How to Ask an

Answerable/ Right
Question?

Ns. Gst. Kade Adi Widyas Pranata, S.Kep., M.S.

What we have known…..
• Evidence-based practice (EBP) solves
clinical problems by integrating the
available best evidence, expert opinions,
and patient values and preferences.

• Implementing EBP result in higher

quality health care and superior patient
outcomes.
(Melnyk et al., 2012)
The JBI Model
• The JBI Model of Evidence-based Healthcare was
developed in 2005 and updated in 2016.
• The inner circle represents the pebble of knowledge
while the 'inner wedges' provide the Institute’s
conceptualisation of the steps involved in the process
of achieving an evidence-based approach to clinical
decision-making.
• The 'outer wedges' operationalise the component parts
of the model and articulate how they might be actioned
in a pragmatic way.
• The arrows indicate that the flow can be bi-directional.
 The Seven Steps of EBP
• Step 0: Cultivate a spirit of inquiry
• Step 1: Ask clinical questions in PICOT format
• Step 2: Search for the best Evidence
• Step 3: Critically appraise the evidence.
• Step 4: Integrate the evidence with clinical
expertise and patient preferences and
values
• Step 5: Evaluate the outcomes of the practice
decisions or changes based on
evidence
• Step 6: Disseminate EBP results
(Melnyk &Fineout-Overholt, Stillwell, Williamson, 2010)
Session Objectives

A. Distinguish background and foreground

questions
B. Recognize elements of an answerable
question (PICOT)
C. Differentiate between the various types of
questions
D. Constructs background and foreground
questions (PICOT) from the scenario
 Why Should We Ask an
Answerable Question?
• Increasing complexity of patient’s
illness.
• An overwhelming amount of information.
• Rare time to search evidence.
• To guide the right searching strategies.
Why Should We Ask an
Answerable Question?
 Where to Find Question?

• Keep having a critical attitude

towards your clinical work.

• Why do we do it this way?

• What's the best way of ....?
 Two Kinds of Clinical
Question

• Background question

• Foreground question  answerable

question
 Background Question
• Considerably broader and when answered, provide
general knowledge or information about a clinical
issue.
• Biologic, psychological and social aspects of human
illness.
 The starting place of the question
 What, where, when, why and how
 The outcome of interest
 Clinical diagnosis

Ex:
• How does the drug acetaminophen work to affect
fever?
• How do hemodynamic differ with positioning?
 Foreground Question
• Specific and relevant to the clinical issue.
• Those can be answerable from scientific
evidence about diagnosing, treating, or assisting
patients with understanding their prognosis.

Ex:
 Which is more effective in reducing fevers in
children, acetaminophen or ibuprofen?
 Which is more effective in patients with
ARDS, prone or supine positioning?
 “In adult patients undergoing surgery, how
does guided imagery compared with music
therapy affect analgesia use within the first
24 hours post-op?”
 Tugas
Metode penugasan:
 Kelas masih dibagi menjadi 7 kelompok untuk mengerjakan
tugas berikut. Kelompok berhak tidak mencantumkan nama
mahasiswa yang tidak terlibat dalam pengerjaan tugas.
 Dalam mengerjakan tugas mahasiswa wajib menggunakan
minimal 3-5 sumber terkini seperti artikel ilmiah dari jurnal, e-
book, dll seperti yang tercantum pada RPS atau yang
disediakan di perpustakaan (paling lama 10 tahun terakhir).
Sumber dari “blog”, “wordpress”, dll yang tidak terpercaya
tidak diperkenankan.
 Segala bentuk plagiarism seperti Copy Paste tugas dari
kelas lain tidak diperkenankan. Jika terbukti melanggar,
otomatis nilai kelompok akan langsung 0.

Bentuk dan Format Tugas:

 Bentuk: paper tentang background and foreground question
(masing-masing 6 pertanyaan)
 Format: -
 Tugas
Waktu pengumpulan dan format pengiriman tugas:
 Tugas dikumpulkan selambat-lambatnya satu jam
sebelum pertemuan berikutnya ke alamat email
ebp.itekesbali@gmail.com
 Pada saat pengiriman tugas, format penulisan pada
SUBJEK EMAIL adalah sebagai berikut:
Nama Mata Kuliah_Prodi & Kelas_Nama
Kelompok_Jenis Tugas
 Contoh:
EBP_Anestesiologi 2A_Kelompok 1_Paper
Background and Foreground Question