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Forming Focused Questions with PICO: PICO Examples

Created by health science librarians.

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  • PICO's Limitations

Practice Your Skills

Cancer care and peer support, cultural awareness and nursing care, labor & delivery, infection control, nurse educator, nurse practitioner, public health, school nursing.

  • Other Question Frameworks

Practice writing out PICO components and then forming a focused question about one of the case studies below. Choose one or several that interest you.

You have read that peer support interventions help individuals and families affected by cancer across the care continuum from prevention through survivorship and end-of-life care. You wonder about the characteristics of peer support programs and how peer support programs have been used to reduce disparities and barriers to care.

Open to check your PICO analysis of the scenario for cancer care.

Nurses in oncology units interact frequently with adults with cancer who do not speak English as their primary language. You are curious whether cultural awareness among nurses improves these patients’ care and participation in the decision-making process.

Open to check your PICO analysis of the scenario for nursing care.

You’re a new nurse on a labor and delivery unit. You’ve noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you’re sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum.. or did you? You want to find some literature to back up your claim.

Open to check your PICO analysis of the scenario for labor and delivery.

You work in the Big City Hospital ICU. Your mechanically ventilated patients sometimes contract nosocomial pneumonia, which leads to costly complications. You want to know if raising the head of the bed lowers the chance of the patient contracting pneumonia compared to letting the patient lie flat on their back.

Open to check your PICO analysis of the scenario for the ICU..

In the past few years, your hospital has installed antibacterial foam dispensers on all the nursing units. You’ve had nurses asking you if the foam is just as effective as washing their hands with water and soap.

Open to check your PICO analysis of the scenario for infection control.

Shift change on your busy med-surg unit can be frustrating for you and your coworkers. Report at the nursing station takes up to 30 minutes, by the end of which you’re anxious to see your patients. You read something in a recent ANA newsletter about other hospitals switching to a bedside shift report, and you want to find out if staff liked that style of shift change better.

Open to check your PICO analysis of the scenario in med-surg.

Open to check your pico analysis of the scenario in the nicu..

It’s the last semester of your BSN students’ time in school and they’re excited.. and anxious! They’ve been asking you if they should take the NCLEX right after they graduate or wait for a while after graduation so they can relax and study.

Open to check your PICO analysis of the scenario for nurse educators.

It’s winter at your family practice, and you have a lot of patients coming in with runny noses and general malaise. Brenda, a 35 year old working mother in for a checkup states, "I’m so busy between work and home that I definitely don’t have time to get sick! Can those vitamin C or zinc pills prevent colds?"

Open to check your PICO analysis of the scenario for nurse practitioners.

The main concern for most of your patients coming out of anesthesia in your PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.

Open to check your PICO analysis of the scenario for PACU.

You work in a pediatrician’s office and give patients their routine vaccinations. The younger children are often fearful of needles, and some of the staff use toys to distract the patients. You want to know if this technique actually has an effect on the children's pain response.

Open to check your PICO analysis of the scenario for pediatrics.

You work on an inpatient psychiatric unit. One of your patients with chronic schizophrenia, Joe, normally mumbles to himself, but will occasionally speak to others when residents play games together. Noticing this, you say to a coworker that maybe social skills group training sessions would bring out Joe’s conversational skills. Your coworker shakes her head and says "I don’t think so. Joe is in and out of this hospital, he’s a lost cause."

Open to check your PICO analysis of the scenario for psychiatry.

You coordinate health education programs and have been holding seminars for teenagers about STI prevention. You’ve been found that they’re hesitant to open up to you during classes to ask you questions. You’re wondering if recruiting peer educators closer to their age will encourage them to actively participate and get more satisfaction out of the classes.

Open to check your PICO analysis of the scenario for public health.

On your pulmonary unit, many of your COPD patients receive injections of heparin to prevent pulmonary emboli, and patients find the bruises associated with heparin injections unsightly. You’ve had nursing students shadowing you lately, so you’ve been particularly concerned with injection technique. You want to find out if the duration of injection has any effect on the extent of bruising.

Open to check your PICO analysis of the scenario for pulmonary.

You’re a school nurse and one aspect of your job is counseling pregnant teens with the aim of enabling them to complete high school. You’ve even been conducting home visits on top of your normal in-school meetings as part of their preparation-for-motherhood counseling. You want sources to backup the effectiveness of these home visits.

Open to check your PICO analysis of the scenario for school nursing.

A diabetic patient from a nursing home has recently been admitted with a stage III pressure ulcers on his heels. The unit nurses have called you in for a wound consult. You have to choose between standard moist wound therapy and using a wound vac.

Open to check your PICO analysis of the scenario for wound care.

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School of Nursing

  • What is EBP?

Background vs. Foreground

Pico examples, asking different types of questions, pico resources & worksheet.

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Evidence based practice requires that clinicians make use of the best research they can find to help them in decision-making. To find that research efficiently, the clinician must ask a well-designed clinical question with all the elements that will lead to finding relevant research literature.

The first step in doing this is to determine the type of question: background or foreground. The type of question helps to determine the resource to access to answer the question.

Background questions ask for general knowledge about a condition or thing.

  • Broaden the scope - "The Forest"
  • Provides basics for a a greater grasp of concepts
  • Typically found in textbooks, guidelines, point-of-care monographs, encyclopedias, or topic reviews
  • A question root (who, what, when, etc.) with a verb
  • A disorder, test, treatment, or other aspect of healthcare

The background question is usually asked because of the need for basic information. It is not normally asked because of a need to make a clinical decision about a specific patient.

Foreground questions ask for specific knowledge to inform clinical decisions or actions.

  • Focused in scope - "The Trees"
  • Requires a grasp of basic concepts to fully comprehend
  • Typically found in journals and conference proceedings
  • Have 3 or 4 essential components (see PICO below)

PICO is a mnemonic used to describe the four elements of a good clinical foreground question:

P = Population/Patient/Problem - How would I describe the problem or a group of patients similar to mine?

I = Intervention - What main intervention, prognostic factor or exposure am I considering?

C = Comparison - Is there an alternative to compare with the intervention?

O = Outcome - What do I hope to accomplish, measure, improve or affect?

 Fill in the blanks with information from your clinical scenario: THERAPY In_______________, what is the effect of ________________on _______________ compared with _________________?

PREVENTION For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________? DIAGNOSIS OR DIAGNOSTIC TEST Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________? PROGNOSIS Does ____________ influence ______________ in patients who have _____________? ETIOLOGY Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without______________? MEANING How do _______________ diagnosed with _______________ perceive __________________? Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice . Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

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Nursing Research

  • Getting Started
  • PICO Questions & Levels of Evidence

Asking a PICO Question

Evaluating the evidence, primary & secondary sources.

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Clinical and nursing practice questions can be broken down into the PICO(T) format, which breaks a question apart into searchable parts:

Population (P)  – what individual or group are we interested in studying? Intervention (I)  – what is the action (intervention, treatment, etc.) we are considering taking? Comparison (C)  – to what other action (intervention, treatment, etc.) are we comparing the considered action? Outcome (O)  – what do we anticipate as the outcome? Time (T)  – how long will it take to reach the outcome?

  • Note:  not all PICO(T) questions require the "TIME" component 

Potential PICO(T) Question Formats

In__ [Population] __, how does __ [Intervention] __ compared to __ [Comparison] __ affect __ [Outcome] __ within __ [Time] __ ?

In__ [Population] __, how does __ [Intervention] __ compared to __ [Comparison] __ influence/predict __ [Outcome] __ over __ [Time] __ ?

In__ [Population] __, are/is __ [Intervention] __ compared with __ [Comparison] __ more accurate in diagnosing __ [Outcome] __?

Are __ [Population] __, who have  __ [Intervention] __ compared with those without __ [Comparison] __ at risk for/of  __ [Outcome] __ over __ [Time] __ ?  

Sample PICO Question

Scenario:   A committee decides to conduct a case study to determine whether postoperative gum chewing for abdominal surgery patients can prevent postoperative ileus (lack of intestinal movement).

  • P – Patients recovering from abdominal surgery
  • I –  Gum chewing
  • C – Not chewing gum
  • O – Impacts post-operative ileus

PICO Question:  “In patients recovering from abdominal surgery, is there evidence that suggests gum-chewing postoperatively, compared to not chewing gum, impacts postoperative ileus?”

nursing research questions using pico

Levels of evidence are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. The combination of these attributes gives the level of evidence for a study.  In nursing, the system for assigning levels of evidence is often from Melnyk & Fineout-Overholt's 2011 book,  Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice . 

Depending on their purpose, design, and mode of reporting or dissemination, health-related research studies can be ranked according to the strength of evidence they provide, with the sources of strongest evidence at the top, and the weakest at the bottom:

nursing research questions using pico

     

Secondary Sources: studies of studies

A secondary source summarizes or quotes content from primary sources.

Systematic Review

  • Identifies, appraises, and synthesizes all empirical evidence that meets pre-specified eligibility criteria
  • Methods section outlines a detailed search strategy used to identify and appraise articles
  • May include a meta-analysis, but not required (see Meta-Analysis below)

Meta-Analysis

  • A subset of systematic reviews: uses quantitative methods to combine the results of independent studies and synthesize the summaries and conclusions
  • Methods section outlines a detailed search strategy used to identify and appraise articles; often surveys clinical trials
  • Can be conducted independently, or as a part of a systematic review
  • All meta-analyses are systematic reviews, but not all systematic reviews are meta-analyses

Evidence-Based Guideline

  • Provides a brief summary of evidence for a general clinical question or condition
  • Produced by professional health care organizations, practices, and agencies that systematically gather, appraise, and combine the evidence

Meta-Synthesis or Qualitative Synthesis (Systematic Review of Qualitative or Descriptive Studies)

  • a systematic review of qualitative or descriptive studies, low strength level

Primary Sources: original studies

Primary sources are written by the person who originated or is responsible tor generating the ideas published. 

Randomized Controlled Trial

  • Experiment where individuals are randomly assigned to an experimental or control group to test the value or efficiency of a treatment or intervention

Non-Randomized Controlled Clinical Trial (Quasi-Experimental)

  • Involves one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment

Case-Control or Case-Comparison Study (Non-Experimental)

  • Individuals with a particular condition or disease (the cases) are selected for comparison with individuals who do not have the condition or disease (the controls)

Cohort Study (Non-Experimental)

  • Identifies subsets (cohorts) of a defined population
  • Cohorts may or may not be exposed to factors that researchers hypothesize will influence the probability that participants will have a particular disease or other outcome
  • Researchers follow cohorts in an attempt to determine distinguishing characteristics
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Evidence Based Nursing Practice

  • PICO(T) and Clinical Questions
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PICO Templates

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)?

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

Based on Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins .

Using PICO to Formulate Clinical Questions

PICO  (alternately known as PICOT ) is a mnemonic used to describe the four elements of a good clinical question. It stands for:

P --Patient/Problem I --Intervention C --Comparison O --Outcome

Many people find that it helps them clarify their question, which in turn makes it easier to find an answer. 

Use PICO to generate terms - these you'll use in your literature search for the current best evidence.   Once you have your PICO terms, you can then use them to re-write your question.  (Note, you can do this in reverse order if that works for you.)

Often we start with a vague question such as, "How effective is CPR, really?"  But, what do we mean by CPR?  And how do we define effective?  PICO is a technique to help us - or force us - to answer these questions.   Note that you may not end up with a description for each element of PICO. 

P -  our question above doesn't address a specific problem other than the assumption of a person who is not breathing. So, ask yourself questions such as, am I interested in a specific age cohort? (Adults, children, aged); a specific population (hospitalized, community dwelling); health cohort (healthy, diabetic, etc.)   

I - our question above doesn't have a stated intervention, but we might have one in mind such as 'hands-only'

C - Is there another method of CPR that we want to compare the hands-only to?  Many research studies do not go head to head with a comparison.  In this example we might want to compare to the standard, hands plus breathing

O - Again, we need to ask, what do we mean by 'effective'?  Mortality is one option with the benefit that it's easily measured. 

Our PICO statement would look like:

From our PICO, we can write up a clearer and more specific question, such as:

 In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?

More information on formulating PICO questions

Now that we've clarified what we want to know, it will be much easier to find an answer.

Breaking Down Your PICO into a Search Strategy

We can use our PICO statement to list terms to search on.  Under each letter, we'll list all the possible terms we might use in our search. 

P - Community Dwelling:  It is much easier to search on 'hospitalized' than non-hospitalized subjects.  So I would leave these terms for last. It might turn out that I don't need to use them as my other terms from the I, C, or O of PICO might be enough.

community dwelling  OR out-of-hospital

P - adults: I would use the limits in MEDLINE or CINAHL for All Adults.  Could also consider the following depending upon the population you need:

adult OR adults OR aged OR elderly OR young adult

CPR  -  cardiopulmonary resuscitation

I - Hands-only

 hands-only OR compression-only OR chest compression OR compression OR Heart Massage

C - Hands plus breathing Breathing is a tougher term to match.

breathing OR mouth to mouth OR conventional OR traditional

O - Mortality:  If your outcomes terms are general, they may not as useful in the literature search.  They will still be useful in your evaluation of the studies.

mortality OR death OR Survival

Putting it together - a search statement from the above might look like this:

cardiopulmonary resuscitation AND (hands-only OR compression-only OR chest compression OR compression OR Heart Massage) AND (breathing OR mouth to mouth OR conventional OR traditional)

Note that the above strategy is only using terms from the I and the C of PICO.  Depending upon the results, you may need to narrow your search by adding in terms from the P or the O.  

An easy way to keep track of your search strategy is to use a table. This keeps the different parts of your PICO question and their various keywords and subject terms together. This document shows you how to use the tables and provides a few options to organize your table. Use whichever works best for you!  Search Strategy Tables to Break your PICO into Concepts .

PICO and Qualitative Questions

A qualitative PICO question focuses on in-depth perspectives and experiences.  It does not try to solve a problem by analyzing numbers, but rather to enrich understanding through words.  Therefore, the emphasis in qualitative PICO questions is on fully representing the information gathered, rather than primarily emphasizing ways the information can be broken down and expressed through measurable units (though measurability can also play an important role). 

A strength of a qualitative PICO question is that it can investigate what patient satisfaction looks like, for example, instead of only reporting that 25% of patients who took a survey reported that they are satisfied. 

When working with qualitative questions, an alternative to using PICO in searching for sources is the SPIDER search tool.  SPIDER is an acronym that breaks down like this:

P=Phenomena of Interest

E=Evaluation

R=Research Type

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis . Qualitative Health Research, 22 (10), 1435-1443. doi:10.1177/1049732312452938

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PICO- What's in a queston?

The PICOT question format is a consistent "formula" for developing answerable, researchable questions.

nursing research questions using pico

Note: Not every question will have an intervention (as in a meaning question) or time (when it is implied in another part of the question) component.

PICO(T) Templates

Template for Asking PICOT Questions

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)?

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

Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.

Develop your Research Question

The PICO(T) Question

A clinical question that is composed using the PICO or PICOT format will help you to focus your search and help you to develop your research skills which are essential in finding the best available evidence.

The most common PICO(T) elements are:

P - Population

  • How you would describe a group of people with a similar problem or complaint.

I - Intervention

  • How you plan to treat, medicate, diagnose and/or observe the patient's care.

C - Comparison (if applicable)

  • The main intervention alternative you are considering (i.e. placebo, alternative therapy, different drug, surgery).

O - Outcome

  • The result from proposed treatment that is measurable, including improvement of symptoms,no symptoms, or complications.

(T) - Time (if applicable)

  • The time frame of treatment and/or measurable outcome.

In order be successful in using Evidence Based Practice (EBP) you will need to learn how to develop well-composed clinical questions.  By formatting your research question in a PICO(T) format you can gather evidence relevant to your patient's problem.   Well-composed PICO(T) questions generally contain up to four components each represented in the acronym  " PICO(T)"  P=Patient or Population and Problem; I=Intervention or Indicator; C=Comparison or Control (not part of all questions); O=Outcome; T=Time or Type.

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Nursing Students' Guide to Evidence Based Research: Asking Research Questions

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Getting Started with Nursing Research

This guide will help you improve your nursing research skills by helping you:

  • develop a focused research question
  • search  nursing and allied health databases   for articles, reports and other publications to gather evidence
  • evaluate evidence for credibility and usefulness
  • apply evidence to clinical practice

First Steps

If your research is taking you into unfamiliar territory (it usually does), one of the best ways to gain a working knowledge of your topic is to check out introductory articles and chapters of reference sources, like special encyclopedias and handbooks. Check out the  Reference Tools  tab for a selection of our print and online reference sources for nursing.

Planning Your Research

One of the keys to effective database searching is to ask focused, specific questions. You also need to choose your search terms carefully, and combine them in ways that give you control over your search results. The PICO model, described below, provides a framework for constructing questions and search strategies for clinical research questions.

Research Process Overview

The research process can be broken down into four simple steps:

  • Evidence-Based Practice: PICO
  • Example PICO Worksheet
  • Blank PICO Worksheet

PICO: How Nurses Plan Their Research

Organizing the issue into four simple parts helps to identify the main concepts. 

PICO in Action

There are several variations of the PICO method. In the video below, the T in PICOT refers to TIME.

PICO Example

Scenario: A 64 year old obese male who has tried many ways to lose weight presents with a newspaper article about ‘fat-blazer’ (chitosan). He asks for your advice. Begin by identifying the main concepts: obese, adult, chitosan, weight loss

Your research question might be: I n obese patients, does chitosan, compared to a placebo, decrease weight?

Use these keywords when searching nursing databases such as CiNAHL . 

From PICO to Search Strategy

  • Search Strategies with PICO
  • 7 STEPS TO THE PERFECT PICO SEARCH
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nursing research questions using pico

PICOT Question Examples for Nursing Research

nursing research questions using pico

Are you looking for examples of nursing PICOT questions to inspire your creativity as you research for a perfect nursing topic for your paper? You came to the right place.

We have a comprehensive guide on how to write a good PICO Question for your case study, research paper, white paper, term paper, project, or capstone paper. Therefore, we will not go into the details in this post. A good PICOT question possesses the following qualities:

  • A clinical-based question addresses the nursing research areas or topics.
  • It is specific, concise, and clear.
  • Patient, problem, or population.
  • Intervention.
  • Comparison.
  • Includes medical, clinical, and nursing terms where necessary.
  • It is not ambiguous.

For more information, read our comprehensive PICOT Question guide . You can use these questions to inspire your PICOT choice for your evidence-based papers , reports, or nursing research papers.

If you are stuck with assignments and want some help, we offer the best nursing research assignment help online. We have expert nursing writers who can formulate an excellent clinical, research, and PICOT question for you. They can also write dissertations, white papers, theses, reports, and capstones. Do not hesitate to place an order.

List of 180 Plus Best PICOT Questions to Get Inspiration From

Here is a list of nursing PICO questions to inspire you when developing yours. Some PICOT questions might be suitable for BSN and MSN but not DNP. If you are writing a change project for your DNP, try to focus on PICOT questions that align to process changes. 

