclusion:
What evidence needs to be reviewed? (Check all that apply)
☐ Peer-reviewed publications (from databases such as PubMed, CINAHL, Embase)
☐ Standards (regulatory, professional, community)
☐ Clinical Practice Guidelines
☐ Organizational data (e.g., quality improvement or financial data, local clinical expertise, patient/family
preferences)
☐ Evidence-based professional organization position statements
☐ Consensus studies (e.g., commissioned reports from the National Academy of Medicine, professional
organizations, philanthropic foundations)
☐ Other ______________________________
Revised EBP question:
What are measures that indicate if the EBP project is successful? (Measures may be structure, process,
and/or outcome)Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Question Development Tool
Appendix B
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Directions for Use of the Question Development Tool
Purpose: This form guides the EBP team to develop an answerable
EBP question. It is meant to be fluid and dynamic as the team engages
in the PICO question development process. As the team becomes
familiar with the evidence base for the topic of interest, they revisit, revise, and/or refine the question, search
terms, search strategy, and sources of evidence.
What is the problem?
Describe and specify the problem that needs to be addressed. What led the team to question this practice?
Validate the problem statement with staff who experience it day to day. It is important for the interprofessional
team to work through the problem definition process together to probe the problem description, reflect, gather
information, observe current practice, and listen to clinicians’ perspectives. This team deliberation ensures the
problem statement defines the actual problem rather than a solution and guides the type of measure(s) they will
use to determine if the intervention results in improvements once implemented.
What are the data and sources of information that validate the problem?
Confirm the problem with concrete, rather than anecdotal, information. Concrete information exists in the form
of staff or patient safety concerns, data demonstrating unsatisfactory process or outcome measures, financial
reports, identification of the lack of evidence for a current practice, or unsatisfactory quality indicators. Formal
information or observations may demonstrate variations within the practice setting or variation within the
community. These elements are not mutually exclusive, and the problem may be evidenced in multiple areas.
Why is the problem important and relevant? What would happen if it were not addressed?
Establishing a sense of importance and urgency for a practice problem can help build support for the EBP
project and on-board other stakeholders. Emphasize why the problem must be addressed and the potential
consequences of not doing so. This is the place to establish your “burning platform” for practice change.
What is the current practice?
Define the current practice as it relates to the problem by identifying the gap or performance issue. Think about
current policies and procedures as well as adherence to these guidelines. What is commonly considered
acceptable among the staff related to their daily practice? Do policy and practice align? What do you see?
Is this a background question to establish the evidence on a topic (with no comparison group) or a
foreground question to compare specific interventions?
Select if you are intending to write a background or foreground question. Background questions are broad and
produce a wide range of evidence to establish best practices when the team has little knowledge, experience, or
expertise in the area of interest. Background questions do not include a “comparison” group. Foreground
questions are focused, with specific comparison of two or more ideas or interventions. Foreground questions
often flow from an initial background question and evidence review.
What are the PICO components?
See Chapter 11, Lessons from
Practice, for examples of
completed tools.Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Question Development Tool
Appendix B
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Complete each section. Definitions of each PICO element are included below.
P (patient, population, problem): This may include characteristics such as age, sex, setting, ethnicity, condition,
disease, type of patient or community.
I (intervention): This can be a best practice statement or include a specific treatment, medication, education,
diagnostic test, or care practice.
C (comparison): Not applicable for background questions. For foreground questions, comparisons are typically
with current practice or an intervention identified in the evidence.
O (outcomes): structure, process, or outcomes measures that indicate the success of evidence translation. More
than one measure can be listed; examples include structure (e.g., adequacy of resources, space, people, training),
process (e.g., care coordination, adherence to protocols for care, performance), or outcomes (e.g., satisfaction
scores or retention, fall rates, rates of disease in a population).
Initial EBP Question:
Combine each element of the PICO to create an answerable EBP question. The initial question is refined
throughout the PET process.
List possible search terms for each part of the PICO question:
Select concepts from each PICO component to identify search terms. Mapping search terms to each component
aids the evidence search; ensure terms are neither too broad nor too narrow. Brainstorm common synonyms for
each concept. Be sure to consider alternate spellings or terms used in different countries (e.g., “ward” vs. “unit”)
as well as brand names of specific interventions. It may be appropriate to leave some of the rows blank (e.g., the
O in PICO) in order to avoid building solutions into the search itself (e.g., words like “reduction” will only
provide evidence that exhibited reductions in the outcome of interest and may miss evidence with no change or
even an increase).
What are preliminary inclusion and exclusion criteria (e.g., publication date, population, and setting)?
As a team, list initial characteristics you want to include or exclude from your evidence search (for example you
may want to include student nurses but do not want to include post-licensure nurses). This will help to ensure
the team has a mutual understanding of the scope of the project. The group should revisit the list throughout the
process to provide further clarifications and refine evidence search results.
What evidence needs to be reviewed?
Select the types of evidence you intend to gather based on the PICO and initial EBP question. This will guide
you to the appropriate sources to begin the search.
Revised EBP question:
Often the question that you start with will not be the final EBP question. Needed revisions to the EBP question
may not be evident until after the initial evidence review; examples include revision to the background question
or a change from a background to a foreground question. Additionally, preliminary reviews of the evidence may
indicate a need to focus or broaden the question, update terminology, and/or consider additional measures of
success.Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals
Question Development Tool
Appendix B
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What are measures that indicate if the EBP project is successful? (Measures may be structure, process
and/or outcome)
It is essential to consider a measurement plan from the onset of an EBP project. As a team, reflect on how you
will determine project success. Success can be captured in many ways, and measures can include:
• Structure measures that describe the physical or organizational environment (e.g., nurse-patio ratios)
• Outcome measures that occur at the conclusion of a project (e.g., number of safety events)
• Process measures that are gathered throughout to track progress toward the goals (e.g., use of a new tool
or protocol)