Clinical Inquiry: Evidence-Based Practice and Research

Clinical Inquiry and Structuring Practice Questions

In the AACN Synergy Model, clinical inquiry is defined as the ongoing process of questioning and evaluating practice, providing evidence-based care, and innovating through research. A critical care nurse demonstrating clinical inquiry critically evaluates evidence, questions outdated routines, and collaborates through approved organizational processes to improve practice within the RN role. Rather than accepting bedside routines out of habit, the nurse continuously asks whether unit protocols align with current science.

To direct clinical inquiry effectively, nurses must distinguish among research, quality improvement, and evidence-based practice. The primary goal of research is to generate new, generalizable knowledge. In contrast, the primary goal of quality improvement is to enhance internal organizational processes and outcomes. Evidence-based practice projects integrate the best available evidence with clinical expertise, patient preferences, and local data to improve bedside critical care practice. Evidence-based practice as a whole integrates the best research evidence with clinical expertise and patient values and preferences.

The standardized steps of evidence-based practice follow a systematic path: cultivate inquiry, ask the clinical question, search for evidence, critically appraise the evidence, integrate the evidence into practice, evaluate outcomes, and disseminate findings. When formulating questions, nurses distinguish between background and foreground inquiries. Background questions seek general knowledge. Foreground questions address specific questions about interventions, diagnosis, prognosis, or other clinical decisions and may use a comparison.

Foreground queries are structured using the PICOT format to ensure precise searching. In this framework, 'P' represents the patient population or clinical problem. 'I' represents the intervention, treatment, or issue of interest. 'C' represents the comparison intervention, control, or current standard of care. 'O' represents the measurable clinical outcome. Finally, 'T' represents the designated timeframe over which the outcome is evaluated.