Expert answer:Background questions

Solved by verified expert:This is a three part assignment step on is posted I completed it step 2 is creating backgroung questions for depression on adolescents age 14 to 17 middle adolescents the 3 step is posting one page this is what I’m doing this how I’m doing it this is what I hope to achieve and do you have any suggestiond type og paper. step 4 2 to 3 page paper off of chapter two which is posted in the paper read the instructions and good luck
wk_2_graduate_project_assignment_2_background.doc

nsg6999wk2_dq2_instructions.doc

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The parts of your paper should include:
Introduction
Definition
Epidemiology
Clinical Presentation
Complications
Diagnosis
Conclusion with PICOT Question
Background Question
You will be looking for overview/background information and you will need to answer
a BACKGROUND QUESTION with general knowledge about a disorder or topic. “What
you know.”
Background information may be found in sources such as:
•
•
•
•
reference book entries
•
textbooks, chapters, appendices
•
drug monographs, guides to diagnostic tests
•
the library
•
selected in the health sciences
Asks for general information about a clinical issue
Usually has two components:
1. The starting place of the question (e.g., what, where, when, why, and how)
2. The outcome of interest
Broader in scope than a foreground (PICOT) question
Foreground questions (PICOT format)
•
•
•
Asks for specific scientific evidence about diagnosing, treating, or educating patients
The focus is on specific knowledge
Use of PICOT format is recommended for a focused literature search
Foreground questions are clinical questions that can only be answered by specific
scientific evidence that is usually found in original studies or systematic reviews of
original studies (e.g., RCTs). This type of evidence is not available in textbooks, which
are more appropriate for answering background questions.
Scoping Search
A Background search also called a Scoping Search:
Background Questions: This is where you do an extensive exploration of the topic of
choice—with a disease issue ie: heart disease or depression the following questions
must be answered. With a clinical issue the exploration must be exhaustive based on
the topic.
Background questions, ask about general knowledge about a disorder or
topic. A scoping search begins to locate general knowledge about a topic.
Expert opinions, pre-synthesized and pre-appraised guidelines, summaries.
To insure a complete understanding of the issue a clinical background question would
include the following:
•
•
•
•
•
•
Definition
Epidemiology
Clinical Presentation
Complications
Diagnosis
Conclusion
And, this will lead to the PICOT question.
Barriers to EBP
•
•
•
•
•
•
Clinical Inquiry must be cultivated in the work environment and in the presence of
uncertainty.
Uncertainty is the inability to predict what an experience will mean or what outcome will
occur. In the face of uncertainty and clinical inquiry clinicians must be able to find the
right information at the right time—thus setting up specific barriers to EBP.
Access tends to be the biggest barrier.
Access to computers on the unit, access to electronic resources and information and
access to time to search for the best evidence to answer our questions.
Additional barriers include nurses’ comfort level in searching the library and search
technology and skills in developing a strong researchable question.
What other barriers can you think of?
Chapter 2 Asking Compelling, Clinical Questions Ellen Fineout-Overholt and Susan B. Stillwell A
prudent question is one-half of wisdom. —Francis Bacon Seeking and using health information has
changed over the past several decades, not only for healthcare professionals (e.g., the Internet;
electronic health records with evidence-based clinical decision support systems; Ferran-Ferrer,
Minguillón, & Pérez-Montoro, 2013) but also for patients, who are moti- vated to access health
information via the web (Shaikh & Shaikh, 2012). Over the past few years, significant strides have
been made to make digital health information even more readily available, thus leading to informed
clinical decisions that are evidence based (Institute of Medicine, 2011). In addition, growing
complexity of patient illness has required practitioners to become increasingly more proficient at
obtaining information they need when they need it. Access to reliable information is necessary to
this endeavor (Kosteniuk, Morgan, & D’Arcy, 2013) as well as clinicians definitively identifying what
they want to know and what they need to access (Fineout-Overholt & Johnston, 2005; Melnyk,
Fineout-Overholt, Stillwell, & Williamson, 2010). Additionally, resources (e.g., computers, databases,
and libraries) have to be in place to ensure that prac- titioners can retrieve needed information so
that they can perform the best patient care possible. Not all practice environments have or allow
unrestricted access to these resources. There are many variables that influence whether a
