Comprehensive Systematic Review for Advanced Practice Nursing by 
Statistics for Evidence-Based Practice in Nursing by 
The Pharmacist's Guide to Evidence-Based Medicine for Clinical Decision Making by 
Making Sense of Evidence-Based Practice for Nursing: An Introduction to Quantitative and Qualitative Research and Systematic Reviews by 
How to read a paper : the basics of evidence-based medicine and healthcare by 
Evidence-Based Practice for Health Professionals by 
Evidence-Based Practice for Nurses and Healthcare Professionals by 
Evidence-Based Practice in Nursing and Healthcare: a guide to best practice by 
Evidence-Based Practice for Nurses, Third Edition by The first step in EBP is to ask an answerable clinical question.
Background questions ask for general knowledge about a condition, disease or drug. The background question is asked because of the need for basic information. It’s not asked because of a need to make a clinical decision about a specific patient.
Before you begin your search for information, you may have to do some reading to better understand the disease state or drug you would like to study. You need to find general/factual information on a topic which can be applied to all patients.
Examples:
Such questions can usually be answered using resources such as textbooks, drug references, review articles, etc. As you gain skills and experience, you will do less background reading, but even experienced practitioners need to ask background questions from time to time.
Foreground questions seek evidence to form a basis for decisions about a specific patient, intervention or therapy. They often compare two things: two drugs or treatments, the prognosis of two groups, two diagnostic tests, or the harms or benefits of two approaches. They require you to comprehensively search the literature for primary sources that synthesize a wide range of knowledge that call for evidence-based answers.
Examples
Such questions can usually be answered using resources such as original research articles or secondary sources such as systematic reviews. Using the PICO(T) format (more information below) can help you design an answerable clinical foreground question.
Full-text scholarly articles for the areas of nursing and allied health, including occupational therapy, physiotherapy, radiologic technology, laboratories, and social sciences. CINAHL Ultimate is an expanded version of CINAHL Complete that includes fewer embargos and more full text content.
PICO is a method that can help take you from a patient care situation/scenario to developing a foreground question, to help you focus on what exactly your information need is. Once you have these elements, you can move to converting them to search terms for your literature search.
P refers to the patient or population or problem.
Describe either the patient's chief complaint or generalize the patient's condition to a larger population.
I refers to the intervention or indicator.
What do you plan to do for that patient? This may include the use of a specific diagnostic test, treatment, adjunctive therapy, medication or the recommendation to the patient to use a product or procedure.
C refers to the comparison or benchmark against which the intervention is measured.
This is the main alternative you are considering. It should be specific and limited to one alternative choice in order to facilitate an effective computerized search. The Comparison is an optional component in the PICO question. You may look at the Intervention without exploring alternatives or, in some cases, there may not be an alternative.
O refers to the outcome or the anticipated result of the intervention.
This specifies the result(s) of what you plan to accomplish, improve or affect and should be measurable. When the intervention is a diagnosis the outcome may be about the reliability or validity of the test. With prognosis or treatment as the intervention, the outcome might be some specific morbidity. Outcomes may be worded in terms of relieving or eliminating specific symptoms, improving quality of life or maintaining or enhancing function, lowering costs, etc.
T refers to the timeframe for data collection or time to outcome. This element is optional.
Fill in the blanks with information from your clinical scenario:
THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?
ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without ______________?
DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?
MEANING
How do _______________ diagnosed with _______________ perceive __________________?
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Here is an example of a scenario/patient situation expressed in PICO and the elements that might be identified:
Systemic steroids, such as prednisone, slow bone growth. Children with chronic asthma are often prescribed inhaled steroids or corticosteroids. Do these drugs have any impact on growth before adolescence?
P: preadolescents with asthma
I: inhaled corticosteroids
C: treatment without corticosteroids
O: growth at predicted rate
In preadolescents with asthma will inhaled corticosteroids suppress normal growth (as compared to treatment without corticosteroids)?
You try it:
Your patient is a 73 year old female in good health with normal cholesterol levels and no chronic diseases. However she has started to notice that she is forgetting things more often and having problems with some every-day tasks like balancing her checkbook; she’s fearful that she might be “getting Alzheimer’s Disease.” She mentions that her neighbor told her that Lipitor is supposed to help with the symptoms or maybe even prevent Alzheimer’s disease. She wants your advice. Would this help?
P:
I:
C:
O:
This template can help you put it all together
In ______________________________________________
P component
how does ________________________________________
I component
compared with ____________________________________
C component
*affect ___________________________________________
O component
*This verb will vary depending on your outcome; it might be a term such as lower,decrease, reduce, increase, relieve, eliminate, prevent, etc.
Not everyone will "see" the same question(s) in the same patient scenario. Some possible clinical questions from this situation: