Nursing: PICO

Evidence-based models use a process for framing a question, locating, assessing, evaluating, and repeating as needed. PICO (T) elements include: Problem/Patient/Population, Intervention/Indicator, Comparison,Outcome, and (optional) Time element or Type of Study.

  1. Frame the question: write out your information need in the form of a question, for example:   

Does hand washing among healthcare workers reduce hospital acquired infections? 

  The question above includes the PICO elements:

• by identifying the major elements of your question, and translate natural language terms(the topic in  your own words) to subject descriptors, MeSH terms, or descriptors (the subject terms database indexers use)
• start with the P and the I only to begin your search and keep initial search results broad:
   

A simple database search strategy should begin with the  AND :    

cross infection AND  (Handwashing OR Hand disinfection) 

Start with  CINAHL or Medline/PubMed as initial article databases for a scoping search for most health sciences questions.  If your topic has a behavioral/mental health component, also try PsycINFO. (knowing your search must be in the nursing literature, however.)

 After viewing the initial search results you may decide to narrow your search with terms for the Comparison, Outcome, Time factors or Type of study. Or you may view results, abstracts, and full text of articles to view the comparison and outcome elements.

In patients with type 2 diabetes and obesity, is bariatric surgery more effective than standard medical therapy at increasing the probability of remission of diabetes?

PICO elements                                                                               CINAHL headings suggestions

P =   obese, male, type 2 diabetes                                                    Diabetes Mellitus, Type 2; Obesity; Sex: Male (dropdown box)         

I = stomach stapling (gastric bypass surgery, bariatric surgery)           Bariatric Surgery

C = standard medical care

O = remission of diabetes, weight loss, mortality                                Disease remission (minor subject heading) or do a keyword search

In infants born prematurely, compared to those born at full term, what is the subsequent lifetime prevalence of sensory deafness?

P = infants                                                                                       Infants OR select appropriate AGE GROUP (dropdown box) 

I = premature                                                                                    Infant, Premature

C =  fullterm                                                                                     Term birth

O= sensorial deafness                                                                     Deafness

For pregnant women, is nuchal translucency ultrasound plus serum biochemistry testing in the first trimester as accurate (ie with equal or better sensitivity and specificity) as conventional amniocentesis for diagnosing Down's Syndrome?

P = pregnant women                                                                         CINAHL uses "In Pregnancy" as a subheading

I = nuchal translucency ultrasound plus serum biochemistry (first trimester) Nuchal Translucency Measurement   AND Pregnancy        Trimester, First       

C  =    conventional amniocentesis                                                                         Amniocentesis

O =   accurate diagnosis (measured by sensitivity and specificity)          Down Syndrome Diagnosis    

of Down's Syndrome (trisomy 21)                                                                                                                                                    

Try words from your topic in these templates.  Your PICO should fit only one type of question in the list.

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Prevention:

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Prognosis/Predictions

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

Meaning

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Templates from Sonoma State University.

It may seem tempting to pick a very specific PICO question and spend a lot of time honing the question before you start researching.  It may be wiser, however, to start with a general idea, investigate what literature is out there, and THEN craft your PICO question.

Additionally, if you can't locate articles about your PICO topic, try searching for one or two components first instead of all of them at once. Some articles many cover one part of your PICO and other articles may cover other parts of it.  You need to build your case and explain the research that is out there, so it is alright if your articles don't 100% match your entire PICO question.

“During pediatric venipuncture what are the effects of using distractive techniques on reducing pain and stress compared to not using these techniques?” 

In pediatric adolescent patients, is it more effective for the nurse to use a sex trafficking victim identification assessment tool upon admission to the hospital, than to not use a sex trafficking victim identification assessment tool in discovering high risk patients or patients with a history of sex trafficking?

What effect does the reliance on nurses as care coordinators have on cost and potential outcomes for hospitals and patients in an ER or ICU setting, and is that affected by the integration of ANP’s as opposed to a solely doctor-nursing staff?

Keywords: catheter-associated urinary tract infection, nurse-driven removal protocol, indwelling urinary catheter, hospital-associated infections, evidence-based practice, quality improvement

In the treatment and prevention of CAUTIs, how does a nurse-directed removal protocol (NDRP) compare to the standard guidelines in the reduction of infections and deaths?

Are new graduate nurses who have a mentor, compared with those without a mentor, at lower risk for leaving the nursing profession within their first year working?