PICO
Instructions
Evidence-based practice begins with identifying a clinical problem. All of us have seen things in our workplaces that we think should be done differently. Gathering evidence for this potential solution, though, requires creating a PICO question to narrow the search and help you find relevant articles that support your solution.
The assignments in this course will help you go through this process to arrive at a solution to a selected problem and to present this entire process in the Unit 7 assignment.
For this assignment, you will select a topic and PICO question from the list below. This will be the
problem and solution you will research throughout the rest of the assignments.
·
For novice nurses, does a nurse mentorship program increase nurse retention compared with no mentorship?
· For the pre-surgical patient, does the addition of music therapy to the current standard of care decrease anxiety compared with no intervention?
· In the acute care setting, does the implementation of a nurse-led rounding program compared to no rounding program decrease patient falls?
Paper Directions:
1. Write your PICO question, identify key search terms for each element and frame it in table format as presented here and in the
attached article
Download attached article
.
|
PICO Elements |
Keywords |
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P= |
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I= |
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C= |
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|
O= |
2. Search the literature using the keywords and find 3 articles that address the problem which is the focus of your PICO question. For instance, in question #1, the problem is nurse-retention.
Find articles that address the PROBLEM ONLY, not the solution. You are finding evidence that this is a problem. Search techniques are discussed in Unit 2. Also, the Library tab has tutorials about the search engines. Finally, use the article
“7 Steps to the Perfect PICO Search White Paper”
Download “7 Steps to the Perfect PICO Search White Paper”
referenced previously as a guide.
3. For this paper, identify the problem (NOT the solution!) and address the following:
· Scope of the problem (Who has the problem and how widespread is the problem?)
· Significance of the problem (costs, safety, outcomes?)
· Significance of the problem to nursing: How is the problem significant to nursing? How does the problem negatively affect nursing practice?
Support your ideas with the articles you found. These articles should be less than five (5) years old. They should not be from the Web, but from the library databases. Use narrative format, except for your PICO table as shown above.
·
· Include an APA cover page, a reference page, and in-text citations.
· 3 professional references are required.
· These articles must be from peer-reviewed professional journals.
· Use an opening and closing paragraph. This paper should be 250-300 words.
Please review the rubric to ensure that your assignment meets criteria
Estimated time to complete: 4 hours
Rubric
NSG324 PICO Question Rubric
| NSG324 PICO Question Rubric | |||
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Criteria |
Ratings |
Pts |
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This criterion is linked to a Learning OutcomeContent |
40 pts |
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This criterion is linked to a Learning OutcomeAnalysis |
40 pts 5 36 pts 4 32 pts 3 28 pts 2 24 pts 1 0 pts 0 |
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This criterion is linked to a Learning OutcomeWriting |
10 pts |
||
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This criterion is linked to a Learning OutcomeAPA |
10 pts 5 9 pts 4 8 pts 3 7 pts 2 6 pts 1 0 pts 0 |
||
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Total Points: 100 |
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7 STEPS TO THE PERFEC T PICO SEARCH
Evidence-Based Nursing Practice
www.dynamed.com
EVIDENCE-BASED NURSING PRACTICE:
7 Steps to the Perfect PICO Search
2
OVERVIEW
Searching for high quality clinical research evidence can be a daunting task to many in the healthcare arena,
yet it is an integral part of the evidence-based practice process. Depending on your role in the clinical
environment – librarian, nurse or student nurse – you may possess some of the skills needed, but not all. For
example: librarians are well-versed in conducting literature reviews but may be unfamiliar with using the PICO
framework to facilitate their literature search. Staff nurses generally understand the key concepts of evidence-
based practice but might lack basic literature searching skills. Student nurses learn about the importance of
evidence-based practice in nursing school; however, until they become practicing nurses, they might not
fully understand the correlation between evidence-based interventions and improved patient outcomes.