practitioner has the capacity to gather information quickly (e.g., financial ability to purchase a
computer, availability of Internet service providers); however, every clinician must be able to
articulate the clinical issue in such a way that it maximizes the information obtained with the least
amount of time investment. Hence, the first step in getting to the right information is to determine
the “real” clini- cal issue and describe it in an answerable fashion, that is, a searchable, answerable
question. However, skill level in formulating an answerable question can be a barrier to getting the
best evidence to apply to practice (Gray, 2010; Green & Ruff, 2005; Rice, 2010). This chapter
provides practitioners with strategies to hone skills in formulating a clinical question to clarify the
clinical issue and to minimize the time spent in searching for relevant, valid evidence to answer it. A
NEEDLE IN A HAYSTACK: FINDING THE RIGHT INFORMATION AT THE RIGHT TIME Th e key to
successful patient care for any healthcare professional is to stay informed and as up to date as
possible on the latest best practices. External pressure to be up to date on clinical issues
increasingly comes from patients, employers, certifying organizations, insurers, and healthcare
reform (Centers for Medicare & Medicaid Services, 2006; Greiner & Knebel, 2003; Rice, 2010). The
clinician’s personal desire to provide the best, most up-to-date care possible along with
expectations from healthcare consumers that practice will be based on the latest and best
evidence fosters evidence-based practice (EBP). However, the desire to gather the right information
in the right way at the right time is not suffi cient. Practical, lifelong learning skills (e.g., asking
focused questions, learning to search efficiently) are required to negotiate the information-rich
environment that every clinician encounters. With the amount of information that clinicians have at
their disposal today, finding the right information at the right time is much like weeding through the
haystack to find the proverbial needle. If one has any hope of finding the needle, there must be
some sense of theneedle’s characteristics (i.e., a clear understanding of what is the clinical issue).
Clinical questions arise from inquiry. Clinicians notice that there is something curious in the clinical
environment that they then formulate into a question, or a patient or layperson may foster the
question. Whoever initiates the question, it is important to carefully consider how to ask it so that it
is reasonable to answer. Formulating the clinical question is much like identifying the
characteristics of the needle. Question components guide the search- ing strategies undertaken to
find answers. Yet, clinicians are not always equipped to formulate searchable questions (Melnyk,
Fineout-Overholt, Feinstein, Sadler & Green-Hernandez, 2008), which often can result in irrelevant
results and inefficient use of clinicians’ time (Rice, 2010). Once the needle’s characteristics are well
understood (i.e., the PICOT question), knowing how to sift through the haystack (i.e., the evidence)
becomes easier (see Chapter 3 for searching strategies). Huang, Lin, and Demnar-Fushman (2006)
found in a study examining the utility of asking clini- cal questions in PICOT format (i.e., P:
population of interest; I: intervention or issue of interest; C: comparison of interest; O: outcome
expected; and T: time for the intervention to achieve the outcome) that when clinicians asked
clinical questions for their patient’s clinical issues, their format almost always fell short of
addressing all the aspects needed to clearly identify the clinical issue. Two of 59 questions
contained an intervention (I) and outcome (O), but no other components (P, C, or T), although these
aspects were appropriate. Currie et al. (2003) indicated that approximately two thirds of clinicians’
ques- tions are either not pursued or answers are not found even though pursued. However, if
properly formu- lated, the question could lead to a more effective search. Price and Christenson
(2013) concur with these researchers’ findings, indicating that getting the question right
determines the success of the entire EBP process. In addition, in a randomized controlled trial
(RCT) examining the effect of a consulting service that provides up-to-date information to
clinicians, Mulvaney et al. (2008) found that such a knowledge broker improves the use of evidence
and subsequent care and outcomes. However, without having a well-built question to
communicate what clinicians genuinely want to know, efforts to search for or pro- vide appraised
evidence will likely be less than profitable. Hoogendam, de Vries Robbé, and Overbeke (2012)
determined that the PICO(T) format was not helpful in guiding efficient searches; however, their
report did not indicate how they measured proficiency of participants in writing PICOT questions or
how they were taught about their formulation. Learning how to properly formulate a clinical
question is essential to a successful search and to effectively begin the EBP process. The
