Nurses are natural problem solvers. If there’s a patient, family, or clinical need, we want to fix it. We see this all the time—jumping right to the solution when we should stay open to weigh options and use the best evidence. This premature focus on the solution creates the shiny object syndrome, potentially slowing progress (Cullen et al., 2023a). This can happen when nurses preselect a practice change that becomes a shiny object or grabs their attention before determining practice recommendations from the best evidence.  

The goal of evidence-based practice (EBP) is to implement and sustain effective practice improvements based on the best available evidence. This is achieved by following an EBP process with clear steps to guide you. However, despite clear processes, gaps in basic EBP competence continue (Harper et al., 2017; Li et al, 2004). To promote nurses’ engagement in EBP work, we want to clarify areas where confusion remains. In fact, now is the time to apply implementation science and update steps in the EBP process (Cullen et al., 2023a; Cullen et al., 2022; Edmonds et al., 2024; Halm et al., 2024; Tucker et al., 2023).

We begin by sharing updates to one of the early steps in the EBP process—determining the purpose (Cullen et al., 2023b; Dang et al., 2022; Melnyk et al., 2010). The purpose is meant to establish what will be accomplished and guide steps that come later. The purpose is not just for use in the search for best evidence. Traditionally, nurses have been taught to create a PICO (population, intervention, comparison, outcome) question. While this method has been used widely to guide early steps of the EBP process, we find that the ‘I’ (intervention) in PICO has the potential to encourage the shiny object syndrome by narrowing the focus to the first idea for the intervention too early.

Instead of focusing on one intervention, we propose a new framework to develop a meaningful purpose statement. Our solution is to identify the PURPOSE: Population, Users, Responsible team, Problem, Outcomes, Setting, and Effort (Cullen et al., 2023a). This framework removes the premature emphasis on one specific intervention or practice and allows nurses to wait until seeing the best evidence to determine the practice recommendation that meets the needs of patients and fits the setting, when addressing that topic. 

Benefits of PURPOSE

There are multiple benefits to using PURPOSE as the framework for establishing the aim for the EBP.

First, the Population of patients (or people) is identified so you know which patients to engage in this EBP work. You can then incorporate their preferences, values, and experiences (Melnyk et al., 2010; Sackett et al., 2000). This will help you search for evidence specifically for vulnerable patient groups while reflecting on the patients served in your practice setting. This helps keep patient needs, health equity, and patient engagement central when incorporating the patient perspective (Fowler et al., 2025).

Second, you can now identify the User early. When you read the evidence with this user in mind, it’s easier to focus on details that will help guide design of both the practice change and the implementation plan specifically to meet these users’ needs.

Third, the Responsible team links the work to the governance structure—potentially improving access to resources and data and creating a built-in transdisciplinary approach. This early work will pay off when creating a plan for sustainability and when disseminating within the organization.

Fourth is the Problem you identified and want to address. Often the problem is the main driver for an EBP change and addresses an issue or opportunity for improvement. Consider the problem as the rationale motivating the team. By describing the problem now, it can be strategically incorporated into later steps in the EBP process. These steps include using the problem when searching for the best evidence, but also when planning evaluation, and making key decisions about the pilot, identifying any need for adaptations, and later for sustainability and internal dissemination.

Fifth is the Outcome that shows an opportunity for improvement. Improving outcomes remains the focal and core point of EBP, just as when using PICO. This focus on the outcome also remains important for many later steps in the EBP process, to use when you search the evidence, plan evaluation, make pilot decisions, design adaptations, sustainability planning, and reporting. In particular, this avoids the shiny object syndrome and keeps the focus on the outcome and not the pre-selected intervention when doing a search for evidence. Using PURPOSE keeps options for the practice change open to be answered from the synthesis of best evidence and not narrowed in a way that will eliminate other solutions.  

Sixth, establish the Setting for where to pilot the EBP practice change. Identifying the setting will 1) create boundaries for piloting the EBP practice change and 2) promote adaptation to fit that setting. Piloting remains an important step to identify trip hazards and missed details in the localized EBP protocol. Each unit or clinic serves different patients and has unique facility and equipment needs, teamwork, and workflow. Identifying the setting early keeps fit and feasibility core to adaptation that can improve adoption. Completing a pilot requires good communication, coordination and troubleshooting that gets the input needed for local adaptation. These local adaptations can facilitate adoption and sustainability (Dizon et al., 2016).

Seventh, Effort is referring to the timeframe. Including Effort is optional for use if setting a timeframe is helpful. This may be most helpful for nurses in a residency program or students who have predetermined time limits (e.g., semester schedules).

An additional benefit to writing a PURPOSE statement and not a PICO question is that the PURPOSE statement helps to avoid confusion between conducting research and EBP. This may help the team better describe the intent and avoid unintended barriers to the practice improvement.

Case Example of PURPOSE

Let’s work through a case scenario: You are talking with a nurse in an ambulatory surgery center with patients who regularly receive procedural sedation. The nurse wants to ensure accurate use of pulse oximetry for early identification of oversedation, and to promote proactive intervention. Oversedation is a patient risk in this setting, and clinicians need to ensure risk is mitigated for patient safety (Joint Commission International, 2020). Collaboratively, you create a project aim. Let’s compare results when creating a PICO question and PURPOSE statement.

Table 1: Comparison between the PICO question and PURPOSE statement

PICO Elements		PURPOSE Elements
Patients/population: Patients receiving procedural sedation		Population: Patients receiving procedural sedation
Intervention: oximetry monitoring		Users: Ambulatory surgery nurses
Comparison: monitoring respiration		Responsible team: Pain Committee
Outcome: identify oversedation		Problem: Maintaining comfort while avoiding oversedation
		Outcome(s): Oversedation
		Setting: Ambulatory surgery center
PICO question: Can oximetry monitoring for patients receiving procedural sedation identify oversedation better than monitoring respiration?		PURPOSE statement: The purpose of this EBP project is to identify oversedation while maintaining comfort for patients receiving procedural sedation in the ambulatory surgery center with assistance from the Pain Committee.

Our example demonstrates how using PURPOSE opens the door to finding the best solution and ties to a governance committee with expertise and responsibility to inform the design, evaluation, implementation, and sustainability of the practice over time. This example supports identification of DEI concerns that can get lost with over-use and assumed benefit of oximetry monitoring as the solution (Parr et al., 2024). Redesigning this early step in the EBP process will pay off in later EBP steps to build toward sustaining the change.

Introduce PURPOSE in Your Nursing Professional Development (NPD) Practice

If you would like to use the PURPOSE framework, start by comparing the two approaches, as we did above. While leading EBP work, we found there was a need to make this update, and you can determine if your team has a similar need. Look for resources and the free tools that can help (Cullen et al., 2011; Cullen et al., 2022; Cullen, et al., 2023a Cullen et al., 2023b; Edmonds et al., 2024; Fowler et al., 2025; Tucker et al., 2023; University of Iowa Health Care, n.d.).

When using PICO, often the initially proposed solution for the “I” (e.g., intervention or practice change) was developed too early. Ask yourself, have you ever jumped to the intervention or to the solution prematurely? This can lead to early identification of the intervention rather than a deeper exploration of potential interventions that offer a better solution to the problem, for these patients and the setting. In our experience, we have seen time invested in the shiny object only to find a need to go back to earlier steps. This can happen when the proposed solution or the “I” is included in the evidence search to narrow the search yield. It may be that the proposed solution isn’t the best solution, supported by the best evidence. As EBP experts, we find that PURPOSE improves how we identify aim to best meet the needs of the population and user.

Being open to a change in your EBP process may create questions. Try using both techniques and compare the results. Bring your sample comparisons to your NPD colleagues for discussion and planning. We hope you get support to innovate and see the same benefits when using PURPOSE.

Finding Your PURPOSE in EBP

Facilitating scientific inquiry is one of the roles of the NPD practitioner and is identified in the Nursing Professional Development Scope and Standards of Practice (Harper & Maloney, 2022) and the NPD Practice Model (Bub, 2023; Krom & Harper, 2023). One way to cultivate and support scientific inquiry is through EBP and NPD engagement in EBP as a priority (Harper, 2024). We need to question practice and seek solutions with the best evidence to improve nursing practice; this includes questioning the processes we use. Switching to using PURPOSE is only one of several updates to the EBP process that we have identified. Now is the time to challenge the status quo in EBP and update how we use each step. We encourage you to find your PURPOSE in EBP.

References

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