October 9, 2026

How to Develop a Clinical Question for Your Nursing Project: Purpose, Significance, Levels of Evidence, Search Strategy and Databases

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In this guide

A step-by-step guide to the first sections of any nursing EBP paper, capstone or DNP project: finding a clinical question, writing the purpose statement, stating the significance of the problem, stating the levels of evidence, planning your search strategy and choosing databases. It ends with 68 real clinical question and EBP assignments from collepals.com.

How to come up with a clinical question for your project

A clinical question turns a problem you have noticed in practice into a focused, answerable question that guides your whole project. Good questions usually come from real gaps between current practice and best evidence.

Notice problems in practice. Keep a clinical journal and look for recurring issues: falls, infections, pain, readmissions, medication errors, delays or patient confusion.
Check the data. Unit quality dashboards, incident reports and patient satisfaction scores confirm whether the problem is real and measurable.
Talk to stakeholders. Ask preceptors, nurse managers and staff what problems they would most like solved.
Look at national priorities: Joint Commission National Patient Safety Goals, Healthy People 2030 and nurse-sensitive indicators.
Question routine practice. Ask “Why do we do it this way? Is there better evidence?”
Write it in PICO(T) format: Population, Intervention, Comparison, Outcome and Time.
Test it with the FINER criteria: feasible, interesting, novel, ethical and relevant.

Example: In adult medical-surgical patients at high risk for falls (P), does hourly purposeful rounding (I), compared with rounding every 2 hours (C), reduce falls per 1,000 patient-days (O) over 12 weeks (T)?

For templates and 114 more examples, see How to Develop a PICOT Question: 114 PICOT Question Examples.

Stating the purpose of your paper for your clinical question

The purpose statement tells readers exactly what your paper or project will do to answer your clinical question. It should appear early, usually at the end of the introduction, and it must align with your PICOT question, methods and outcomes.

Purpose statement formula

“The purpose of this [paper / evidence-based project / quality improvement project] is to [examine / evaluate / synthesize evidence on / implement] [intervention] compared with [comparison] to [reduce / improve] [outcome] among [population] in [setting] over [time].”

Examples

EBP paper: “The purpose of this paper is to synthesize current evidence on whether hourly purposeful rounding, compared with rounding every 2 hours, reduces falls among adult medical-surgical patients at high risk for falls.”
QI or DNP project: “The purpose of this quality improvement project is to implement and evaluate a nurse-driven urinary catheter removal protocol to reduce CAUTI rates on a 32-bed medical unit over 12 weeks.”

Tip: Use one clear sentence and avoid vague verbs like “look at” or “talk about.” If your purpose statement and PICOT question name different populations or outcomes, revise one of them until they match.

Importance of stating the significance of the problem

The significance section answers the reader’s question: “Why does this problem matter, and why now?” It persuades faculty, committees and organizational leaders that the problem deserves time and resources, and it justifies your project. A paper without a clear significance statement can seem trivial, however well it is written.

What to include

Element	What to show
Scope / prevalence	How common the problem is, nationally and locally
Impact on patients	Harm, complications, mortality, quality of life
Financial impact	Costs to patients, hospitals and the health system; penalties or non-reimbursement
Local data	Your unit’s or organization’s rates compared with benchmarks
Gap	The difference between current practice and best evidence
Relevance to nursing	Why the problem is within nursing’s influence and how nurses can improve it
Alignment with priorities	National Patient Safety Goals, Healthy People 2030, organizational goals

Example significance paragraph

An estimated 700,000 to 1,000,000 patients fall in U.S. hospitals each year (Agency for Healthcare Research and Quality [AHRQ], 2013), and falls with injury add substantially to length of stay and costs (The Joint Commission, 2015). On the project unit, the fall rate over the past 6 months exceeded the organization’s target, and most falls occurred at night during unassisted toileting. Because falls are a nurse-sensitive indicator, nurses are well placed to reduce them through evidence-based prevention strategies such as purposeful rounding.

Stating the levels of evidence used

Stating the level of evidence shows readers how strong your supporting evidence is and how much confidence they can place in your recommendations. Rate every source with a recognized hierarchy and state the hierarchy you used.

Levels of evidence hierarchy (intervention questions)

Level	Type of evidence
I	Systematic review or meta-analysis of randomized controlled trials (RCTs); evidence-based clinical practice guidelines
II	At least one well-designed RCT
III	Well-designed controlled trials without randomization (quasi-experimental)
IV	Well-designed case-control and cohort studies
V	Systematic reviews of descriptive and qualitative studies
VI	A single descriptive or qualitative study
VII	Opinion of authorities and/or reports of expert committees

Source: adapted from Melnyk and Fineout-Overholt (2023). Many programs instead use the Johns Hopkins EBP Model, which rates evidence from Level I (experimental studies) to Level V (non-research evidence such as QI reports and expert opinion), with a quality grade of A (high), B (good) or C (low) (Dang et al., 2022).

How to state levels of evidence in your paper

In the text: “Evidence for this project included two Level I systematic reviews, three Level II RCTs and one Level IV cohort study (Melnyk & Fineout-Overholt, 2023).”
In an evidence table with columns for author and year, design, level of evidence, sample and setting, intervention, outcomes and key findings, and limitations.
Summarize the overall strength: “Overall, the body of evidence is strong and consistent, supporting implementation.”

Search strategy for references to use

A clear, reproducible search strategy shows that your evidence was found systematically, not by chance. Describe it in your paper so that others could repeat it.

Turn PICOT into keywords: list the main concepts (P, I, O) and their synonyms.
Use subject headings: MeSH terms in PubMed and CINAHL Headings in CINAHL, such as “Accidental Falls.”
Combine terms with Boolean operators: OR within a concept (synonyms), AND between concepts, and NOT to exclude, used carefully.
Use search techniques: quotation marks for phrases (“hourly rounding”), truncation with an asterisk (nurs* finds nurse, nurses and nursing).
Apply limits: publication date (often the last 5 years), English language, peer-reviewed, age group, and study type if needed.
Set inclusion and exclusion criteria before screening. For example, include adult inpatients and primary studies or systematic reviews; exclude pediatric and outpatient settings.
Screen titles, then abstracts, then full texts, and record numbers at each stage. A PRISMA flow diagram is the standard way to show this (Page et al., 2021).
Hand-search the reference lists of key articles and use “cited by” links.
Document the databases, dates searched, terms, limits and number of results.

Example search string

(“hourly rounding” OR “purposeful rounding” OR “intentional rounding”)
AND (“accidental falls” OR fall* OR “fall prevention”)
AND (inpatient* OR hospital* OR “medical-surgical”)

Example write-up: “A search of CINAHL Complete, PubMed and the Cochrane Library was conducted in September 2026 using the terms above, limited to peer-reviewed articles published in English from 2021 to 2026. The search returned 186 articles. After duplicates were removed and titles and abstracts screened against the inclusion criteria, 14 full-text articles were reviewed, and 7 were included.”

Databases to use for your clinical problem research

Database or source	Best for
CINAHL (Complete / Plus)	Nursing and allied health literature; the first choice for most nursing questions
PubMed / MEDLINE	Biomedical and clinical research; free, with MeSH indexing
Cochrane Library	High-quality systematic reviews (Level I) and trial registers
JBI EBP Database	Evidence summaries, best-practice sheets and systematic reviews for nursing
PsycINFO	Mental health, behavioral and psychological topics
Embase	Drugs, pharmacology and international biomedical literature
ProQuest Nursing & Allied Health	Nursing journals plus dissertations
ERIC	Nursing education and teaching topics
TRIP Database	Quick searches for guidelines and synthesized evidence
Guideline sources	Professional organizations, AHRQ, CDC, WHO, NICE, and ECRI Guidelines Trust
Google Scholar	Broad searching and “cited by” tracking; check source quality carefully

Tip: Access databases through your university library for full-text articles, and ask a nursing librarian to review your search strategy. Point-of-care tools such as UpToDate are useful for background but are not usually cited as primary evidence.

Clinical questions: 68 examples from collepals.com

The following real assignment questions from collepals.com show the range of clinical question, PICOT, practice-problem and EBP tasks nursing students receive. Click any question to view it, or order a custom answer from a qualified tutor.

Developing PICO(T) and clinical questions

Identifying a practice problem and its significance

Evidence-based projects and practice change

Evidence-based practice concepts, models and research

Conclusion

A strong EBP paper or project follows a clear chain. A clinical question grounded in practice leads to an aligned purpose statement, a persuasive significance section, clearly rated evidence, a reproducible search strategy and appropriate databases. Getting these first sections right makes the rest of your project easier to write and much easier for faculty and committees to approve.

References

Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals: A toolkit for improving quality of care (AHRQ Publication No. 13-0015-EF). U.S. Department of Health and Human Services.

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

The Joint Commission. (2015). Preventing falls and fall-related injuries in health care facilities. Sentinel Event Alert, (55), 1–5.

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