  • Among healthy newborn infants in low- and middle-income countries (P), does early skin-to-skin contact of the baby with the mother in the first hour of life (I) compared with drying and wrapping (C) have an impact on neonatal mortality, hypothermia or initiation/exclusivity/ duration of breastfeeding (O)?
  • Is it necessary to test blood glucose levels 4 times daily for a patient suffering from Type 1 diabetes?
  • Does raising the head of the bed of a mechanically ventilated patient reduce the chances of pneumonia?
  • Does music therapy is an effective mode of PACU pain management for patients who are slowly coming out from their anesthesia?
  • For all neonates (P), should vitamin K prophylaxis (I) be given for the prevention of vitamin K deficiency bleeding (O)?
  • For young infants (0-2 months) with suspected sepsis managed in health facilities (P), should third generation cephalosporin monotherapy (I) replace currently recommended ampicillin-gentamicin combination (C) as first line empiric treatment for preventing death and sequelae (O)?
  • In low-birth-weight/pre-term neonates in health facilities (P), is skin-to-skin contact immediately after birth (I) more effective than conventional care (C) in preventing hypothermia (O)?
  • In children aged 2–59 months (P), what is the most effective antibiotic therapy (I, C) for severe pneumonia (O)?
  • Is skin-to-skin contact of the infant with the mother a more assured way of ensuring neonatal mortality compared to drying and wrapping?
  • Are oral contraceptives effective in stopping pregnancy for women above 30 years?
  • Is spironolactone a better drug for reducing the blood pressure of teenagers when compared to clonidine?
  • What is the usefulness of an LP/spinal tap after the beginning of antivirals for a pediatric population suffering from fever?
  • In children aged 2–59 months in developing countries (P), which parenteral antibiotic or combination of antibiotics (I), at what dose and duration, is effective for the treatment of suspected bacterial meningitis in hospital in reducing mortality and sequelae (O)?
  • Does the habit of washing hands third-generation workers decrease the events of infections in hospitals?
  • Is the intake of zinc pills more effective than Vitamin C for preventing cold during winter for middle-aged women?
  • In children with acute severe malnutrition (P), are antibiotics (I) effective in preventing death and sequelae (O)?
  • Among, children with lower respiratory tract infection (P), what are the best cut off oxygen saturation levels (D), at different altitudes that will determine hypoxaemia requiring oxygen therapy (O)?
  • In infants and children in low-resource settings (P), what is the most appropriate method (D) of detecting hypoxaemia in hospitals (O)?
  • In children with shock (P), what is the most appropriate choice of intravenous fluid therapy (I) to prevent death and sequelae (O)?
  • In fully conscious children with hypoglycaemia (P) what is the effectiveness of administering sublingual sugar (I)?
  • Is using toys as distractions during giving needle vaccinations to toddlers an effective pain response management?
  • What is the result of a higher amount of potassium intake among children with low blood pressure?
  • Is cup feeding an infant better than feeding through tubes in a NICU setup?
  • Does the intervention of flushing the heroin via lines a more effective way of treating patients with CVLs/PICCs?
  • Is the use of intravenous fluid intervention a better remedy for infants under fatal conditions?
  • Do bedside shift reports help in the overall patient care for nurses?
  • Is home visitation a better way of dealing with teen pregnancy when compared to regular school visits in rural areas?
  • Is fentanyl more effective than morphine in dealing with the pain of adults over the age of 50 years?
  • What are the health outcomes of having a high amount of potassium for adults over the age of 21 years?
  • Does the use of continuous feed during emesis a more effective way of intervention when compared to the process of stopping the feed for a short period?
  • Does controlling the amount of sublingual sugar help completely conscious children suffering from hypoglycemia?
  • Is the lithotomy position an ideal position for giving birth to women in labor?
  • Does group therapy help patients with schizophrenia to help their conversational skills?
  • What are the probable after-effects, in the form of bruises and other injuries, of heparin injection therapy for COPD patients?
  • Would standardized discharge medication education improve home medication adherence in adults age 65 and older compared to-standardized discharge medication education?
  • In patients with psychiatric disorders is medication non-compliance a greater risk compared with adults experiencing chronic illness?
  • Is the use of beta-blockers for lowering blood pressure for adult men over the age of 70 years effective?
  • Nasal swab or nasal aspirate? Which one is more effective for children suffering from seasonal flu?
  • What are the effects of adding beta-blockers for lowering blood pressure for adult men over the age of 70 years?
  • Does the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
  • Is medical intervention a proper way of dealing with childhood obesity among school-going children?
  • Can nurse-led presentations of mental health associated with bullying help in combating such tendencies in public schools?
  • What are the impacts of managing Prevacid before a pH probe study for pediatric patients with GERD?
  • What are the measurable effects of extending ICU stays and antibiotic consumption amongst children with sepsis?
  • Does the use of infrared skin thermometers justified when compared to the tympanic thermometers for a pediatric population?
  • What are the roles of a pre-surgery cardiac nurse in order to prevent depression among patients awaiting cardiac operation?
  • Does the increase in the habit of smoking marijuana among Dutch students increase the chances of depression?
  • What is the direct connection between VAP and NGT?
  • Is psychological intervention for people suffering from dementia a more effective measure than giving them a placebo?
  • Are alarm sensors effective in preventing accidents in hospitals for patients over the age of 65 years?
  • Is the sudden change of temperature harmful for patients who are neurologically devastated?
  • Is it necessary to test blood glucose levels, 4 times a day, for a patient suffering from Type 1 diabetes?
  • Is the use of MDI derive better results, when compared to regular nebulizers, for pediatric patients suffering from asthma?
  • What are the effects of IVF bolus in controlling the amount of Magnesium Sulfate for patients who are suffering from asthma?
  • Is the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
  • What are the standards of vital signs for a pediatric population?
  • Is daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
  • Does receiving phone tweets lower blood sugar levels for people suffering from Type 1 diabetes?
  • Are males over the age of 30 years who have smoked for more than 1 year exposed to a greater risk of esophageal cancer when compared to the same age group of men who have no history of smoking?
  • Does the increase in the use of mosquito nets in Uganda help in the reduction of malaria among the infants?
  • Does the increase in the intake of oral contraceptives increase the chances of breast cancer among 20-30 years old women in the UK?
  • In postpartum women with postnatal depression (P), does group therapy (I) compared to individual therapy (C) improve maternal-infant bonding (O) after eight weeks (T)?
  • In patients with chronic pain (P), does mindfulness-based cognitive therapy (I) compared to pharmacotherapy (C) improve quality of life (O) after 12 weeks (T)?
  • In patients with type 2 diabetes (P), does continuous glucose monitoring (I) compared to self-monitoring of blood glucose (C) improve glycemic control (O) over a period of three months (T)?
  • In patients with chronic kidney disease (P), does a vegetarian diet (I) compared to a regular diet (C) slow the decline in renal function (O) after one year (T)?
  • In pediatric patients with acute otitis media (P), does delayed antibiotic prescribing (I) compared to immediate antibiotic prescribing (C) reduce antibiotic use (O) within one week (T)?
  • In older adults with dementia (P), does pet therapy (I) compared to no pet therapy (C) decrease agitation (O) after three months (T)?
  • In patients with chronic heart failure (P), does telemonitoring of vital signs (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with anxiety disorders (P), does exposure therapy (I) compared to cognitive therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
  • In postpartum women with breastfeeding difficulties (P), does lactation consultation (I) compared to standard care (C) increase breastfeeding rates (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does long-acting bronchodilator therapy (I) compared to short-acting bronchodilator therapy (C) improve lung function (O) after three months (T)?
  • In patients with major depressive disorder (P), does bright light therapy (I) compared to placebo (C) reduce depressive symptoms (O) after six weeks (T)?
  • In patients with diabetes (P), does telemedicine-based diabetes management (I) compared to standard care (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) decrease serum phosphate levels (O) after one year (T)?
  • In pediatric patients with acute gastroenteritis (P), does probiotic supplementation (I) compared to placebo (C) reduce the duration of diarrhea (O) within 48 hours (T)?
  • In patients with chronic pain (P), does acupuncture (I) compared to sham acupuncture (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a home modification program (I) compared to no intervention (C) reduce the incidence of falls (O) over a period of six months (T)?
  • In patients with schizophrenia (P), does cognitive remediation therapy (I) compared to standard therapy (C) improve cognitive function (O) after one year (T)?
  • In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to angiotensin receptor blockers (C) slow the progression of renal disease (O) over a period of two years (T)?
  • In postoperative patients (P), does chlorhexidine bathing (I) compared to regular bathing (C) reduce the risk of surgical site infections (O) within 30 days (T)?
  • In patients with type 2 diabetes (P), does a low-carbohydrate, high-fat diet (I) compared to a low-fat diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does pulmonary rehabilitation combined with telemonitoring (I) compared to standard pulmonary rehabilitation (C) improve exercise capacity (O) after three months (T)?
  • In patients with heart failure (P), does a nurse-led heart failure clinic (I) compared to usual care (C) improve self-care behaviors (O) after six months (T)?
  • In postpartum women with postnatal depression (P), does telephone-based counseling (I) compared to face-to-face counseling (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic migraine (P), does prophylactic treatment with topiramate (I) compared to amitriptyline (C) reduce the frequency of migraines (O) after three months (T)?
  • In pediatric patients with acute otitis media (P), does watchful waiting (I) compared to immediate antibiotic treatment (C) reduce the duration of symptoms (O) within seven days (T)?
  • In older adults with dementia (P), does reminiscence therapy (I) compared to usual care (C) improve cognitive function (O) after three months (T)?
  • In patients with chronic heart failure (P), does telemonitoring combined with a medication reminder system (I) compared to telemonitoring alone (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with asthma (P), does self-management education (I) compared to standard care (C) reduce asthma exacerbations (O) over a period of one year (T)?
  • In postoperative patients (P), does the use of wound dressings with antimicrobial properties (I) compared to standard dressings (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with chronic kidney disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve psychological well-being (O) over a period of three months (T)?
  • In adult patients with chronic pain (P), does biofeedback therapy (I) compared to relaxation techniques (C) reduce pain intensity (O) after eight weeks (T)?
  • In patients with type 2 diabetes (P), does a low-glycemic index diet (I) compared to a high-glycemic-index diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does regular physical activity (I) compared to no physical activity (C) improve health-related quality of life (O) after three months (T)?
  • In patients with major depressive disorder (P), does mindfulness-based cognitive therapy (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In postpartum women (P), does perineal warm compresses (I) compared to standard perineal care (C) reduce perineal pain (O) after vaginal delivery (T)?
