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Nursing : PICOT

This guide is intended for all those studying nursing and related disciplines.

Evidence-Based Nursing

Evidence-based nursing is the use of evidence in combination with the practitioner's expertise and nursing theory in order to make decisions about nursing patient care. It consists of 5 stages:

  1. Asking a question after assessing the patient
  2. Acquire the evidence by finding literature to answer the question
  3. Appraising the evidence to determine its validity (truth) and usefulness to the current situation
  4. Applying the evidence used alongside clinical expertise and with the patient’s input
  5. Evaluating the effectiveness of the plan through audit, peer assessment or reflection

The following information will help you complete the first stage of evidence-based nursing, asking a PICO question. Watch the CINAHL Database Tutorial for help with the second stage of EBN, acquiring evidence for your question.

Breaking Down PICO

In the first step, the PICO model can be used to gather all of the necessary facts in order to come up with a research question:

Patient / Population / Problem:  How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the patient’s sex, age, or other characteristics may be relevant to diagnosis or treatment.

Intervention / Prognostic factor / Exposure: What do you want to do for the patient? Prescribe a drug? Order a test? Order a procedure? What patient characteristics may influence their prognosis? Has the patient been exposed to something?

Comparison: What is the main alternative to compare with the intervention? Another drug? A placebo? A diagnostic test? Note that your clinical question may not involve a specific comparison.

Outcomes: What is the goal? Symptom relief? Reduce the number of adverse episodes? Improve function or test scores?

Time: the time it takes for the intervention to achieve an outcome or how long participants are observed

For more information on using PICO, you can watch the video below.

Example

The patient is a 45 year-old female with a long history of type 2 diabetes and obesity. Over the years, she has tried numerous diets and exercise programs to reduce this weight but has not been very successful. Her work colleague recently had her stomach stapled and has not only lost over 100 lbs. but has also “cured” her diabetes. She wants to know if this procedure really works.

Question Elements Patient / Treatment Characteristics Alternate keywords
Population / Problem Female, obesity, type 2 diabetes Obese, type 2 diabetes
Intervention Stomach stapling Bariatric surgery
Comparison Standard medical care  
Outcomes Weight loss, remission of diabetes Remission, weight loss

Possible clinical question: In patients with type 2 diabetes and obesity (P), is bariatric surgery (I) more effective than standard medical therapy (C) at increasing the probability of remission of diabetes (O)?

Using the case characteristics and alternate keywords above, and the guidelines from the Search Tips & Tutorials tab you can begin searching for evidence!

Possible search terms: female AND obes* AND "type 2 diabetes" AND "bariatric surgery" AND (remission OR weight)

PICOT Question Templates

The American Academy of Ambulatory Care Nursing provides the following guidance for framing PICOT questions. Click here for a printer-friendly version.

INTERVENTION

Questions addressing the treatment of an illness or disability.

In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)? THERAPY In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?

Example: In African-American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?

PROGNOSIS/PREDICTION

Questions address the prediction of the course of a disease.

In ______________ (P), how does ___________________ (I) compared to _____________(C) influence __________________ (O) over _______________ (T)?

Example: For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

DIAGNOSIS OR DIAGNOSTIC TEST

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

In ___________________(P) are/is ____________________(I) compared with _______________________(C) more accurate in diagnosing _________________(O)?

Example: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared to one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

ETIOLOGY

Questions addressing the causes or origins of disease (i.e., factors that produce or predispose toward a certain disease or disorder).

Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O) over ________________(T)?

Example: Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

MEANING

Questions addressing how one experiences a phenomenon.

How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________(T)?

Example: How do young males (P) with a diagnosis of below the waist paralysis (I) perceive their interactions with their romantic significant others (O) during the first year after their diagnosis (T)?