Problem Identification

A problem is the statement of a question that needs to be answered or a situation that needs a solution. The problem emerges from a clinical situation in which there is a knowledge gap or uncertainty regarding the "best" response to the situation.

• Recognize that a problem exists
• Phrase the problem accurately to facilitate the searching for a precise answer

• Crucial step in the EBP process and therefore,
• The right people must be involved in this process and adequate time must be allotted.

• Design a multi-disciplinary team to work on the entire EBP process.
• Group should represent all of the key healthcare providers for the particular clinical situation in question, for example one group may have representatives from medicine, nursing, pharmacy, physical therapy, nutritional support, case management and home care. Some level of administration is also helpul to have represented on the team.
• Representation on the team often facilitates support for the recommended practice change that is the outcome of the EBP process.
• Co-leaders are accepted more readily. Ideal co-leaders for many groups may be an Advanced Practice Nurse and a physician.

• Adequate time must be allotted for this phase in the EBP process.
• Adequate time is needed to consider and develop the best question. The more exact the question is, the more focused the search for evidence can be.
• Prioritize by asking, "What is the most important issue for this current situation?" or "What issue should be addressed first?

Question should contain the following essential components to guide the search for evidence:

1. Patient or situation being addressed
2. Phenomenon being considered
3. Comparison intervention, when relevant
4. Clinical outcomes of interest

Problems may identify knowledge gaps within a clinical situation in the following areas:

1. Diagnosis: questions regarding the selection and interpretation of diagnostic tests.
   Example: Should a venogram dye study be performed on all central venous devices from which a nurse is unable to obtain a blood return?
2. Prognosis: questions regarding the likely patient's clinical outcome. Example: Is there a difference in response rate of IV heparin administration compared to SQ low molecular weight heparin in a patient with lower extremity deep vein thrombosis?
3. Therapy: questions regarding the selection of treatments that are most beneficial.
   Example: What bowel regimen will be most effective in relieving constipation associated with the administration of opioid therapy for the relief of pain?
4. Prevention: questions regarding screening and prevention methods to reduce the risk of disease.
   Example: Would performing a prostate-specific-antigen (PSA) test in an elderly asymptomatic male decrease his risk of mortality from prostate cancer?
5. Education: questions regarding best teaching strategies for colleagues, patients or family members.
   Example: What is the most effective teaching strategy to educate patients and family members about medication administration of Coumadin?