Identifying a Researchable Problem

A challenging but fundamental task for a nurse in evidence-based practice (EBP) is formulating a clinical question that is answerable with research evidence (Polit & Beck, 2012). Therefore, a clinical question that is pertinent and patient centered can guide a nurse to obtain needed knowledge in addressing the needs of patients or patient populations (Krainovich-Miller, Haber, Yost, & Jacobs, 2009). A nurse formulating an answerable clinical question requires a strategy that first identifies a relevant nursing issue or problem. Then the nurse puts the nursing issue or problem of interest into a format that is easy to research and that will provide the best evidence to realize EBP (Davies, 2011). Through an analysis of current nursing issues of best care practices for mothers and their newborns after delivery, a nurse is able to identify the steps for developing a well-structured clinical question that focuses the key features to achieve EBP. Best Care Practices for Mothers and their Newborns

A nurse developing a clinical question first requires identifying a nursing issue in terms of interest, familiarity with the topic, and research feasibility (Polit & Beck, 2012). The next step for the nurse is evaluating a nursing issue based on relevance and significance to practice (Polit & Beck, 2012). One concern nursing professionals are now focused on is the importance and need to update nursing procedures and methods to evidence based and professional guideline as an avenue to improve patients’ outcomes (Shaheen et al., 2011). An issue that is currently drawing attention, in the maternal child health clinical setting is implementing best nursing care practices after delivery for mothers and their healthy newborns.

The American Academy of Pediatrics (AAP), the Neonatal Resuscitation Program (NRP), and the World Health Organizations (WHO) are now recommending the practice of early skin-to-skin contact (SSC) or known as kangaroo mother care for newborns versus the traditional hospital practice of swaddling (Phillips, 2013). Early SSC is mothers holding the naked infant on their chest immediately or within 30 minutes after birth rather than the standard practice of infants under a radiant warmer and mothers not holding their infants until swaddled in blankets (Phillips, 2013). A nurse developing a clinical question related to SSC for mothers and their newborns has the potential to improve nursing practice. After identification of relevant clinical nursing issue now is the time to move onto to generating five questions to determine feasibility. Feasibility of the Clinical Question

Determining the feasibility of a clinical question requires the nurse to narrow the issues focus sufficiently to ensure researchability (Kainovich-Miller et al., 2009). One technique Polit and Beck (2012) recommend is the nurse to ask expansive questions that focuses a nursing issue on diagnosing, assessing, treating patients or developing a better understanding of care practices. The following five questions related to SSC are developed from Polit and Beck’s (2012) recommendations: What is an effective way to implement early SSC on maternity units? What is the effect of early SSC on breastfeeding rates?

What is the effect of early SSC on maternal-infant bonding? What are the physiological effects of early SSC on mothers and their newborns? What are professional organizations currently recommending for early SSC be on maternity units? The nurse puts the topic of interest into a question using “what is” then analyzing it to determine if it meets the desired objectives for a researchable question that can positively contribute to the nursing profession (Polit and Beck, 2012, p.76). Once the feasibility of the clinical question is identified, then it is time for the nurse to move onto formatting the topic into an answerable question. Formatting a Clinical Question

The nurse identifying a well thought-out feasible clinical issue and then applying that to a structured format will enable the question to be answered with research (Davies, 2011). Researchers have found the patient/intervention/comparison/outcome (PICO) structured format to be an effective way to phrase a clinical question (Davies, 2011). A PICO question about SSC for mothers and their newborns can be developed to specifically identify effects on breastfeeding. The PICO question for this paper: “Does early SSC in the delivery room for newborns and their mothers increase breastfeeding rates compared to newborns who receive standards of care at delivery”? The outcome variable measured any breastfeeding or exclusive breastfeeding. Exclusive breastfeeding is defined by the World Health Organization (WHO) as only breast milk feeding (WHO, 2014). Having the clinical question in a structured format can assist the nurse with identifying keywords for a literature search. Literature Search with Keywords

The PICO format identifies the keywords to enable an effective electronic search of the literature (Davies, 2011). The keywords should be related to all the variables of the PICO questions (Polit & Beck, 2012). Examples of keywords for this paper’s patient or population variables are newborns, infants, and mothers. The related terms to the intervention are skin-to-skin contact, kangaroo mother care, Baby Friendly Initiative, and/or standards of care. The third variable of comparison related terms is birth. Finally, the last variables of outcome are breastfeeding or exclusive breastfeeding. The identified keywords are related directly to the terms in this paper’s PICO question. The above terms are frequently found in research literature looking at best after delivery care practices for mothers and their newborns. The nurse utilizing these related terms in various electronic databases search engines will assist with identifying research evidence to answer this paper’s PICO question. Summary

A nurse is able to identify the steps for developing a well-structured clinical question that focuses on the key elements to achieve EBP, through an analysis of current nursing issue of best care practices for mothers and their newborns after delivery. After delivery care is a common clinical scenario on maternal child health units that can be positively impacted by the latest research literature. The knowledge nurses gain from the best research evidence will provide them the opportunity to answer their PICO question. Answering the PICO question will provide the evidence to support implementing EBP for the highest quality of healthcare.

References:

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8
144 Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186-195. doi:10.3928/01484834-20090401-07 Phillips, R. (2013). The sacred hour: Uninterrupted skin-to-skin contact immediately after birth. Newborn & Infant Nursing Reviews, 13, 67–72. doi.org.ezp.waldenulibrary.org/10.1053/j Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association: JMLA, 99(3), 229-236. doi:10.3163/1536-5050.99.3.010