EBP - Nursing
Clinical Evidence-Informed Questions
- Clinical Questions
- PICO Further Defined
- Background Questions
- Foreground Questions
- Articles About PICO Questions
Elements to a well-built clinical question:
P - Population/patient/problem
I - Intervention or treatment
C - Comparison
O - Outcome
P - Population/problem/patient
C - Concept
C - Context
Often, in nursing, comparison is not a component of the clinical question.
The PICO question format is a consistent "formula" for developing answerable, researchable questions. When you write a good one, it makes the rest of the process of finding and evaluating evidence much more straightforward.
P: Population/patient - age, gender, ethnicity, individuals with a certain disorder
I: Intervention/indicator (Variable of Interest) - exposure to a disease, risk behavior, prognostic factor
C: Comparison/control - could be a placebo or "business as usual" as in no disease, absence of risk factor, Prognostic factor B
O: Outcome - risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome
From: Melnyk, BM & Fineout-Overholt, E: Evidence-Based Practice in Nursing & Healthcare Lippincott Williams & Wilkins, Philadelphia, 2011.
If you know very little about a disease or condition you may be in need of background information.
Often provide a foundation or introduction to an area of study, including generalized information about a condition such as descriptions, causes, symptoms, progression, accepted treatment, outcomes, and prevention.
Simple questions focusing on the basics of a disease/condition – who, what, where, when, why
Posed by clinicians who have a precise need for information about a specific clinical situation (i.e. specific patient)
Narrowly focused, specific question
More complex than background questions
Usually posed by experts who already know the background
Foreground questions often use the PICO format
Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. Journal of the Canadian Chiropractic Association, 56(3), 167-71.
Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing management, 45(8), 9-12.
Note: click "Get FullText" from the left to obtain the fulltext of the article
Different types of clinical questions, require different types of PICO questions. Clinical or practice-based questions are often focused on:
- diagnosis or diagnostic test
The attached PDF provides a template for asking different types of PICO questions. The template is also available from:
Population: Bariatric adolescents considering or undergoing gastric bypass surgery.
Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.
Comparison: The nurse's role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.
Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.
Time: perioperative including the 6 weeks post recovery.
PICOT Question: Does the bariatric adolescent patient undergoing gastric bypass have better continuity of care perioperatively and postoperatively when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?
Intervention PICOT Question, an Intervention example:
In adult patients with total hip replacements (Patient population) how effective is PCA pain medication (Intervention of interest) compared to prn IM pain medication (Comparison intervention) in controlling post operative pain (Outcome) during the perioperative and recovery time? Note: The IM pain medication would be called the control group. It would be unethical to have a control group that received NO pain medication. Many times the control group means they get "business as usual!" or the current standard of care.
Therapy PICOT Question, a non-intervention example:
What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?
Etiology PICOT Question:
Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?
Diagnostic PICOT Question:
Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Time is implied in two weeks and 24 hours old.
Prevention PICOT Question:
In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?
Prognosis/Prediction PICOT question:
Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?
Meaning PICOT Question:
How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?
The attached PDF provides a template for your PICO(T) question, PICO(T) search terms, databases searched, and information found.
Remember, when you are searching for answers to clinical questions, you may not search every part of PICO(T). Often you only search the P (patient/problem) and sometimes also the intervention. But keep in mind your PICO(T) question when reading through the results from your search so you can match the evidence to your clinical question.
Search Example for Library Instruction Session
What are the most effective prevention and treatment interventions for diabetic foot ulcers?
Put this question into PICO(T) format:
- Last Updated: Jan 19, 2023 10:02 AM
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