  • In patients with chronic kidney disease (P), does a low-protein, low-phosphorus diet (I) compared to a low-protein diet alone (C) slow the progression of renal disease(O) after two years (T)?
  • In pediatric patients with attention-deficit/hyperactivity disorder (P), does mindfulness-based interventions (I) compared to medication alone (C) improve attention and behavior (O) after six months (T)?
  • In patients with chronic pain (P), does cognitive-behavioral therapy (I) compared to physical therapy (C) reduce pain interference (O) after 12 weeks (T)?
  • In elderly patients with osteoarthritis (P), does aquatic exercise (I) compared to land-based exercise (C) improve joint flexibility and reduce pain (O) after eight weeks (T)?
  • In patients with multiple sclerosis (P), does high-intensity interval training (I) compared to moderate-intensity continuous training (C) improve physical function (O) after three months (T)?
  • In postoperative patients (P), does preoperative carbohydrate loading (I) compared to fasting (C) reduce postoperative insulin resistance (O) within 24 hours (T)?
  • In patients with chronic obstructive pulmonary disease (P), does home-based tele-rehabilitation (I) compared to center-based rehabilitation (C) improve exercise capacity (O) after six months (T)?
  • In patients with rheumatoid arthritis (P), does tai chi (I) compared to pharmacological treatment (C) reduce joint pain and improve physical function (O) after six months (T)?
  • In postpartum women with postpartum hemorrhage (P), does early administration of tranexamic acid (I) compared to standard administration (C) reduce blood loss (O) within two hours (T)?
  • In patients with hypertension (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce blood pressure (O) after eight weeks (T)?
  • In elderly patients with hip fractures (P), does multidisciplinary geriatric care (I) compared to standard care (C) improve functional outcomes (O) after three months (T)?
  • In patients with chronic kidney disease (P), does aerobic exercise (I) compared to resistance exercise (C) improve renal function (O) after six months (T)?
  • In patients with major depressive disorder (P), does add-on treatment with omega-3 fatty acids (I) compared to placebo (C) reduce depressive symptoms (O) after 12 weeks (T)?
  • In postoperative patients (P), does preoperative education using multimedia materials (I) compared to standard education (C) improve patient satisfaction (O) after surgery (T)?
  • In patients with type 2 diabetes (P), does a plant-based diet (I) compared to a standard diet (C) improve glycemic control (O) after three months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does high-flow oxygen therapy (I) compared to standard oxygen therapy (C) improve exercise tolerance (O) after three months (T)?
  • In patients with heart failure (P), does nurse-led telephone follow-up (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In postpartum women with postnatal depression (P), does online cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic migraine (P), does mindfulness-based stress reduction (I) compared to medication alone (C) reduce the frequency and severity of migraines (O) after three months (T)?
  • In older adults with delirium (P), does structured music intervention (I) compared to standard care (C) reduce the duration of delirium episodes (O) during hospitalization (T)?
  • In patients with chronic low back pain (P), does yoga (I) compared to physical therapy (C) reduce pain intensity (O) after six weeks (T)?
  • In pediatric patients with acute otitis media (P), does watchful waiting with pain management (I) compared to immediate antibiotic treatment (C) reduce the need for antibiotics (O) within one week (T)?
  • In patients with schizophrenia (P), does family psychoeducation (I) compared to standard treatment (C) improve medication adherence (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) slow the progression of renal disease (O) after one year (T)?
  • In postoperative patients (P), does wound irrigation with saline solution (I) compared to povidone-iodine solution (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with type 1 diabetes (P), does continuous subcutaneous insulin infusion (I) compared to multiple daily injections (C) improve glycemic control (O) over a period of six months (T)?
  • In postoperative patients (P), does the use of prophylactic antibiotics (I) compared to no antibiotics (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
  • In patients with chronic obstructive pulmonary disease (P), does smoking cessation counseling (I) compared to no counseling (C) decrease the frequency of exacerbations (O) over a period of six months (T)?
  • In patients with diabetes (P), does a multidisciplinary team approach (I) compared to standard care (C) improve self-management behaviors (O) over a period of one year (T)?
  • In pregnant women with gestational hypertension (P), does bed rest (I) compared to regular activity (C) reduce the risk of developing preeclampsia (O) before delivery (T)?
  • In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to placebo (C) slow the progression of renal disease (O) over a period of two years (T)?
  • In older adults with hip fractures (P), does early surgical intervention (I) compared to delayed surgery (C) improve functional outcomes (O) after six months (T)?
  • In patients with major depressive disorder (P), does exercise (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In children with autism spectrum disorder (P), does applied behavior analysis (I) compared to standard therapy (C) improve social communication skills (O) over a period of one year (T)?
  • In postoperative patients (P), does the use of incentive spirometry (I) compared to no spirometry (C) decrease the incidence of postoperative pulmonary complications (O) within seven days (T)?
  • In patients with hypertension (P), does a combination of diet modification and exercise (I) compared to medication alone (C) lower blood pressure (O) after six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does home oxygen therapy (I) compared to no oxygen therapy (C) improve exercise capacity (O) after threemonths (T)?
  • In patients with heart failure (P), does a multidisciplinary heart failure management program (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In postpartum women with postnatal depression (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic kidney disease (P), does a low-sodium diet (I) compared to a regular diet (C) lower blood pressure (O) after six months (T)?
  • In pediatric patients with attention-deficit/hyperactivity disorder (P), does neurofeedback training (I) compared to medication (C) improve attention and behavior (O) after six months (T)?
  • In patients with chronic pain (P), does transcranial direct current stimulation (I) compared to sham stimulation (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults with osteoporosis (P), does a structured exercise program (I) compared to no exercise (C) improve bone mineral density (O) after six months (T)?
  • In patients with type 2 diabetes (P), does a low-carbohydrate, high-protein diet (I) compared to a standard diet (C) improve glycemic control (O) over a period of six months (T)?
  • In patients with chronic obstructive pulmonary disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve dyspnea symptoms (O) after three months (T)?
  • In postpartum women with postnatal depression (P), does online peer support (I) compared to individual therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • In patients with chronic kidney disease (P), does resistance training (I) compared to aerobic training (C) improve muscle strength (O) after six months (T)?
  • In pediatric patients with asthma (P), does a written asthma action plan (I) compared to verbal instructions (C) reduce emergency department visits (O) within six months (T)?
  • In patients with chronic pain (P), does yoga (I) compared to pharmacological treatment (C) reduce pain interference (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a multifactorial falls prevention program (I) compared to no intervention (C) reduce the rate of falls (O) over a period of six months (T)?
  • In patients with schizophrenia (P), does cognitive-behavioral therapy (I) compared to medication alone (C) reduce positive symptom severity (O) after six months (T)?
  • In postpartum women with breastfeeding difficulties (P), does breast massage (I) compared to no massage (C) improve milk flow (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does long-term oxygen therapy (I) compared to short-term oxygen therapy (C) improve survival rates (O) after one year (T)?
  • In patients with major depressive disorder (P), does repetitive transcranial magnetic stimulation (I) compared to sham treatment (C) reduce depressive symptoms (O) after six weeks (T)?
  • In patients with diabetes (P), does a digital health app (I) compared to standard care (C) improve medication adherence (O) over a period of six months (T)?
  • In patients with chronic kidney disease (P), does a low-potassium diet (I) compared to a regular diet (C) lower serum potassium levels (O) after one year (T)?
  • In pediatric patients with acute gastroenteritis (P), does oral rehydration solution (I) compared to intravenous fluid therapy (C) reduce hospital admissions (O) within 48 hours (T)?
  • In patients with chronic pain (P), does hypnotherapy (I) compared to no hypnotherapy (C) reduce pain intensity (O) after eight weeks (T)?
  • In older adults at risk of falls (P), does a tai chi program (I) compared to no exercise program (C) improve balance and stability (O) after six months (T)?
  • In patients with chronic heart failure (P), does a home-based self-care intervention (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
  • In patients with anxiety disorders (P), does acceptance and commitment therapy (I) compared to cognitive-behavioral therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
  • In postpartum women with breastfeeding difficulties (P), does the use of nipple shields (I) compared to no nipple shields (C) improve breastfeeding success (O) after four weeks (T)?
  • In patients with chronic obstructive pulmonary disease (P), does a comprehensive self-management program (I) compared to usual care (C) improve health-related quality of life (O) after three months (T)?
  • In patients with major depressive disorder (P), does internet-based cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
  • Does the increase in the habit of smoking marijuana among Dutch students increase the likelihood of depression?
  • Does the use of pain relief medication during surgery provide more effective pain reduction compared to the same medication given post-surgery?
  • Does the increase in the intake of oral contraceptives increase the risk of breast cancer among women aged 20-30 in the UK?
  • Does the habit of washing hands among healthcare workers decrease the rate of infections in hospitals?
  • Does the use of modern syringes help in reducing needle injuries among healthcare workers in America?
  • Does encouraging male work colleagues to talk about sexual harassment decrease the rate of depression in the workplace?
  • Does bullying in boarding schools in Scotland increase the likelihood of domestic violence within a 20-year timeframe?
  • Does breastfeeding among toddlers in urban United States decrease their chances of obesity as pre-schoolers?
  • Does the increase in the intake of antidepressants among urban women aged 30 years and older affect their maternal health?
  • Does forming work groups to discuss domestic violence among the rural population of the United States reduce stress and depression among women?
  • Does the increased use of mosquito nets in Uganda help in reducing malaria cases among infants?
  • Can colon cancer be more effectively detected when colonoscopy is supported by an occult blood test compared to colonoscopy alone?
  • Does regular usage of low-dose aspirin effectively reduce the risk of heart attacks and stroke for women above the age of 80 years?
  • Is yoga an effective medical therapy for reducing lymphedema in patients recovering from neck cancer?
  • Does daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
  • Does a regular 30-minute exercise regimen effectively reduce the risk of heart disease in adults over 65 years?
  • Does prolonged exposure to chemotherapy increase the risk of cardiovascular diseases among teenagers suffering from cancer?
  • Does breastfeeding among toddlers in the urban United States decrease their chances of obesity as pre-schoolers?
  • Are first-time mothers giving birth to premature babies more prone to postpartum depression compared to second or third-time mothers in the same condition?
  • For women under the age of 50 years, is a yearly mammogram more effective in preventing breast cancer compared to a mammogram done every 3 years?
  • After being diagnosed with blood sugar levels, is a four-times-a-day blood glucose monitoring process more effective in controlling the onset of Type 1 diabetes?