Whether you are a librarian, a nurse or a nursing student, the chances are good that you will learn something
new as you read, 7 Steps to the Perfect PICO Search.
WHAT IS EVIDENCE-BASED NURSING PRACTICE AND WHY IS IT IMPORTANT?
Evidence-based nursing is a process founded on the collection,
interpretation, appraisal, and integration of valid, clinically
significant, and applicable research. It is not about developing
new knowledge or validating existing knowledge, but rather
translating existing evidence so that it can be applied to clinical
decision making. The expected standard in modern healthcare
systems, evidence-based nursing practice links research and theory
to practice, providing clinicians with current, reliable research-
driven data to guide patient care decisions.
Research has shown that patient outcomes are substantially
improved when health care is based on evidence from well-
designed studies versus tradition or clinical expertise alone.
Better patient outcomes lead to more efficient performance,
which is crucial for hospitals with staffing challenges.
“Evidence-based practice in nursing is using and carrying out nursing practices based on the best
available knowledge. Evidence-based practice integrates the nurse’s clinical expertise with the best
external research evidence, and takes into account patient preferences to deliver quality nursing care.”
-Victoria Schirm, Director of Nursing Research, Penn State University
Evidence-Based
Practice
Best External
Research
Evidence
Nurse’s Clinical
Expertise
Patient
Preferences
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
3
WHAT IS THE PICO PROCESS?
PICO is a format for developing a good clinical research question prior to starting one’s research. It is a
mnemonic used to describe the four elements of a sound clinical foreground question. (Yale University’s
Cushing/Whitney Medical Library). The question needs to identify the patient or population we intend
to study, the intervention or treatment we plan to use, the comparison of one intervention to another (if
applicable) and the outcome we anticipate. These make up the four elements of the PICO model: Patient/
Problem, Intervention, Comparison and Outcome.
The PICO process starts with a case scenario from which a question is constructed that is relevant to the
case and is phrased in such a way as to facilitate finding an answer. Once a well-structured question is
formulated, researchers will be in a better position to search the literature for evidence that will support their
original PICO question.
STEP 1: FORMULATE THE PICO QUESTION
Case Scenario:
You are a Registered Nurse working on a Urology unit. One of your patients is a 55-year-old man who is
recovering from abdominal surgery – specifically a laparoscopic prostatectomy. The patient complains
of abdominal pain and nausea. His abdomen is distended, and he has no bowel sounds. The physician
suspects a paralytic ileus and confirms the diagnosis based on the combination of clinical features and
imaging.
At the next Evidence-Based Nursing Practice Committee meeting, you discuss this case. The committee
decides to do a case study to determine if there is evidence to suggest that a simple intervention such as
chewing gum post-operatively can prevent a post-operative ileus following abdominal surgery.
Based on this scenario, our research question is: “In patients undergoing abdominal surgery, is there
evidence to suggest that chewing gum post-operatively compared with not chewing gum post-operatively
affects post-operative ileus?”
1. Formulate the PICO Question
2. Identify Keywords for each PICO Element
3. Plan the Search Strategy
4. Execute the Search
5. Refine the Results
6. Review the Literature
7. Assess the Evidence
Review the
Literature
Assess the
Evidence
Refine the
Results
Execute
the Search
Plan the Search
Strategy
Identify
Keywords
Formulate the
PICO Question
7 Steps to the Perfect PICO Search
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
4
STEP 2: IDENTIFY KEYWORDS FOR EACH PICO ELEMENT
Population (P) – What individual or group are we interested in studying?
Intervention (I) – What is the action (intervention, treatment) we are considering taking?
Comparison (C) – To what other action (intervention, treatment) are we comparing the considered action?
Outcome (O) – What do we anticipate as an outcome?
“In patients undergoing abdominal surgery, is there evidence to suggest that chewing gum post-operatively
compared with not chewing gum post-operatively affects post-operative ileus?”
