A common approach taken by nurses who are trying to find research questions to study is to look in the literature or at research priorities published by professional nursing organizations. Although this approach may lead to identification of research ideas, it does not necessarily identify research ideas that are likely to result in the successful completion of a project by busy clinicians. Conducting research while employed in the service setting as a staff nurse, advanced practice nurse, or clinical educator requires careful consideration of research topic selection to avoid common roadblocks to research completion (Figure 1). This article highlights characteristics of research questions that help avoid some of the roadblocks or barriers commonly encountered when conducting research in the clinical setting. In addition, a novel approach to identifying research questions by a team of unit staff will be described.
Figure 1: Common roa...Image Tools
Roadblocks to Completion of a Research Project by Clinicians
Many of the roadblocks to completion of research projects by clinicians are related to time constraints inherent in clinical nursing positions (Table 1).1–3 The primary responsibility of service-setting employees is patient care, not the conduct of nursing research. Not surprisingly, it may be difficult for service-setting employees to find the time to carry out typical research activities, such as finding the research questions, reviewing the literature, writing the research protocol, and performing data collection. Waiting for a time when staffing is good enough and/or meetings are at a minimum so you can have some consolidated time to focus on research activities is wishful thinking. To be successful in research endeavors as a service-setting employee, you need to find ways to integrate research activities into your normal work routines.
Table 1: Common Road...Image Tools
A significant roadblock to successful completion of a research project is when accrual of subjects for the study does not occur rapidly. Given that clinicians will have to squeeze data collection into their hectic schedules, it's important that there are eligible patients available for entry into the study. This will not occur if the research question focuses on a patient population that is not present on the unit at all times.
Lack of experience in conducting research is yet another roadblock to successful completion of a project. In addition to the time and energy to conduct the study, neophyte researchers have to expend additional time just to learn how to accomplish some of the basic steps in conducting a research study. This time requirement will be further extended if the researchers have little or no clinical expertise in the content area of the research question. Time must not only be spent in increasing the researcher's knowledge of how to conduct research, but also be spent in becoming an expert in the new topical area, increasing the chance the study may never be completed.
Another roadblock to research completion is finding fiscal support to conduct your study. If you design a research study that requires additional funds to purchase equipment or to pay individuals to do data collection and you are unable to procure the funds, your project is doomed before you even get started. Most hospital nursing budgets have little, if any, money set aside for research. Groups that provide funding for research studies are inundated with requests for their limited funds. Without prior experience conducting research and applying for grants, your chances of successfully competing for grant money to support your study are small.
A roadblock that is not well-appreciated until you are in the midst of collecting data for your study is not having enough people to assist you with data collection. In the best of circumstances, it's difficult to conduct research by yourself or with just one person to share the work. Conducting research when you're a busy clinician is especially difficult without a team of people committed to working on the project.
And last, but certainly not a trivial roadblock, is a lack of administrative support for your research study. When the research proposed for study is not viewed by administrators as important to patient care or organizational outcomes, even small requests for support related to the study may not be supported.
Ideal Research Studies for Busy Clinicians
Finding good research studies for clinicians requires an understanding of the realities of clinical practice today and the types of roadblocks that can be encountered when attempting to conduct clinical research (Table 1). One must find ways to avoid or overcome these obstacles to maximize the chance of successful study completion. Pivotal to success will be the ability to consider what constitutes a good research study for service setting clinicians and to adapt how the research process is undertaken in a clinical setting.1–3
While no one study will probably ever possess all of the criteria of an ideal research study for busy clinicians, the more criteria that can be achieved with the proposed research study, the higher the chances for successful completion. No matter what the source of ideas for research questions are (eg, questions that arise from daily practice, research priorities identified by nursing associations or expert researchers, journal clubs, or suggestions for future study in published research), consideration should be given to how many of the ideal characteristics are present in the question prior to selecting it for study (Table 2).
Table 2: Characteris...Image Tools
Large Numbers of Patients Eligible for the Study
One of the most important criteria is that the research question should be relevant to a large number of patients typically cared for on the unit. By selecting this type of question, the clinician researcher ensures that whenever they have time to perform data collection, there will likely be a patient on the unit who meets the eligibility criteria for the study. For example, consider a research question about the best method for preventing hemostasis following arterial sheath removal in postcardiac catheterization patients. If your unit has at least 2 or 3 patients each day undergoing cardiac catheterization, there will likely always be a patient eligible for entry into the study when the clinician researcher is able to squeeze data collection into his or her patient care assignment. The presence of this criterion also maximizes the chance that data collection can be completed in a reasonable amount of time (<3 to 4 months), minimizing roadblocks related to loss of staff interest in the study over time. If your unit has only 2 or 3 patients per week eligible for the study, completing data collection will be prolonged, since busy clinicians attempting to collect data may only be able to study 1 patient per week, at best. Slow accrual of patients will prolong data collection, significantly increasing the chance that staff will loose interest in the project, and/or other intervening unit activities will take priority over completion of the research study.