Haystack: Too Much Information Although there is a plethora of information available and
increasingly new modalities to access it, news of clinical advances can diffuse rather slowly
through the literature. Additionally, only a small percent- age of clinicians access and use the
information in a timely fashion (Cobban, Edgington, & Clovis, 2008; Estabrooks, O’Leary, Ricker, &
Humphrey, 2003; MacIntosh-Murray & Choo, 2005; McCloskey, 2008; Melnyk, Fineout-Overholt,
Gallagher-Ford, & Kaplan, 2012; Pravikoff, Tanner, & Pierce, 2005). Clini- cians are challenged with
the task of effectively, proactively, and rapidly sifting through the haystack of scientific information
to find the right needle full of the best applicable information for a patient or practice. Scott,
Estabrooks, Allen, and Pollock (2008) found that uncertainty in clinicians’ work envi- ronment
promoted a disregard for research as relevant to practice. In a 2012 study of over 1,000 nurses,
Melnyk and colleagues reinforced these researchers’ finding with their participants indicating that
lack of access to information was one of the top five deterrents to implementing EBP in daily
practice. To reduce uncertainty and facilitate getting the right information at the right time, EBP
emphasizes first asking a well-built question, then searching the literature for an answer to the
question. This will better prepare all clinicians to actively discuss the best available evidence with
colleagues and their patients. The EBP process focuses on incorporating good information-seeking
habits into a daily routine. Pravikoff et al. (2005) indicated that not all nurses were engaged in daily
information seeking, support- ing the notion that, in a busy clinical setting, there is seldom time to
seek out information, which was reinforced in the study by Melnyk et al. (2012). The purchase of a
good medical text and regular perusal of the top journals in a specialty were once considered
adequate for keeping up with new information, but scientific information is expanding faster than
anyone could have foreseen. The result is that signifi- cant clinical advances occur so rapidly that
they can easily be overlooked. Reading every issue of the top three or four journals in a particular
field from cover to cover does not guarantee that clinicians’ profes- sional and clinical knowledge
is current. With the increase in biomedical knowledge (especially infor- mation about clinical
advances), it is clear that the traditional notion of “keeping up with the literature” is no longer
practical. Before the knowledge explosion as we know it today, Haynes (1993) indicated that a
clinician would have to read 17–19 journal articles a day, 365 days a year to remain current. This
com- pels every clinician to move toward an emphasis on more proactive information-seeking
skills, starting with formulating an answerable, patient-specific question. Digitization and the
Internet have improved accessibility to information, regardless of space and time; however, these
innovations have not resolved the issue of finding the right information at the right time. It is
important to become friendly with and proficient at utilizing information technology, includ- ing the
Internet and other electronic information resources, which means that clinicians must be skilled in
using a computer. Access to computers at the point of care is also essential. The information
needed cannot be obtained if the clinician has to leave the unit or seek an office to locate a
computer to retrieve evidence. Proficient use and access to computers are essential to EBP and
best practice. In addition, other barriers described by nurses and other healthcare professionals to
getting the right information at the right time include (a) access to information, (b) a low comfort
level with library and search tech- niques, (c) access to electronic resources, and (d) a lack of time
to search for the best evidence (Melnyk & Fineout-Overholt, 2002; Melnyk, Fineout-Overholt,
Gallagher-Ford & Kaplan, 2012; Pravikoff et al., 2005; Sackett, Straus, Richardson, Rosenberg, &
Haynes, 2000). Skills in clinical question formulation lead to an efficient search process. Other
barriers to finding the necessary evidence to improve patient outcomes can be adequately
addressed through clinicians first learning to ask a searchable, answerable question. The important
thing is not to stop questioning. —Albert Einstein AskiNg seARcHAble, ANsweRAble QuestioNs
Finding the right information in a timely way amidst an overwhelming amount of information is
imper- ative. The first step to accomplish this goal is to formulate the clinical issue into a
searchable, answerable question. It is important to distinguish between the two types of questions
that clinicians might ask— background questions and foreground questions. Background
Questions Background questions are those that need to be answered as a foundation for asking the
searchable, answerable foreground question (Fineout-Overholt & Johnston, 2005; Stillwell, FineoutOverholt, Melnyk, & Williamson, 2010; Straus, Richardson, Glasziou, et al., 2005). Background
