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“If I have ever made any valuable discoveries, it has been owing more to patient attention than to any other talent.”

–Isaac Newton

High-quality healthcare for patients and families, as well as clinicians, demands a culture of inquiry and continuous improvement. This mindset leads to identification of many practice questions that can be addressed through evidence-based practice (EBP). EBP is the process of shared decision-making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996; Sigma Theta Tau International 2005–2007 Research and Scholarship Advisory Committee [STTI], 2008). Point-of-care clinicians are in a key position to ask and answer clinical questions to promote quality and safety. Shared governance committee members and organizational leaders also generate clinical or operational questions (Cullen, Wagner, Matthews, & Farrington, 2017). Identifying a question initiates or triggers the EBP process (Iowa Model Collaborative, 2017). Questioning practice creates a culture of inquiry and is the foundation to developing a learning healthcare system (Wilson, Sleutel, et al., 2015). Identifying triggering issues or opportunities for improvement is the first step in the Iowa Model and EBP process, which is described in the remaining chapters.

The triggering issue or opportunity for improvement may be generated in a variety of ways. Potential sources are:

  • Clinical or patient identified issue

  • Organization, state, or national initiative

  • Data or new evidence

  • Accrediting agency requirements or regulations

  • Philosophy of care


Doing the right thing for patients is always a priority. Staying focused on meeting patient and family needs and continuous improvement leads to practice questions and a culture of inquiry. Clinicians are able to identify triggering issues by considering common patient symptoms or experiences, frequent assessments or interventions, and questions from patients and their families. By partnering with patients and families, clinicians can also identify EBP opportunities that promote shared decision-making so people can manage their own health (Agency for Healthcare Research and Quality [AHRQ], 2017).


Triggering issues and opportunities can also be generated when considering organization, state, or national initiatives. Consider the organization’s strategic plan, messages from senior leaders, or discussion with other leaders to identify opportunities for EBP. High-volume patient and quality care issues may be the target of some organizational initiatives. However, low volume, highly specialized procedures with their own unique set of practice implications also need to be considered. Organizations are always interested in topics supporting recognition for excellence (e.g., American Nurses Credentialing Center, 2017).

Healthcare settings are often influenced by activities happening within the state or territory in which they reside. Health systems increasingly cross boundaries ...

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