Another advantage of selecting a research question that is relevant to a large number of patients on the unit is that the study is more likely to be perceived by others as important, since it has the potential to affect a large number of patients. If the research question selected is related to an important patient care situation, but is one that occurs only once or twice a month at most, not only will the time for data collection be excessive, but the impact of the findings will not be as great as a study that applies to higher volume patients. Convincing others within the institution to support your study, both conceptually and financially, will be important for success and much easier to accomplish if the study has relevance to a large number of patients.
Sample Size Requirement of <75 Subjects
Also of importance to getting data collection done quickly is the need to have a study question that does not require a large sample size. The larger the number of subjects required to be studied, the longer the data collection time will be and the more likely staff will be to lose interest in the study. In order to complete data collection in a reasonable amount of time, preferably <3 months, the study sample size required should generally not exceed 75 subjects. The impact of sample size on data collection times can be readily appreciated if one estimates the number of weeks of data collection, assuming at least 5 subjects/week are enrolled in a study (Table 3). In estimating the weeks for data collection, you should not assume that all subjects eligible for the study will actually complete data collection. Some patients will decide not to participate, staff may be too busy to enter every patient that is eligible, and/or data collection will not be completed on all subjects due to logistical problems or interferences that may occur during data collection.
Table 3: Estimate of...Image Tools
While it is beyond the scope of this article to adequately describe how one determines the sample size requirements for a study, suffice it to say that a sample size calculation should be performed when planning a research study to estimate the number of subjects required. Often, this calculation is done by a statistician or nurse researcher and is dependent on the frequency of the problem under study, as well as an estimate of the effectiveness of the intervention to be tested. For example, if the problem of interest is a comparison of 2 different methods for oral care on the incidence of ventilator-associated pneumonia (VAP), a sample size calculation would require knowing the incidence of VAP in your patient population and then an estimate of how much of a reduction in VAP is likely or desired to occur with oral care. Standard formulas and software programs are available to calculate sample sizes.2,4–11
Focuses on Important Patient Outcomes (Clinical and/or Fiscal)
To maximize the chances that the research will be viewed as valuable by others in the institution, the study should deal with important clinical problems or issues. Getting other nursing or medical colleagues to support your study will be easier if the research question focuses on a patient care issue of importance. As administrators make difficult choices on the use of scarce resources, it is much easier to justify supporting a research project with the potential for cost savings or improved patient outcomes than one with no apparent benefit to practice.
No Additional Funds Required to Conduct the Study
Research topics that allow you to use equipment that is already within the institution is ideal, since conducting the study will not be dependent on finding money to purchase needed equipment or supplies. If your study requires money to purchase new medical devices/equipment or supplies and if you cannot get administrative support for those costs, you will need to apply for a grant to support your study. Even though a variety of groups, associations, and federal agencies provide grant money for clinical research, with large numbers of individuals competing for those limited funds, you are unlikely to be funded. Even if you are funded, the time and energy required to submit a grant request may be significant, with considerable delays to begin your research project.
Measurement Tools Exist to Quantify the Variables of Interest
If prior research has not identified a way to measure the variables of interest in your study, the first step is to perform a separate research study to develop and test the new variable measure. So now, instead of having one research study to complete, you really have 2: the study to test the new measurement tool and then the study you originally proposed to do. For busy clinicians, committing to 2 research studies is not a realistic approach to answer a research question.
Data Collection Can Be Easily Integrated into Usual Patient Care Routines
The ideal research topic would not require the researchers to be released from patient care responsibilities and/or require staff to come in on their off time in order to collection data for the study. While nursing research studies that receive research grants typically have money for hiring data collectors, without external funding, the majority of nursing budgets would not have extra monies for support of nonproductive staff time to conduct research. So, the ideal study would allow for data collection to be easily accomplished along with normal patient care, so that payment of free-standing data collectors would not be a requirement for successful completion of data collection.