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Nursing 472: picking a pico.

  • Back to Lovejoy Library
  • Nursing 472
  • Picking a PICO
  • Levels of Evidence
  • Using databases
  • Finding guidelines
  • Finding review articles
  • Appraising the Evidence
  • Cite Sources
  • Class Exercises

PICO is a mnemonic used to help you clarify your clinical question.  It acts as a framework, asking you to think specifically about different aspects of what you want to investigate.  As you build your PICO, you should make sure that you are clear and specific about what you are looking for. This helps you target the right evidence to use in practice.  

In some questions, a T is added to the PICO framwork as well to help find a specific level of evidence.

P: Patient, Problem, or Population

I: Intervention

C: Comparison

T: Timeframe, Type of Study, or Type of Question

Be sure to make your question specific.  What type of patient are you looking for?  Are you using a specific test as your intervention, or a broad group?  If you are looking for better outcomes, what are examples of those outcomes?

Good PICO or bad PICO?

A good clinical question will address most, if not all, parts of the PICO framework.  A good PICO will be specific and define terms and outcomes if necessary.  A good PICO will investigate something new in terms of diagnosis, etiology, therapy, harm, etc.

A bad PICO is usually a background question disguised as a research question.  For example, "what are the effects of Prilosec on patients taking immune suppressants" might seem like a good research question, but it is not.  First, effects of a drug are often considered background information because you can look up this information in a drug monograph- you don't need an article to tell you this.  Second, the question is very vague.  What immune suppressant are you looking at?  What are the characteristics of your population?  You need more details to make this a question worth researching.

It may seem tempting to pick a very specific PICO question, but remember, for many nursing school assignments, you need to find existing literature.  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.

  • PICO question templates Use this guide to help structure your PICO question.
  • The Well-Built Clinical Question Check out this guide to building a PICO question, developed by UNC.
  • Asking Focused Questions PICO guide from the Centre for Evidence Based Medicine.
  • Formulating Answerable Questions Practice building your PICO questions here.
  • Forming Focused Questions with a Specialty A UNC Health Sciences Library guide about PICO questions within a specialty.

PICO Template Questions

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

In__________ (P) how does ________ (I) compared to _______(C) influence _______ (O) over ______ (T)?

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

Templates from Sonoma State University .

Example PICO Questions

Intervention/Therapy:

In school-age children (P), what is the effect of a school-based physical activity program (I) on a reduction in the incidence of childhood obesity (O) compared with no intervention (C) within a 1 year period (T)?

In high school children (P), what is the effect of a nurse-led presentation on bullying (I) on a reduction in reported incidences of bullying (O) compared with no intervention (C) within a 6 month time frame (T)?

Are males 50 years of age and older (P) who have a history of 1 year of smoking or less (I) at an increased risk of developing esophageal cancer (O) compared with males age 50 and older (P) who have no smoking history (C)?

Are women ages 25-40 (P) who take oral contraceptives (I) at greater risk for developing blood clots (O) compared with women ages 25-40 (P) who use IUDs for contraception (C) over a 5 year time frame (T)?

Diagnosis/Diagnostic Test:

Is a yearly mammogram (I) more effective in detecting breast cancer (O) compared with a mammogram every 3 years (C) in women under age 50 (P)?

Is a colonoscopy combined with fecal occult blood testing (I) more accurate in detecting colon cancer (O) compared with a colonoscopy alone (C) in adults over age 50 (P)?

For women under age 60 (P), does the daily use of 81mg low-dose Aspirin (I) reduce the future risk of stroke (O) compared with no usage of low-dose Aspirin (C)?

For adults over age 65 (P) does a daily 30 minute exercise regimen (I) reduce the future risk of heart attack (O) compared with no exercise regimen (C)?

Prognosis/Predictions:

Does daily home blood pressure monitoring (I) influence compliance with medication regimens for hypertension (O) in adults over age 60 who have hypertension (P) during the first year after being diagnosed with the condition (T)?

Does monitoring blood glucose 4 times a day (I) improve blood glucose control (O) in people with Type 1 diabetes (P) during the first six months after being diagnosed with the condition (T)?

How do teenagers (P) diagnosed with cancer (I) perceive chemotherapy and radiation treatments (O) during the first 6 months after diagnosis (T)?

How do first-time mothers (P) of premature babies in the NICU (I) perceive bonding with their infant (O) during the first month after birth (T)?

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Acknowledgments

Guide developed with assistance from S. Pruitt, student, SIUE School of Nursing, and 2014 URCA program assistant.

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  • Last Updated: Jan 12, 2024 9:39 AM
  • URL: https://libguides.siue.edu/NURS472

nursing research questions using pico

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NRS 302 - Nursing Research

Pico questions.

  • Creating Search Strategies
  • Finding Evidence
  • APA Style (7th ed.)

PICO questions are a tool used to help you

  • Assess your situation or problem. What does your patient need? What is their clinical problem or question?
  • Construct a well-built question based on your assessment.
  • Search the evidence.

Watch the video and review the examples below to help you develop a PICO question to guide your research proposal.

Download the PICO Question Generator worksheet for a guide:

  • PICO Question Generator

Case Example

Rita is an RN who works in a nursing home. One of her patients complains of arthritic pain that is worsening. Her medication doesn't seem to be helping. Rita wonders whether massage therapy would present an effective means of treatment for her patient.

Before Rita can look for sources of literature on the subject, she needs to form a question that will:

  • Address all the elements of the problem
  • Yield relevant results

Constructing the Question using PICO

The PICO format helps you form an answerable questions that identifies the patient problem, the treatments or tests that are being considered, any alternative treatments or tests (if any), and the desired outcome of the treatment(s).

P = Patient or Problem: Who is your patient? What patient population do they belong to? Are there problems endemic to this population?

I = Intervention or Exposure: Which intervention or treatments are you going to research? What do you want for the patient (a prescription, a test, surgery, etc.)?

C = Comparison or Control: What is the main alternative to compare with the intervention? Is your patient already receiving an intervention? Or none at all (control)?

O = Outcome: What do you hope to accomplish, improve, or achieve? What are you trying to do for the patient?

Case Example Revisited

After assessing the problem and constructing a question using the PICO format, Rita comes up with the following question:

P = Geriatric patients with arthritic pain

I = Massage therapy

C = Patient's prescribed NSAID or similar anti-inflammatory drugs

O = Reduced arthritic pain

Complete clinical question: Do geriatric patients with arthritis who receive regular massage therapy have lessened arthritic pain compared to those that do not?

Another Example

Let's look at another example. You're working with an elderly client who is in a nursing home and experiencing social isolation. You're interested in exploring options to help them cope and connect with their loved ones. While doing some quick background research, you discover the potential for digital communication technology to have an impact on social isolation. Before you can proceed with this, you need to find evidence to support your decision, so forming a PICO question will help you effectively search for relevant literature.

Using what we know from our scenario, let's break it down:

  • P:  nursing home residents (population) with social isolation (problem)
  • I:  videoconference program with family (intervention to be explored)
  • C:  normal family visitation at the nursing home (comparison to the new intervention)
  • O:  lessened social isolation (our ideal outcome)

If we piece these components into a complete question, it might sound something like this:

Would a videoconference program (I) improve social isolation (O) amongst nursing home residents (P) compared with traditional visitation (C)?

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Nursing Research: PICO Clinical Questions

  • PICO Clinical Questions
  • Levels of Evidence
  • Nursing Databases

PICO is an acronym for the four elements that every well-designed clinical question must have when researching evidence-based practices. 

Creating an effective search strategy with pico, there are four key elements required for an effective pico question..

P: Population / Patient

  • Who or What?  Patient, Population, Problem.
  • How would you describe a group of patients similar to your group?
  • What are the most important characteristics of the patient?  Primary problem; disease; co-existing conditions.
  • Consider sex, age and/or race of a patient as this may be relevant to the diagnosis or treatment of a disease.

 I: Intervention / Indicator

  • Intervention, prognostic factor or exposure - Drug, procedure, diagnostic test, exposure.
  • Which main intervention, prognostic factor, exposure are you considering?
  • What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery?
  • What factor might influence the prognosis of the patient? Age; co-existing problems.
  • What exposure has the patient experienced? Asbestos; cigarette smoke.

  C: Comparator / Control

  • What is the main alternative?  Comparison or intervention?
  • What is the main alternative to compare with the intervention?
  • Are you trying to decide between? Two drugs; a drug and no medication or placebo; two diagnostic tests.
  • Your clinical question may not always need a specific comparison.

  O: Outcome

  • What are you trying to accomplish, measure, improve, effect, achieve?
  • What can you hope to accomplish measure, improve or affect?
  • What are you trying to do for the patient? Relieve or eliminate the symptoms; reduce the number of adverse events; improve function or test scores.

Clinical problem: A patient asks if drinking carrot juice will reduce the likelihood of developing prostate cancer.

Answerable clinical question:

P - In males

I - Does drinking carrot juice

C - Compared to not drinking carrot juice

O - Reduce the incidence of prostate cancer

Created by Katrina Henderson at Griffith University

Shared under Creative Commons Attribution 4.0 International (CC BY 4.0) license

Creative Commons License CC BY

DiCesno, A., Bayley, L., & Haynes, B. (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence Based Nursing, 12 (4). https://doi.org/10.1136/ebn.12.4.99-b

eHealth NSW. (2018). Clinical Information Access Portal (CIAP) EBP Learning Modules. https://www.ciap.health.nsw.gov.au/training/ebp-learning-modules/module1/index.html

Glossary of basic statistical terms

Null and alternative hypothesis.

The null and alternative hypotheses are two competing claims that researchers weigh evidence for and against using a statistical test:

  • Null hypothesis: There’s no effect in the population.
  • Alternative hypothesis: There’s an effect in the population.

(Scribbr, May 6, 2022. Learn more...)

Dependent and Independent Variables

In research, variables are any characteristics that can take on different values, such as height, age, temperature, or test scores. Researchers often manipulate or measure independent and dependent variables in studies to test cause-and-effect relationships.

  • The independent variable is the cause. Its value is independent of other variables in your study.
  • The dependent variable is the effect. Its value depends on changes in the independent variable.

(Scribbr, Dec. 2, 2022. Learn more...)

Subject variables

Subject variables are characteristics that vary across participants, and they can’t be manipulated by researchers. For example, gender identity, ethnicity, race, income, and education are all important subject variables that social researchers treat as independent variables.