PICO ELEMENTS KEYWORDS
P (Patient or Population) Patients undergoing abdominal surgery
I (Intervention) Chewing gum
C (Comparison) Not chewing gum
O (Outcome) Affects post-operative ileus
STEP 3: PLAN YOUR SEARCH STRATEGY
Plan a search strategy by:
• Determining which database(s) to search
• Identifying the major elements of your question
• Translating natural language terms to subject
descriptors, CINAHL Headings, or synonyms
Interface: EBSCOhost® Research Databases
Database: CINAHL® Complete
Search Screen: Advanced Search
Fig. 1
CINAHL® Complete is just one of the information
resources a nursing researcher can utilize to
execute a perfect PICO search. Considered to
be the definitive research tool for nursing and
allied health professionals, CINAHL Complete
provides fast and easy access to top nursing
and allied health journals, evidence-based care
sheets, quick lessons and continuing education
modules. This database contains full text for
many of the most-used journals found in the
CINAHL® index. With CINAHL Complete, users
can access a comprehensive scope of content
covering over 50 nursing specialties as well as
allied health subjects including speech and
language pathology, nutrition, physical therapy
and much more.
Synonyms, words or phrases that mean exactly
or nearly the same as another word or phrase,
can help expand your search appropriately. For
example: when searching the keyword ‘surgery’,
you might miss articles that instead describe a
patient as ‘postoperative’ or in ‘recovery’. Adding
synonyms will help to expand your results to those
articles that are still relevant but might not include
the words ‘abdominal surgery’. These are shown as
‘Search Strategies’ in the table below.
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
5
PICO ELEMENTS KEYWORDS SEARCH TERMS SEARCH STRATEGIES
P (Patient or Population) Patients undergoing
abdominal surgery
Abdominal Surgery Abdominal surgery
OR
Surgery
OR
Postoperative
OR
Recovery
I (Intervention) Chewing gum Chewing Gum Chewing Gum
OR
Gum
C (Comparison) Not chewing gum
O (Outcome) Affects post-operative ileus Postoperative Ileus Postoperative Ileus
OR
Paralytic Ileus
OR
Ileus
Fig. 2
STEP 4: EXECUTE THE SEARCH
Before you begin your search, you will want to ensure the Search Mode is set to Boolean/Phrase. The reason this is
important is because this option allows for “exact phrase” searching. For example, if you searched for the phrase,
Heart Disease, the system will search for records where the two words heart and disease appear together, as a
phrase, and not simply records where the two words appear separately.
To begin your search, first refer to Fig. 2 above. Each PICO Element (P, I, C, O) will be searched individually
using the correlating Search Strategy. After each search, you will clear the screen and start a new search before
beginning your next search.
• P (Patient or Population): Begin your search with the Patient or Population, which are those patients
undergoing abdominal surgery. As mentioned above, to increase your search results, try adding less
descriptive terms that have the same meaning, such as Surgery, Postoperative or Recovery. *Note: Be sure to
use the Boolean operator, “Or”, so that each result contains at least one of these search terms.
Fig. 3
is an
example of this search strategy shown on EBSCOhost.
Fig. 3
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
6
• I (Intervention): Start a new search for the Intervention, which is Chewing Gum or Gum. Be sure to use the
Boolean operator, “Or”. Note the number of results.
• O (Outcome): You can now conduct a search for the Outcome, which is post-operative ileus. Add the
synonyms paralytic ileus or ileus. Your goal is to determine whether chewing gum postoperatively affects
postoperative ileus, positively or negatively. Click search and note the number of results.
• Combine searches: To complete your search, you will combine the Population (those patients undergoing
abdominal surgery); the Intervention (Chewing gum) and the Outcome (Post-operative ileus/paralytic
ileus). By using your database’s Search History, you should be able to combine these searches into one
search showing results from all three of your previous searches.