For example, a study that is evaluating the accuracy of a new temperature device could easily be designed so that the collection of temperatures with several different devices could be done during the times temperatures are normally done on the unit. The clinicians who normally take temperatures would all be taught to properly use the study devices and would measure temperature with the usual therapeutic temperature device, as well as 1 or 2 other devices. The total time for data collection from each subject would not need to be more than a few minutes longer than the time for the therapeutic temperature measurement, making data collection by clinicians feasible. Although prior research on temperature devices may have been conducted by a single researcher who takes all the temperatures (this minimizes user device error), this procedure is not only unrealistic for a clinician researcher to do, it also doesn't provide a very realistic estimate of what the temperature differences would likely be in actual practice, when multiple caregivers use the temperature devices.
Tackling a research topic that has interest to a large number of staff in the unit is more likely to succeed since “many hands make for light work.” If the burden for completing the study is shared by many, the project is likely to get done more quickly and without undue hardship for any of the clinician researchers. In addition, if 1 or 2 members of the research team are no longer able to participate in the project, the study will likely not be affected by their absence, since there are other members of the research team who will remain on the project.
Research Topic of Interest to Staff
Another criteria of ideal research questions is one that requires the project to be of high interest to the researcher clinicians and represents an aspect of their practice for which they would love to know the answer. Given the time it will take to complete a research study (approximately 1 year from identification of the research question to completion of data analysis), it will be easier to maintain interest and enthusiasm for the project if staff members have a strong interest in, or passion for, the question at the onset of the study. It's also easier to get support from noninvestigator staff members in the unit, particularly during data collection, if the questions being studied are perceived by others as interesting and important to patient care.
Special Considerations for Neophyte, Clinical Researchers
For individuals who have little or no experience conducting research while employed in the service setting, a few additional criteria of an ideal research study should be added to the list.
By selecting a research question which has already been studied, clinician researchers gain the ability to quickly design a research study because they can follow the map laid out by the prior research team. This also allows the neophyte researcher the opportunity to focus on doing the research rather than spending lots of time figuring out the best way to perform the research. While the classic replication study is one where the research process is carried out exactly as described in the prior study, replication studies can also be done by improving on the research methodology of the previous study, conducting the study in a different patient population from the original study, or in different age groups, or under different clinical conditions.2,3,11–16
Replication studies are exceedingly important in any field to validate and extend the findings of a single study and to clarify which patients are likely to benefit from the study intervention. And for neophyte researchers, replication studies have the added benefit of guiding the selection of appropriate research methods, so the inexperienced researcher doesn't have to be a research expert in order to conduct a good study.
Avoids Politically Charged Areas of Practice
Given that conducting a research study is not an inherently easy task, as a new researcher, one should ask why increase the difficulty by selecting a topic that addresses politically charged aspects of practice? For example, if there is heated debate and polarization of members of the healthcare team on how best to withdraw sedation in the critically ill patient, a research study in this area, which is very important to patient care, may well meet with greater resistance than other projects with little controversy. Best to avoid these topics until one has a bit more clinical research experience under the belt to minimize the obstacles to successful study completion.
Builds on Researcher's Clinical Expertise
As with many of the other special criteria for first-time clinical researcher, selecting a topic that builds on clinical expertise will make completion of the research process much easier since the clinical researchers do not have to spend excessive amounts of time learning about the clinical problem, as well as the research process. For example, critical care clinicians who use hemodynamic monitoring on a daily basis have extensive knowledge in the theory, assessment, and critical interventions required for the proper use of this technology. Conducting a research study on a question related to hemodynamic monitoring would not require extensive time to be spent learning the basics of hemodynamic monitoring. On the other hand, if the critical care clinicians decide to study anxiety in the patient or family member, then precious time will need to be spent learning about the concept of anxiety, how it is measured, and what interventions have been effective in managing anxiety in patients, since the clinicians actually have a very limited knowledge of anxiety.
Within the Scope/Control of Nursing
Selecting a topic that is within the scope of nursing practice and nursings' control avoids the need to convince other disciplines of the study's importance and gain their support in order to conduct the study. Again, just getting through the steps of the research process for the first time is challenge enough for neophyte researchers, without requiring them to have skills in convincing other disciplines to support their study. For example, comparing the current approach to postoperative constipation (no standing orders; individual physician orders at the onset of constipation) with a set of standing bowel management orders that begin immediately postoperatively prior to the onset of constipation would be an important clinical question to be studied. However, nurses do not control this aspect of practice (medical orders for bowel management), so physician support would need to be obtained for this study. The added time that would be required to obtain physician support for patients' to participate in the study, coupled with the possibility that that support may not be provided, makes this study less feasible than those that are also important to patient care but within the control of nursing. Of particular concern for the neophyte researcher is that the lack of support by the other discipline(s) may be so disempowering that they may be unwilling to invest any more time in identifying an alternative study to implement.
