NUR2 606 Clinical Reasoning in a Global Context

What makes a question answerable?

An answerable question is formed with your literature search in mind. It contains the "key concepts" or ideas that you can use to build your search. You will need to look for different types of information to answer different questions, and you may need to look in different places.

A patient scenario, situation or story, may include several questions, which should be formed separately as each will include different key concepts and lead to a different search.

A research topic may also include several questions, which should be formed separately as each will include different key concepts and lead to a different search. This is true for CQI and questions related to implementation as well.

There are two types of questions:

• Background questions are about general knowledge and can best be answered using textbooks.
  • Example: what are warts?
  • Go to STEP 2 on the menu on the left to learn how to answer a foreground question.
     
• Foreground questions are more specific and relate to patient care or research. There are several types of foreground question, and each is best answered by a different type of study:
   

  Type of question	Best Evidence (pre-appraised and synthesized if available)
  Prevention (questions about the effectiveness of interventions to prevent morbidity or mortality)	Quantitative Randomized controlled trials Prospective studies
  Therapy (questions about the effectiveness of treatments or other interventions to improve patient outcomes)	Quantitative Randomized controlled trials
  Diagnosis (differential or test) (Differential: questions about a possible diagnosis given a patient's signs or symptoms) Test: questions about specific diagnostic tests and how well they work)	Quantitative Prospective Studies Comparison to Gold Standard Diagnostic validation studies
  Etiology/Harm (questions about a harmful effect or exposure on)	Quantitative Observational studies (cohort or case control)
  Prognosis (questions about how likely it is for a patient to develop a disease or condition or side-effect, or the probable course of a disease)	Quantitative Observational studies (cohort or case control)
  Economics (questions about cost of healthcare)	Quantitative Cost-effectiveness studies
  Meaning (questions about patients' experiences and concerns.)	Qualitative, Mixed methods Case studies, ethnography, grounded theory, phenomenologic approach
  Implementation (questions about barriers/facilitators to, and methods for implementing, research in practice)	Quantitative, Mixed methods Many of the above types of study methodologies can be used in implementation research, but additional types of studies such as evaluation studies and participatory action research and others can be used.

  • Example Therapy question: Is duct tape an effective treatment option for cutaneous warts in children?
     
  • Go to STEP 2 on the menu on the left to learn how to answer a foreground question, or search for evidence by type of question using:
    • the interactive evidence pyramid or
    • the interactive concept map.

IMPORTANT! Don't forget to identify your key concepts or ideas first!

Additional reading:

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. AJN, American Journal of Nursing, 110(3), 58-61.

Tools & worksheets: