Use the Portfolio [below] to provide background on your project. Use these tools help you see the problem / challenge clearly (to make sure the problem is what you think it is).
Root cause analysis - use the 5 Whys and Fishbone tools below to help you determine the problem. Sometimes we think we know and little investigation shows us other possibilities. If you are looking at a process, use the flowchart guide below to help you "map out" the current process.
1. Watch the Assessment - Understanding the Problem video below BEFORE you begin to formulate your question.
2. Use the 5 Whys/ Fishbone / Flowchart tools as needed.
3. Begin the EBP Portfolio Step 1.
4. Contact your Clinical Inquiry Mentor / and your 1-Up to discuss the current problem and situation.
EBP has long used the PICO framework but - there's a CONCERN: PICO forces selection of an intervention -sometimes before you have solid background knowledge on a topic. It can lead to selecting an intervention, then searching only for evidence that promotes that intervention, rather than looking at overall evidence to get to the outcome you’re seeking.
We suggest a slightly different question framework, the PPCO:
P: Problem -- What's the problem generally?
P: Population - Who does the problem impact?
C: Change - What has been recommended or done to address the problem?
O: Outcome - How are outcomes reported / measured?
Waldrop, J., & Dunlap, J. J. (2024). CE: Beyond PICO-a new question simplifies the search for evidence. The American Journal of Nursing, 124(3), 34–37. https://doi.org/10.1097/01.NAJ.0001007676.91191.dd
Another way to word your question:
What's the current best evidence regarding ____________________________?
View the NExT videos (below left) for more info. (NOTE: NExT uses the PICO question framework).
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. The American Journal of Nursing, 110(3), 58–61. https://doi.org/10.1097/01.NAJ.0000368959.11129.79
Gallagher Ford, L., & Melnyk, B. M. (2019). The Underappreciated and Misunderstood PICOT Question: A Critical Step in the EBP Process. Worldviews on evidence-based nursing, 16(6), 422–423. https://doi.org/10.1111/wvn.12408
Waldrop, J., & Dunlap, J. J. (2024). The Mountain Model for Evidence-Based Practice Quality Improvement Initiatives. The American journal of nursing, 124(5), 32–37. https://doi.org/10.1097/01.NAJ.0001014540.57079.72