Focus Group Method for Finding Good Research Ideas
Given the list of criteria for ideal research questions (Table 2), how can clinicians find research ideas that meet the majority of these criteria? One strategy that has been successful is the use of a focus group method to assist clinicians to brainstorm and prioritize potential research questions.2,3 Using this technique, clinicians with little or no research experience and/or theoretical background can be actively engaged in identifying at least 10 to 30 potential research questions with little or no effort.
The focus group method involves a series of 1-hour meetings, typically 3 to 4 sessions, where a group of clinicians from the same unit complete a series of discrete steps to brainstorm potential research ideas, narrow the list of research ideas based on the criteria of ideal research questions, and then select a final research question for study. The sessions are kept brief and are setup in much the same way that any routine unit committee meeting would be organized to accommodate clinical practice routines. For example, the meetings are usually located close to the unit, so staff can come into/out of the meeting easily, and meeting times are selected to maximize staffs' ability to attend the session and are repeated several times to allow attendance by any staff member who might want to participate. Attendance at meetings is voluntary, with attendance at previous meetings not a requirement for subsequent sessions.
Since one of the criteria of an ideal research project is a team project, the focus group method ensures that a team of people, rather than an individual, identify and commit to a research project. If an individual identifies a research study of interest to them and then attempts to solicit others to join the project, it may be difficult to get others to join the project if they were not involved with selecting the research topic from the beginning. Often, the topic is seen as an individual's research study, rather than a shared ownership of the study by the team members. Also, team members added after selection of the topic will be unlikely to have the same passion, energy, and commitment for the study as those that were involved with selection of the topic. Beginning the process of finding a research question with a team or group of staff who seek to identify a topic of mutual interest will be helpful in avoiding some of the roadblocks to successful project completion discussed earlier.
Step 1: Brainstorming High Volume Patient Care Situations
The first step to identifying a good research study for a team of unit-based clinicians is to clearly identify the high-volume patients cared for on the unit. It is from this list of high-volume situations that potential research ideas will be determined. Starting the group off by focusing on high-volume patient care situations ensures that the research questions raised will be relevant and thus help to avoid some of the roadblocks to successful study completion. The other advantage of this approach to begin the research journey is that it allows clinicians with little to no research knowledge or interest to actively participate immediately in the selection of the topic, since unit-based clinicians have a strong understanding of their high-volume patient care situations.
At the beginning of the first 1-hour session, the members are lead through a brainstorming session, which is a process of soliciting ideas/thoughts in a nonjudgmental manner and to identify common aspects of patient care on the unit. The session is lead by a research mentor, typically an advanced practice nurse, clinical educator, or experienced clinician, who facilitates the group as they identify high-volume patient care situations that are seen or performed a minimum of several times a day (Table 4). High-volume patient care categories that are included in the brainstorming session include: patient diagnoses/populations, patient needs/problems, common symptoms managed by nurses, nursing interventions, important patient outcomes, and commonly used medical equipment/technologies. As the group brainstorms content for each of the categories, it is ideal if the items can be listed on a flip-chart to make it easier for everyone to see what items have already been identified.
During this step, it is essential to ensure that the group thoroughly identifies their high-volume nursing care activities. Often, clinicians are so embedded in their day-to-day practice that they neglect to identify aspects of their practice because they fail to recognize them at all. For example, critical care nurses may neglect to identify all of the patient care assessments that they perform a multitude of times each day (eg, assessment of vital signs, pulmonary artery [PA] pressures, cardiac output, cardiac rhythm, sedation status, neurological status) or important interventions used (eg, management of physiologic instability or cardiac dyrhythmias, patient and family education) or technologies that are inherent in critical care practice (eg, electrocardiogram monitors, automated blood pressure devices, point-of-care glucose meters). The research mentor should be aware of this propensity and assist the group members to articulate all high volume areas of their practice. The resulting list of items should paint a picture of what everyday clinical practice looks like in the unit.
Step 2: Brainstorming of Potential Research Questions
At the second 1-hour brainstorming session, attendees are asked to review the list of high-volume patient care situations generated in the first session and revise the list based on completeness and representation of only high-volume patient care situations. This review also helps those who did not attend the first meeting to get oriented to the work done in the first session. The research mentor then asks the group to consider if they have any clinical questions arising from these high-volume patient care items listed or if they have suggestions for better or more efficient ways to provide patient care (Table 4). Avoidance of the word “research” at this point is wise, so as not to intimidate staff who may not be confident about identifying research questions but who do have a lot of clinical questions on their minds. The research mentor may need to provide an example or 2 of a potential question that could be derived from the high-volume patient care situations identified in Step 1. For example, the research mentor might point out that several different methods for controlling shivering that were identified by the group when discussing nursing interventions used with the postoperative cardiac patient and suggest that clinical questions such as: “What is the best method (eg, warm blankets, meperidine administration, convection heat) for prevention of postoperative shivering? Are any of these methods better than doing nothing? Are there other methods that may be more effective or more efficient in achieving the same outcome?”
Once clinicians hear an example or 2 of what might constitute a clinical question, they have no problem coming up with many clinical research questions.17,18 The research mentor should encourage the group to identify questions for a variety of the categories and items brainstormed in Step 1 (Table 4).
As with Step 1, this is a brainstorming session and group members should refrain from judging the research ideas or questions raised by others and/or prematurely eliminating topics because they are not of interest to them or don't believe anyone would let them do that type of study. There will be a time in Step 3 when judgment of the brainstormed questions will occur, based on the criteria of the ideal research question.
As the group is brainstorming, the research mentor should assist the group to clarify their clinical questions as much as possible, so the intention of the potential study is revealed. For example, it is not uncommon for staff to phrase their question as, “What is the best method for providing mouth care?” or “Are typmpanic thermometers accurate?” Once the question has been raised, the staff should be asked to identify what method(s) is currently used and what other methods they think might be as good as, or better than, the current technique. The staff should then be encouraged to clarify what should be measured to determine which method is “better” than the other. Getting them to articulate what the dependent variable of interest might be is important to completely understand the nature of the study they are proposing. After this type of clarifying discussion, the original question might be further expanded to: “What is the best method for mouth care (current practice [toothettes] versus special toothbrush/suction catheter combination versus regular toothbrush) to prevent bleeding gums in intubated patients?” Or, “What is the difference in temperatures obtained with the infrared tympanic thermometer and the electronic oral thermometer from the core temperature (PA thermister temperature)?”
As questions are being raised during this phase, many of the questions will actually represent studies that have been done previously. Often, the staff is unaware of this, but they raise the question because they would like to know the answer. It is critical that these ideas be respected and not eliminated from the list, since replication studies not only are important, but also are ideal studies for neophyte clinicians. It is rare in nursing that the statement, “We already know the answer to that question!” can be uttered and be true. More often than not, the addition of another study to the literature will expand our knowledge of best practice, particularly if the study is repeated in a different patient population or with methods that are more similar to actual patient care than prior studies.
While a 1-hour session for Step 2 may be sufficient for some groups to identify all of their relevant questions, this may not be enough time for all groups. It is not uncommon for a critical care team to identify 30 to 40 research questions if given enough brainstorming time (Table 5). While the goal of the focus group is to eventually identify just 1 study to be conducted, the exercise of encouraging clinicians to question their practice is important in helping them develop better skills in clinical inquiry. Allowing them the time to consider a variety of aspects of their practice is not a wasted activity.
Table 5: Examples of...Image Tools
Step 3: Narrowing the List of Questions Based on the Criteria of an Ideal Research Project
Having developed a list of potential research questions, the next task is to identify those questions that best fit the criteria for an ideal research project. Although any number of strategies could be used to accomplish this task, a suggested approach would be to first eliminate topics/questions that are not of high interest to the staff. Starting by eliminating topics that do not meet the criteria of staff interest is used because staff are usually very clear (and sometimes passionate!) about topics that hold little or no interest for them.
An easy way to accomplish this first round of topic elimination is to allow each member of the focus group to cast votes to eliminate approximately half the topics on the list. For example, if there are 30 research ideas on the list, each member of the group might be given 15 or so votes. Votes to remove questions could be cast by voice or hand vote when listing each topic or by giving each member small dots or sticky notes to be placed next to questions/topics listed on a flip-chart.