questions are those that ask for general information about a clinical issue. This type of question
usually has two components: the starting place of the question (e.g., what, where, when, why, and
how) and the outcome of interest (e.g., the clinical diagnosis). An example of a background
question is: How does the drug acetamino- phen work to affect fever? The answer to this question
can be found in a drug pharmacokinetics text. Another example of a background question is: How
does hemodynamics differ with positioning? This answer can be found in textbooks as well. Often,
background questions are far broader in scope than foreground questions. Clinicians often want to
know the best method to prevent a clinically undesirable outcome. For example: What is the best
method to prevent pressure ulcers during hospitalization? This question will lead to a foreground
but scientific information is expanding faster than anyone could have foreseen. The result is that
signifi- cant clinical advances occur so rapidly that they can easily be overlooked. Reading every
issue of the top three or four journals in a particular field from cover to cover does not guarantee
that clinicians’ profes- sional and clinical knowledge is current. With the increase in biomedical
knowledge (especially infor- mation about clinical advances), it is clear that the traditional notion of
“keeping up with the literature” is no longer practical. Before the knowledge explosion as we know it
today, Haynes (1993) indicated that a clinician would have to read 17–19 journal articles a day, 365
days a year to remain current. This com- pels every clinician to move toward an emphasis on more
proactive information-seeking skills, starting with formulating an answerable, patient-specific
question. Digitization and the Internet have improved accessibility to information, regardless of
space and time; however, these innovations have not resolved the issue of finding the right
information at the right time. It is important to become friendly with and proficient at utilizing
information technology, includ- ing the Internet and other electronic information resources, which
means that clinicians must be skilled in using a computer. Access to computers at the point of care
is also essential. The information needed cannot be obtained if the clinician has to leave the unit or
seek an office to locate a computer to retrieve evidence. Proficient use and access to computers
are essential to EBP and best practice. In addition, other barriers described by nurses and other
healthcare professionals to getting the right information at the right time include (a) access to
information, (b) a low comfort level with library and search tech- niques, (c) access to electronic
resources, and (d) a lack of time to search for the best evidence (Melnyk & Fineout-Overholt, 2002;
Melnyk, Fineout-Overholt, Gallagher-Ford & Kaplan, 2012; Pravikoff et al., 2005; Sackett, Straus,
Richardson, Rosenberg, & Haynes, 2000). Skills in clinical question formulation lead to an efficient
search process. Other barriers to finding the necessary evidence to improve patient outcomes can
be adequately addressed through clinicians first learning to ask a searchable, answerable question.
The important thing is not to stop questioning. —Albert Einstein AskiNg seARcHAble, ANsweRAble
QuestioNs Finding the right information in a timely way amidst an overwhelming amount of
information is imper- ative. The first step to accomplish this goal is to formulate the clinical issue
into a searchable, answerable question. It is important to distinguish between the two types of
questions that clinicians might ask— background questions and foreground questions. Background
Questions Background questions are those that need to be answered as a foundation for asking the
searchable, answerable foreground question (Fineout-Overholt & Johnston, 2005; Stillwell, FineoutOverholt, Melnyk, & Williamson, 2010; Straus, Richardson, Glasziou, et al., 2005). Background
questions are those that ask for general information about a clinical issue. This type of question
usually has two components: the starting place of the question (e.g., what, where, when, why, and
how) and the outcome of interest (e.g., the clinical diagnosis). An example of a background
question is: How does the drug acetamino- phen work to affect fever? The answer to this question
can be found in a drug pharmacokinetics text. Another example of a background question is: How
does hemodynamics differ with positioning? This answer can be found in textbooks as well. Often,
background questions are far broader in scope than foreground questions. Clinicians often want to
know the best method to prevent a clinically undesirable outcome. For example: What is the best
method to prevent pressure ulcers during hospitalization? This question will lead to a
foregroundquestion, but background knowledge is necessary before the foreground question can
be asked. In this example, the clinician must know what methods of pressure ulcer prevention are
being used. Gener- ally, thi …
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