# Welcome to SMIRK Unit
2 - Practice-based
questions

- Why develop a question?
- Key steps to evidence based practice
- Step 1
- Why focus a question?
- Focusing your question
- Back to main index

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Why develop a question?

Sometimes you will be asked to develop your own question, either on your own or working in a group. These pages will help you to:

- Identify the types of questions that arise from areas of practice
- Develop a focused practice-based question
- Recognise how research studies reflect practice-based questions that are of interest to practitioners

If you understand the components of a practice-based question, you will recognise how researchers focus these even further into investigative questions that form the starting point of a research study. Categorising questions and focusing them clearly will lead you to the right types of study to fill your knowledge gap.

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Key steps to evidence based practice

|  |  | Step 5 Evaluate and reflect
| Step 4 Implement the evidence |
|  | Step 3 Critically appraise the evidence |  |
| Step 2 Find the evidence |  |  |
Step 1 Review the practice and ask the question |  |  | Key Steps to Evidence-based practice (CASP, 2002)

Here are the five steps to evidence based practice. These are taken from the Critical Appraisal Skills Programme funded by the NHS. We will be concentrating on step 1, particularly on how to develop an appropriate focused question and pointing you in the direction of sources of evidence to match your question.

In step 2, the sort of evidence we want you to find as part of this module is primary research evidence. You are looking for this to build up a literature review which in turn is presented as a critically appraised body of evidence to examine your question. In other words, did you find strong, good evidence in the form of six primary pieces of research, to answer your practice based question or is additional or better quality research required?

Step 3, the appraisal process - SHLS use the appraisal framework in the ‘Blue Book’, Accessing and Assessing Research for Evidence-based Practice’). Stages 4 and 5 are up to you in practice!

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Step 1

The first step in the CASP framework is to review practice and identify a topic where there is a uncertainty about the evidence base for this practice. Normally in practice the topic would be obvious but for project work, the group needs to find an area of practice that you are all interested in and one in which obtaining some research evidence could enhance your practice. This is the first task of your group.

#### Examples of topic areas:

- The patient experience of having a particular condition
- The experience of family or informal carers in relation to patients with a particular condition
- Patient or carer experience of a service or aspect of care (such as outpatients, Accident and Emergency, receiving a diagnosis)
- Effectiveness of a nursing intervention
- Studies which compare treatments or interventions
- Studies which follow a cohort of patients over time to measure effectiveness of a treatment or intervention
- Studies which ask the patients for their views on an intervention

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Why focus a question?

Once you have decided on a topic you then need to focus it into an answerable question as vague, unfocused questions lead to wide, unfocused searches. These give articles that don’t really apply to your patient or client group.

If you ask the wrong question, you may miss out on relevant data in the literature because you have not searched efficiently for it.

Focused questions enable easier retrieval of appropriate evidence. In other words it is about being effective (finding the information you want) and efficient (finding it as quickly as possible).

#### So, in short, the key reasons for focusing your question are that it:

- Facilitates search for the relevant evidence
- Sorts best evidence from weaker less valid evidence
- Decides whether the evidence is applicable to your patients

###### Craig, J.V., Smyth, R.L. 2012, The evidence-based practice manual for nurses, 3rd edn, Churchill Livingstone Elsevier, Edinburgh ; New York. 610.73 EVI

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.

# Focusing your question

- Unfocused: What is it like to be diagnosed with cancer?
- Focused: What are women’s experiences of receiving a diagnosis of breast cancer?
- Very Focused: What are the experiences of young (<30) Scottish women who receive a first diagnosis of breast cancer?

These three examples show how you can move from an unfocused to a very focused question.
Remember that an advantage of being very focused is that it saves time when searching as it ensures that only relevant research is obtained.
The disadvantage is that, if insufficient evidence exists, you’ll need to widen your search a bit. It is better to start with a focused search, then widen it out, rather than the other way round.
If you need a less focused question, it is also important to consider how to widen the question out – for example, are you more interested in Scottish women or the fact that they’re under 30?

#### So - on to focus a practice based question:

- It is useful to use a process for developing questions
- Useful acronyms for devising a question are: ‘PICO’ (Health) or 'SPICE' (Social sciences)

The next section will describe PICO and SPICE in detail.

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SMIRK - Developing a practice based question by Jamie Frankis, Lesley Price, Ima Jackson SHLS modified by Marion Kelt, Glasgow Caledonian University is licensed under a Creative Commons Attribution 4.0 International License.