P - In males (independent subject variable)

I - Does drinking carrot juice (independent variable)

C - Compared to not drinking carrot juice (independent variable)

O - Reduce the incidence of prostate cancer (dependent variable)

Bhandari, P. (2022, December 02). Independent vs. Dependent Variables | Definition & Examples. Scribbr. Retrieved April 18, 2023, from https://www.scribbr.com/methodology/independent-and-dependent-variables/

More information on statistical analysis can be found on the Scribbr website: The Beginner's Guide to Statistical Analysis | 5 Steps & Examples  on scribbr.com.

Video Tutorials - Researching Evidence Based Practices

Researching evidence based practices is key to nursing education. These video tutorials provide a step-by-step approach for doing nursing research at Bushnell University.   

  • The PICO Question Part 1 of 3. Defining and developing a PICO Question. (4:30)
  • Turning PICO Questions into Keywords Part 2 of 3. Using a PICO Question to develop keywords for searching the databases. (6:21)
  • Searching CINAHL and MEDLINE Part 3 of 3. Navigating to and getting ready to search the databases. (5:41)
  • Using CINAHL and MEDLINE effectively After navigating to the databases, how do you search them effectively? (12:41)
  • FEEDBACK FORM Please provide feedback on each video tutorial that you view. The form takes about 2 minutes to complete. Thank you!

Search Strategies

  • PICO Keyword Chart Making a PICO question into keywords for database searching with Boolean operators. (blank)

PICOT Research Question Generator

  • PICOT Question Generator The PICOT Research Question Generator will help researchers create valid research questions using the PICOT framework. more... less... Created by Eric Heidel, PhD, PStat, Associate Professor of Biostatistics at theUniversity of Tennessee Graduate School of Medicine.
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  • Last Updated: Dec 20, 2023 4:54 PM
  • URL: https://bushnell.libguides.com/nursing

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NURS 3290: Nursing Research 2 - BSN Program

  • Accessing and Navigating Databases
  • Keywords and Subject Headings

Formulating a PICO(T) Question

What is a pico(t) question, tips for building a pico(t) question, ideas for your pico(t) question, example: pico(t) question and search strategy.

  • Database Options
  • Keyword Searching
  • Subject Heading Searching
  • Search History Screen Capture
  • Accessing Full-Text Articles
  • VIDEO TUTORIALS
  • Resources for Clinical Topic Information
  • APA 7th Edition Style

Asking questions is at the heart of evidence-based practice.

If nurses never asked questions about how to improve patient care based on scientific research evidence, then no beneficial changes or advancements in nursing practice would occur. Cultivating a spirit of inquiry is essential for evidence-based practice implementation.

The PICO(T) model is used widely in evidence-based practice to construct a focused, well-built, and searchable clinical question. This page provides you with the following content to guide you in developing a PICO(T) question of your own:

  • What is a PICO(T) Question?  
  • Ideas for your PICO(T) Question

Evidence-based practice (EBP) is a systematic approach to patient care decision-making based on current, best available research evidence. 

The first step in EBP involves re-phrasing a clinical patient care issue in the form of a focused, searchable, and answerable question . 

PICO(T)  is a template for creating a well-built clinical question for evidence-based inquiry.

P - Patient/Population/Problem

I - Intervention/Variable of Interest

C - Comparison ("standard care" or "usual care")

O - Outcome(s)

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

Your required textbook provides a wealth of material for generating and brainstorming ideas for PICO(T) Questions. 

Be sure to review Chapter 8  in your Introduction to Evidence-Based Practice  text for ideas and examples of clinical questions for EBP. 

Two copies of this book are on reserve in the Mulford Library. To use a copy in the library, please ask a staff member at the library front desk to retrieve it for you. 

Cover Art

Helpful web resources for PICOT question ideas can be accessed below: 

  • Johns Hopkins - EBP Exemplar Library Explore this database of EBP projects completed by clinicians. Many of these projects include good examples of PICOT questions.
  • PICO Questions [from University of Kansas Medical Center] This site provides examples by patient care setting under the "PICO Question Examples" section
  • UToledo DNP Student EBP Projects Access and read the full-text of UToledo DNP students' EBP projects. The PICOT questions utilized in these projects may provide you with inspiration and ideas for your own PICOT.
  • Ohio State DNP Final Projects

PICO(T) Question Example: 

"In adult cancer patients experiencing fatigue (P), what is the effect of meditation (I), compared with standard care (C), on quality of life (O) within 6 months (T)?" 

Building a Database Search Strategy for the PICO(T) Question: 

  • A well-built PICO(T) question forms the basis of a database search strategy for finding research literature.
  • Concepts from the PICO(T) question are used to construct a comprehensive database search strategy with search terms describing each relevant component of the PICO(T). 
  • Relevant elements of your PICO(T) question can be used to develop a "starter" list of keywords (including synonyms) to use in a database search. Most commonly, the most important parts of a PICO(T) question for searching are the P, I, and O. 
  • After developing a "starter" list of search terms, you can then begin brainstorming your search strategy for combining terms with OR or AND, and using other techniques such as a truncation (i.e. a keyword search for  letharg* will also find articles with the term lethargic or lethargy ):
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Capstone and PICO Project Toolkit

  • Starting a Project: Overview
  • Developing a Research Question
  • Selecting Databases
  • Expanding a Search
  • Refining/Narrowing a Search
  • Saving Searches
  • Critical Appraisal & Levels of Evidence
  • Citing & Managing References
  • Database Tutorials
  • Types of Literature Reviews
  • Finding Full Text
  • Term Glossary

Defining the Question: Foreground & Background Questions

In order to most appropriately choose an information resource and craft a search strategy, it is necessary to consider what  kind  of question you are asking: a specific, narrow "foreground" question, or a broader background question that will help give context to your research?

Foreground Questions

A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. 

Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. 

 Across most frameworks, you’ll often be considering:

  • a who (who was studied - a population or sample)
  • a what (what was done or examined - an intervention, an exposure, a policy, a program, a phenomenon)
  • a how ([how] did the [what] affect the [who] - an outcome, an effect). 

PICO is the most common framework for developing a clinical research question, but multiple question frameworks exist.

PICO (Problem/Population, Intervention, Comparison, Outcome)

Appropriate for : clinical questions, often addressing the effect of an intervention/therapy/treatment

Example : For adolescents with type II diabetes (P) does the use of telehealth consultations (I) compared to in-person consultations  (C) improve blood sugar control  (O)?

Framing Different Types of Clinical Questions with PICO

Different types of clinical questions are suited to different syntaxes and phrasings, but all will clearly define the PICO elements.  The definitions and frames below may be helpful for organizing your question:

Intervention/Therapy

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which 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)?" 

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)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Beyond PICO: Other Types of Question Frameworks

PICO is a useful framework for clinical research questions, but may not be appropriate for all kinds of reviews.  Also consider:

PEO (Population, Exposure, Outcome)

Appropriate for : describing association between particular exposures/risk factors and outcomes

Example : How do  preparation programs (E) influence the development of teaching competence  (O) among novice nurse educators  (P)?

SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type)

Appropriate for : questions of experience or perspectives (questions that may be addressed by qualitative or mixed methods research)

Example : What are the experiences and perspectives (E) of  undergraduate nursing students  (S)  in clinical placements within prison healthcare settings (PI)?

SPICE (Setting, Perspective, Intervention/phenomenon of Interest, Comparison, Evaluation)

Appropriate for : evaluating the outcomes of a service, project, or intervention

Example : What are the impacts and best practices for workplace (S) transition support programs (I) for the retention (E) of newly-hired, new graduate nurses (P)?

PCC (Problem/population, Concept, Context)

Appropriate for : broader (scoping) questions

Example : How do nursing schools  (Context) teach, measure, and maintain nursing students ' (P)  technological literacy  (Concept))throughout their educational programs?

Background Questions

To craft a strong and reasonable foreground research question, it is important to have a firm understanding of the concepts of interest.  As such, it is often necessary to ask background questions, which ask for more general, foundational knowledge about a disorder, disease, patient population, policy issue, etc. 

For example, consider the PICO question outlined above:

"For adolescents with type II diabetes does the use of telehealth consultations compared to in-person consultations  improve blood sugar control ?

To best make sense of the literature that might address this PICO question, you would also need a deep understanding of background questions like:

  • What are the unique barriers or challenges related to blood sugar management in adolescents with TII diabetes?
  • What are the measures of effective blood sugar control?
  • What kinds of interventions would fall under the umbrella of 'telehealth'?
  • What are the qualitative differences in patient experience in telehealth versus in-person interactions with healthcare providers?
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Step One: Develop a PICO Question

Using the PICO format can be instructive! P atient Population I ntervention C omparison Intervention O utcome

Types of Questions:  Etiology, Diagnostic, Prevention, Prognosis/Prediction, Therapy, Qualitative

Prevention Example : For patients with systolic heart failure  (P) do exercise programs  (I) reduce the future risk of hospital admission due to heart failure  (O) compared with patients without exercise programs (C)? Therapy Example: In patients with chronic wounds  (P) what is the effect of topical negative pressure (TNP)  (I) on promoting healing  (O) compared with traditional moisturized gauze  (C) dressing?

Steps Two through Five

Step Two:   Acquire the most relevant, most current, best evidence. See Evidence Hierarchy

Step Three : A ppraise the evidence.

Step Four:   Apply all evidence with clincial experience, patient preferences and values in making a practice decision or change.

Step Five :  Access the practice decision or change.

PICO Continued (Examples)

Etiology : Are ____(P), who have ____ (I) at ____(increased/decreased)risk for/of_____(O) compared with____(P) with/without_____(C)? Diagnostic: Are(Is)____(I) done on _____(P)more accurate in diagnosis of _____(O)compared to ______(C)?

Qualitative: How do ____ (P), perceive the  ____ (I) on ____ (O) compared to _____ (C)?

Prognosis/Prediction: Does ____ (I) influence ____ (O) in patients who have ____ (P)?

TRIP Database PICO Wizard: You may find this helpful.  Click on the PICO Search button for help building a PICO question.

What is Evidence Based Practice?

nursing research questions using pico

Evidence Pyramid

nursing research questions using pico

This guide will help you locate the highest levels of evidence: systematic reviews & meta-analyses, and practice guidelines. 

If you can't locate the highest levels of research to answer a specific clinical question you should use the highest level available.  Look for tutorials on searching reliable sources such as CINAHL, Medline, and PubMed databases for articles, studies and reports.

Definitions

Systematic Review: A systematic review  tries to identify, appraise, select and synthesize all RCTs (randomized control trials) relevant to a specific clinical question.  Stringent guidelines are set in order to draw a conclusion about whether or not there is conclusive evidence about a specfic treatment or topic. Randomized Control Trial:  An RCT is a clinical trial in which the subjects are randomly distributed into groups that are either subjected to the experimental procedure (such as use of a drug) or that serve as controls.  It is the research design considered to provide the most reliable evidence for evaluating the effectiveness of an intervention. Meta-Analysis: A meta-analysis is a review that combines the quantitative (numbers) results from different studies on a defined intervention in order to obtain a quantitative estimate of the overall effect of the particular intervention.  A meta-analysis produces a stronger conclusion than can be provided by any individual study.

Practice Guideline: Clinical Practice Guidelines are practice recommendations based on rigorous review of the best evidence on a specific topic.

Cohort Study: A study designed to determine the relationship between a condition and a characteristic shared by some members of a group. The population selected is healthy at the beginning of the study. Some of the members of the group share a particular characteristic, such as cigarette smoking. The researcher follows the population group over a period of time, noting the rate at which a condition, such as lung cancer, occurs in the smokers and in the nonsmokers.

Case Control Study:  A study where previously existing incidents of a medical condition are used in lieu of gathering new information. A group of patients with a particular disease or disorder, such as myocardial infarction, is compared with a control group of persons who have not had that medical problem. The two groups, matched for age, sex, and other personal data, are examined to determine which possible factor (e.g., cigarette smoking, coffee drinking) may account for the increased disease incidence in the case group.

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Formulating a PICOT Question

September 26, 2020

View all blog posts under Articles | View all blog posts under Doctor of Nursing Practice

Portrait Of Doctor Working At Nurses Station Smiling At Camera

The word PICOT is a mnemonic derived from the elements of a clinical research question – patient, intervention, comparison, outcome and (sometimes) time. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer.

“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,” Kathy A. Jensen, MHA, RN, wrote in EBSCO Health’s whitepaper, “7 Steps To The Perfect Pico Search.” “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.”

For RNs who are training in a doctor of nursing practice (DNP) program, including an online DNP program , learning how to develop a comprehensive PICOT question is essential to nurse manager competencies. DNP students study PICOT question examples to determine the best process for crafting a question and finding an answer.

Learning the PICOT Process

The PICOT process generally begins with a vague clinical query. Each element of the process helps develop a well-structured question . Once established, researchers can search for evidence that will help answer the inquiry.

The elements of a PICOT question are:

P (Patient, population or problem)

Who or what is the patient, population or problem in question?

I (Intervention)

What is the intervention (action or treatment) being considered?

C (Comparison or control)

What other interventions should be considered?

O (Outcome or objective)

What is the desired or expected outcome or objective?

T (Time frame)

How long will it take to reach the desired outcome?

Using the PICOT process helps develop a careful and thoughtful question that makes the search for evidence easier, the University of Oxford’s world-renowned Centre for Evidence-Based Medicine said.

“The well-formed question makes it relatively straightforward to elicit and combine the appropriate terms needed to represent your need for information in the query language of whichever searching service is available to you,” the University of Oxford author said. “Once you have formed the question using the PICO structure, you can think about what type of question it is you are asking, and therefore what type of research would provide the best answer.”

Steps to the PICOT Process

In developing a PICOT question , researchers must identify a need or a reason for the study. In the EBSCO Health whitepaper, the general example used is this: A committee decides to conduct a case study to determine whether postoperative gum chewing for abdominal surgery patients can prevent postoperative ileus (lack of intestinal movement).

With the scenario in mind, researchers use seven steps to the PICOT search:

  • Formulate the PICOT question in general terms: Based on the EBSCO Health example, the research question would be, “In patients recovering from abdominal surgery, is there evidence that suggests gum-chewing postoperatively, compared to not chewing gum, impacts postoperative ileus?”
  • Identify the keywords for the PICOT mnemonic: P – Patients recovering from abdominal surgery I – Gum chewing C – Not chewing gum O – Impacts post-operative ileus
  • Plan the search strategy: With the question in mind, researchers consider which databases and other search sites they might use to find information and answers. Researchers use strategies to maximize their search terms such as looking up synonyms and phrases that mean the same thing.
  • Execute a search: At first, researchers search each PICOT element individually. For example, when researching patients recovering from abdominal surgery, use the search terms “abdominal surgery,” but also consider the search terms “recovery and postoperative.”
  • Refine the results: Narrow the search results by limiting the works to pertinent content, such as articles from peer-reviewed journals or research documents.
  • Review the content: Review the research results to establish if they have the necessary information to answer the PICOT question.
  • Determine if research results meet standards: After reviewing the research results, determine whether they provide the best available evidence.

After the PICOT question is constructed and researched, the information garnered is used to determine which type of study is most appropriate. Study types include meta-analysis, systematic review, randomized controlled trial, cohort study, case-control study and case report.

“The actual search for high-quality clinical research evidence can be overwhelming to many,” Jensen said in the EBSCO Health whitepaper. “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.”

DNP and PICOT Question

To take a deep dive into advanced nursing practice, many RNs seeking a DNP must submit a final project. At Duquesne University, online DNP program students undertake a DNP Practice Project, which must focus on patient outcomes, quality improvements and clinical practice.

Through the project, Duquesne University DNP candidates will identify a specific problem in patient care or clinical practice and present solutions. Students use a PICOT question to guide the project topic.

The online DNP program at Duquesne University teaches RNs nurse manager competencies as well as other essential leadership skills . The university offers three distinct DNP tracks:

  • Clinical Leadership DNP
  • Post-Bachelor’s Executive Nurse Leadership DNP
  • Post-Master’s Executive Nurse Leadership DNP

About Duquesne University’s Online DNP Program

Duquesne University, a leader in online education, prepares RNs for clinical leadership positions as DNPs. The university’s curriculum builds on existing experiences and knowledge so graduates can implement evidence-based practice in clinical settings.

Duquesne University’s online DNP program provides RNs an opportunity to continue their professional career and maintain family responsibilities while earning an advanced degree.

EBSCOHealth, “7 Steps to The Perfect Pico Search” University of Oxford, “Asking Focused Questions” Duquesne University, “Systematic Reviews: Developing a research question”

A guided search: Formulating a PICOT from assigned areas of inquiry

Affiliation.

  • 1 Department of Acute and Tertiary Care, College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
  • PMID: 35842743
  • DOI: 10.1111/wvn.12598

The evidence-based practice (EBP) competencies of cultivating inquiry and formulation of Population, Intervention, Outcome, and Time (PICOT) questions are essential to quality improvement, healthcare outcomes, and the development of Doctor of Nursing Practice (DNP) scholarly projects. Education and assessment of EBP competencies into the DNP curriculum, particularly formulation of PICOT questions, provide guidance and evaluate mastery of students' individual skills and group work. Utilization of a PICOT template is an approach to aid large cohorts of students in writing healthcare-specific PICOTs to guide them in search of quality evidence. Guided inquiry through collaboration with community partners can aid in identifying community needs. Assigning an area of inquiry allows stakeholders, community partners, and nursing students an opportunity to ask the necessary questions to improve health care, and simultaneously meet the need for evidence-based quality improvement.

Keywords: curriculum; education/curriculum/learning; evidence-based practice; outcome evaluation; patient outcomes/healthcare outcomes/treatment outcomes; quality improvement.

© 2022 Sigma Theta Tau International.

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  • v.56(3); 2012 Sep

What is your research question? An introduction to the PICOT format for clinicians

John j. riva.

† Department of Family Medicine, McMaster University, Hamilton, Ontario.

Keshena M.P. Malik

¶ Graduate Student, Department of Rehabilitation Sciences, McMaster University, Hamilton, Ontario.

Stephen J. Burnie

‡ Canadian Memorial Chiropractic College, Toronto, Ontario.

Andrea R. Endicott

£ Senior Policy Analyst, Ontario Chiropractic Association, Toronto, Ontario.

Jason W. Busse

§ Institute for Work & Health, Toronto, Ontario.

* Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario.

Introduction

Clinicians often witness impressive treatment results in practice and may wish to pursue research to formally explore their anecdotal experiences. The potential to further new knowledge both within the profession and to the greater healthcare system is compelling. An obvious next step for a practitioner considering research is to connect with experienced researchers to convey their idea for a study, who may in turn ask, “What is your research question?” With limited understanding of how to respond, this interaction may result in the first and last experience these clinicians will have with the research community.

It has been estimated that between 1% and 7% of the chiropractic profession in Canada is engaged in research. 1 , 2 Arguably, this low engagement could be the result of practitioners’ perceived importance of research and levels of research literacy and capacity. However, increasing demands for evidence-based approaches across the health system puts pressure on all clinicians to base their decisions on the best available scientific evidence. Lack of clinician representation in research has the probable effect of limiting growth and new developments for the profession. Furthermore, lack of clinician involvement in research complicates the transfer of study findings into practical settings.

The Canadian Institutes of Health Research describes integrated knowledge translation as a process that involves collaboration between researchers and knowledge users at all stages of a research project. 3 This necessitates involvement of clinicians to help in forming a research question, interpreting the results, and moving research findings into practice. This shared effort between clinicians and researchers increases the likelihood that research initiatives will be relevant to practice. 3 Conversely, it has been reported that there is a growing communication gap between clinicians and academics in chiropractic. 4 Clinicians have important practice-related questions to ask, but many may lack the ability to map out their research strategy, specifically in communicating their question in a manner required to develop a research protocol.