STEP 5: REFINE YOUR RESULTS
You can now refine you results by adding limiters. Applying limiters to your search will allow you to focus your
results to the most pertinent and relevant content ensuring that you aren’t wasting time wading through
content that may not be useful.
For example, you may wish to limit your results by Date and Type:
Published Date – Use this option to search for articles within a specified date range.
Evidence-Based Practice – You may wish to limit your articles to only those which are evidence-based. When
searching an EBSCOhost database for example, the Evidence-Based Practice limiter searches the Special Interest
field for the value “Evidence-Based Practice.” Applying this limiter allows you to limit results to:
• Articles from evidence-based practice journals
• Articles about evidence-based practice
• Research articles (including systematic reviews, clinical trials, meta analyses, etc.)
• Commentaries on research studies (applying practice to research)
Should you find that you are left with too few articles by limiting your results to Evidence-Based Practice, you
can instead choose any or all of the following publication types:
1. Case Study
2. Clinical Trial
3. Meta-Analysis
4. Randomized Controlled Trial
5. Research
6. Systematic Review
STEP 6: REVIEW THE LITERATURE
Once you have added limiters to your combined search and run the results again, choose and review articles
that are most relevant to your PICO question. Should you find an article that is particularly relevant to your
search but is not available to you in full text, check with your library to see if they can locate the full text of the
article for you.
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
7
Fig. 4
STEP 7: DETERMINE THE LEVEL OF EVIDENCE
STUDIES DEFINED
Meta-Analysis: A systematic review that uses quantitative methods to synthesize & summarize results.
Systematic Review: A summary of the medical literature that uses explicit methods to perform a
comprehensive literature search & critical appraisal of individual studies.
Randomized Controlled Trial: Participants are randomly allocated into experimental or control groups &
are followed over time for the variables/outcomes of interest.
Cohort Study: Identifies participants who currently have a certain condition or receive a treatment and are
followed over time & compared with another group of people who are not affected by the condition.
Case Control Study: Identifies participants who have a certain outcome (cases) & participants without that
outcome (controls).
Case Report/Case Series: A report on one or more participants with a particular outcome.
(Adapted from CEBM – Centre for Evidence-Based Medicine)
Case Report/Case Series
Case Control Study
Cohort Study
Randomized
Controlled Trial
Systematic
Reveiw
Meta-
Analysis
The final step to the perfect PICO
search is to determine the level of
evidence within each relevant article.
In searching for the best available
evidence, a hierarchy exists regarding
the level and strength of evidence
(see Fig. 4). As you review the journal
articles, select those that are based on
highest level of evidence, such as a
Meta-Analyses or a Systematic Review.
Hierarchy of Evidence
8
Fostering a culture of evidence-based nursing practice within a hospital in no easy task. It
involves the integration of clinical expertise, patient values, and the best research evidence
(Sackett D, 2002). The actual search for high quality clinical research evidence can be
overwhelming to many. By utilizing the PICO format, the search process will be streamlined
and will yield the best available evidence to support clinical decisions and explore alternative
treatments and procedures.
Kathy A. Jensen, MHA, RN
EBSCO Health
10 Estes Street | Ipswich, MA 01938
T: 978-356-6500 x 2879
E: kjensen@ebsco.com
Conclusion
About the Author
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
9
References
1. Conner, Brian T. (June 2014). Differentiating research, evidence-based practice, and quality improvement.
American Nurse Today, Vol. 9 No. 6.
2. Houser, J. (2018). Nursing Research: Reading, Using And Creating Evidence. Burlington, Massachusetts: Jones
& Bartlett Learning.
3. Melnyk, B.M. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA:
Lippincott Williams & Wilkins. pp. 3–7.
4. Schub, E. B., & Walsh, K. C. (2017). Evidence-Based Nursing Practice: Implementing. CINAHL Nursing Guide.
5. Yensen, J. (2013). PICO Search Strategies. Online Journal of Nursing Informatics (OJNI), 17 (3).
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