By counting up the number of votes to remove a questions or topic, it is quite easy to eliminate those topics that a majority of the group members find are not as interesting as the remaining topics on the list. It is important during this phase to focus on elimination of topics that do not meet the criteria, rather than focusing on topics that do meet the criteria. The reason for this is to avoid staff from prematurely identifying topics they really like and thus making it difficult for them to later give-up those topics if they do not meet the many other criteria of an ideal research question. This may seem like a trivial concern, but experience with this approach has shown that getting to consensus on a final topic will occur faster and with less angst if staff members focus on the elimination of topics that do not meet the criteria, rather than selecting those that do meet the criteria.
Depending on the number of individuals involved in the group sessions to this point, more than 1 meeting may be held to get everyone's “votes” registered. Another option is to send around a ballot with all the questions listed and directions on the number of questions/topics each person can vote off the list.
At the end of this first round of elimination, it's a good time to identify those questions or topics that would have excessive sample-size requirements, so those studies can also be eliminated from the list prior to final topic selection. This step ensures that the remaining studies on the list will meet the criteria of a sample size of <75 subjects. Determining the sample size can be done by having someone with expertise in sample-size calculation do an estimate of the subjects required for each remaining topic on the list. Another option is to use one of the software programs available for sample-size calculation.4,5 As a general rule, though, when the dependent variable of a study represents a low incidence situation or occurrence (ie, <15% to 20% incidence), then the requirement for a comparison study sample size will likely be in excess of 100 to 200 subjects, and thus not an ideal study for clinician researchers. Examples of studies that commonly require several hundred or more subjects are those that focus on reduction of infection (eg, VAP, bacteremia, pneumonia), skin breakdown, and/or falls, since the incidence of these problems/complications is rarely >10% to 15%.
Once the research questions that would require a large sample size have been eliminated from the list of potential research questions, the remaining questions on the list are then rated against the criteria of an ideal research question for clinicians. To facilitate this rating process, a grid is used that lists the criteria to be rating in one column with columns for the rating of each research question/topic individually (Table 6).2,3 After totaling the scores for each research question, 3 or 4 highest scoring research questions are then identified for final topic selection.
Table 6: Step 3 of t...Image Tools
Step 4: Final Selection of the Research Study for the Team
At the completion of step 3, the research questions remaining on the list typically represent those that meet many, if not most, of the criteria for ideal research questions for clinicians. At this point, whichever research question/topic is selected by the group is likely to be feasible for a research study by clinician researchers. Final selection can then occur by a simple majority vote by group members of the research question that they are most interested in doing as a research project.
Another strategy that can be used prior to final selection of a question is to have group members read the materials and method section of a published study on each of the remaining 3 or 4 questions on the list. This step helps the clinicians better understand what is entailed when conducting research on each of the remaining questions on the list. For groups that do not have a clear leaning toward 1 of the final 3 or 4 topics, this may be a good approach to assist in their decision making process.
Serendipitous Outcomes From the Focus Group Method
While the intended purpose of the focus group method is to identify appropriate research questions for clinician researchers, several other outcomes typically occur when using this technique. Staff members develop a new appreciation and pride for the breadth and depth of their patient care activities, improve their ability to question their nursing practice, and identify clinical priorities for their practice questions. After involvement in the focus groups, staff members tend to view their practice environment differently and begin to feel empowered to impact practice and patient outcomes.18–20 The work of the group engenders a sense of partnership, common purpose, and an esprit de corps that moves the group to own the selected research idea as “theirs” rather than an individual's idea. Because the focus group process allows active clinician involvement in the identification of research questions, genuine excitement about doing nursing research occurs, an emotion that most clinicians would deny as being even remotely possible prior to participation in a focus group.
Another outcome is the enhancement of clinical inquiry skills. As clinicians are brainstorming research ideas in Step 2, many go from never really challenging their practice routines to beginning to question if the way practice is currently done is really the best way. To some extent, the brainstorming activity itself role models the type of questioning skills we would like to see all the time in clinicians—constantly asking if this is the best way to provide care, are there other methods that we should be evaluating, could we improve patient outcomes if we did things in a different manner or in a new way?
And last, but not least, the process validates for clinicians that they have important questions to ask and to address about patient care. They move from thinking they have few, if any, questions about patient care to realizing there are more questions than time to address them all! Again, this is a very validating and empowering situation for busy clinicians who often don't take the time to recognize the valuable contributions they make to patient care.
The identification of research questions to conduct by service-setting clinicians should include a method or process for ensuring that selected questions are feasible and likely to avoid many of the roadblocks to successful research project completion. By including a method for evaluating potential research questions against the criteria of an ideal research question, one can increase the chances that clinician researchers will be successful in their quest to use the research process to address important clinical practice questions.