David L. Sackett, Officer of the Order of Canada and the founding Chair of Canada’s first Department of Clinical Epidemiology & Biostatistics at McMaster University, highlights the importance of mapping one’s research strategy in exploration of the research question: “one-third of a trial’s time between the germ of your idea and its publication in the New England Journal of Medicine should be spent fighting about the research question.” (personal communication, November 30, 2011) We describe a randomized controlled trial (RCT) example to highlight how clinicians may use existing literature and the PICOT format to formulate a research question on treatment efficacy.

PICOT Defined

The PICOT format is a helpful approach for summarizing research questions that explore the effect of therapy: 5

  • (P) – Population refers to the sample of subjects you wish to recruit for your study. There may be a fine balance between defining a sample that is most likely to respond to your intervention (e.g. no co-morbidity) and one that can be generalized to patients that are likely to be seen in actual practice.
  • (I) – Intervention refers to the treatment that will be provided to subjects enrolled in your study.
  • (C) – Comparison identifies what you plan on using as a reference group to compare with your treatment intervention. Many study designs refer to this as the control group. If an existing treatment is considered the ‘gold standard’, then this should be the comparison group.
  • (O) – Outcome represents what result you plan on measuring to examine the effectiveness of your intervention. Familiar and validated outcome measurement tools relevant to common chiropractic patient populations may include the Neck Disability Index 6 or Roland-Morris Questionnaire. 7 There are, typically, a multitude of outcome tools available for different clinical populations, each having strengths and weaknesses.
  • (T) – Time describes the duration for your data collection.

RCT Design Example Using PICOT

Dosage effects of spinal manipulative therapy for chronic neck pain.

Neck pain is second in frequency only to low back pain among musculoskeletal complaints reported in the general population and among those presenting to manual therapy providers. 8 , 9 Chronic neck pain (i.e. neck pain lasting longer than 90 days) is a common reason for presenting to a chiropractor’s office, and such patients often receive spinal manipulation or mobilization. 10 Recent systematic reviews of RCTs and prior observational studies have shown increases in cervical range of motion, 11 , 12 and decreases in self-rated neck pain 13 , 14 following cervical spine manipulation. In 2010, the Cochrane systematic review concluded, “Optimal technique and dose need to be determined.” 14

Despite evidence of benefit, there is a limited understanding of the optimal dose for neck manipulation; as such, frequency and duration of this treatment varies greatly between clinicians. Although patient characteristics and clinicians’ beliefs likely account for some of this variation, it seems likely that many cases of mechanical neck pain will require a minimal number of spinal manipulative therapy (SMT) treatments to derive benefit and that no further benefit will result after a certain upper threshold is reached. To properly examine the dose effects of manipulation for neck pain, it is necessary to consider three treatment factors:

  • total number of manipulations

A factorial design RCT allows investigators to consider more than one treatment factor at a time and examine possible interactions between them. This trial design allows for determination of, not only, the effects of frequency and duration, but also whether it is more effective to provide a certain number of manipulations over shorter or longer durations (i.e. an interaction between the two factors). Considering a 3x4 factorial design, patients would attend 1, 2, or 3 sessions per week (i.e. the first ’factor’ of frequency) with manipulation provided over a duration of 2 weeks, 4 weeks, 6 weeks, or not at all (i.e. the second ‘factor’ of duration). To improve generalizability of findings, neck manipulation could be performed using standard rotary or lateral break diversified technique, which is the most common manually applied neck manipulation in chiropractic practice. Pain relief is a common concern among patients presenting with neck pain and detection of a resulting difference of 13 mm on the 100mm Visual Analog Scale (VAS) line is considered a clinically important change in intensity for patients with chronic pain. 15

Research Question: In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise at 6 weeks?

  • (P) – Population: Adults 18 to 60 years of age, with a clinical diagnosis of chronic mechanical neck pain who have not received cervical SMT in the past year. Patients with non-mechanical neck pain or contraindications to cervical manipulation will be excluded.

Frequency and Duration of SMT

  • (C) – Comparison: A standardized supervised exercise regimen would be used as an active control group. All subjects, regardless of group assignment, would perform a standardized exercise regime at each session over a period of 6 weeks. Using this strategy, we will be able to minimize the non-specific effects due to attending a clinic.
  • (O) – Outcome: Changes in neck pain, measured using the 100mm VAS for pain.
  • (T) – Time: The outcome would be measured weekly for 6 weeks.

Clinician input, assuming expertise in the ‘gold standard’ standard rotary or lateral break diversified technique and an ability to teach it, would be helpful during the planning of patient recruitment. Specifically, in leading training initiatives to calibrate each treating chiropractor to deliver his/her manipulation in a similar way (i.e. load, force, angle) and to assist in normalizing communication with study subjects. This standardization, through structured training sessions for those rendering treatment, will help ensure no additional interventions were inadvertently applied (i.e. education, extra advice).

Other Study Designs Amenable to PICOT

The PICOT format example described above represents a factorial RCT methodology that has been informed by the existing literature. While a well-conducted RCT is appropriate for answering many questions on treatment efficacy, they are typically costly, time-consuming and challenging to conduct. Not all research questions that clinicians wish answered are feasible using this research methodology and the use of a PICOT format is also applicable to other study designs.

The clinical research question being asked ideally determines the best research design for a study. A prospective or retrospective cohort design may be an easier methodology to administer in comparison to a RCT; but study results can by affected by confounding due to the comparison of non-randomized groups. Another methodology, used to look for associations between respondent characteristics and outcomes of interest, is a cross-sectional survey. This methodology is faster and less expensive to do in comparison to a RCT since it considers one time-point of individuals in various spectrums of the variables of interest. However, this design can also can be prone to recall problems by respondents who self-report information if investigators ask about events in the past. A case-control study is most appropriate when attempting to identify associations between patient characteristics and outcomes that take a long time to occur or are very rare. For example, the study by Cassidy et al. (2008) looking at risk of vertibrobasilar artery stroke following chiropractic care, whilst more complex in the design approach, used aspects of a case-control methodology. 16

While these study designs are common in clinical research today, they are not exhaustive of all designs available. Systematic reviews will be familiar to most as a study design aimed at summarizing bodies of studies; but other less familiar individual patient focus designs, such as N-of-1 RCT, 17 also exist which are amenable to the PICOT format depending on the research question that is being posed.

Many considerations need to be contemplated in the PICOT formulation: How detailed should the literature search be in breadth and quality level? What study design best fits the research question? Should the patient population include very similar types of patients or will there be more of a real-world wide variety of participants? Will the intervention be very specific and rendered by a clinical expert or will there be a combination of tailored interventions rendered by a non-clinician with a more general skill set? Will the comparison be against usual care (i.e. ‘gold standard’) or a sham placebo procedure? Will the outcomes measured be from validated instruments on a form or more from direct patient verbal communication and will these results be presented in a way most important to clinicians, patients or policy-makers? And if so, what amount of difference and how many patients would be required to both statistically and clinically conclude the intervention was effective? Will measurement of outcomes occur at multiple times or once at 5 days, 6 months or 10 years?

While these considerations are clearly complex and not inclusive of the entire process, to develop a strong research question framed in the PICOT format, it is an important basis to understand both the clinical area of investigation and the current literature that exists. As highlighted by the example above, it is necessary to review the type and quality of research that has already been performed in the area of interest to guide development of a question. When initially synthesizing the literature, some key entry questions to examine include:

  • what are the important research questions in the field?
  • what has been found?
  • what areas need further exploration?
  • would the proposed study fill a gap and better an understanding?

In our example design, the literature search identified existing knowledge in the respective area. A recent high-quality Cochrane review reported on previously completed RCTs in the area, strengths and weaknesses of these studies and offered direction as to gaps in current understanding that would benefit from further research exploration. 14 As research is a time consuming and often costly endeavour, building on the best available existing knowledge rather than “re-inventing the wheel” is favourable.

Only after a thorough literature synthesis and investigation into these answers should a research question be formulated – in some instances a systematic review methodology may actually align best with the PICOT framework for your research question. Turning an idea into a good research question requires it to be feasible, interesting, novel, ethical and relevant. 18 This feasibility refers to, not only, resources (time and money), but also to whether there is agreement on the meaning of the research question and to whether everything that needs to be measured can be measured by the study design. The question should be of interest to many in the clinical area to drive both team momentum for the project and dissemination of the results. Generating new knowledge in large existing gaps of healthcare provides the opportunity to help large volumes of patients who previously may have had poorer clinical outcomes. Practically, ethical considerations have to be accounted for in related study designs to ensure subjects are not harmed by the study. Finally, reflection is required on how well the study design will apply to the real world.

A strong research question should always pass the ‘so what?’ test. Who will the research help? What is the benefit? There should be a definitive and strong rationale for the purpose of the research. A well-thought-out focused research question leads directly into hypotheses; the predictions about the nature and direction of the relationship between the variables under study. Hence, the question acts as the foundation of the study.

The importance of moving from studies to empirically supported treatments to evidence-based practices may very well rest on whether or not a clinician views the research as relevant to their daily practice. It is common for clinicians to express frustration that researchers are not asking questions that are of most relevance to practice. Similarly, researchers often find that clinicians have difficulty distilling the important concepts they would like investigated in a way that can be feasibly researched.

To support both clinical and academic interests, an important clinical research question should therefore be one that is developed in conjunction with a diverse team. This expertise should align with the best research methodology available and propose a project feasible to complete through study that will adequately answer the research question asked. In Canada, the Canadian Chiropractic Research Foundation has reported that there are currently 12 university-based research chairs, 15 PhD candidates and 14 Masters students. 19 An opportunity exists to engage these researchers, as well as those from chiropractic schools, in helping to formulate important clinical research questions.

Clinicians interested in research pursuits, related to patient care, should consider the use of a literature search and the PICOT format when engaging clinical researchers. This approach will provide clinicians and researchers an initial basis for mutual understanding, communication and direction to help answer clinical study questions of most relevance.

  • Clinicians should frame practice-based research questions in the PICOT format
  • Look to existing literature for guidance in the formulation of a research question
  • Clinicians have an important role in contributing to the integrated knowledge translation of research studies
  • Framing of a research question offers a common language between clinician and researcher discourse

Funding: No funds were received for the preparation of this manuscript. Dr. Busse is funded by a New Investigator Award from the Canadian Institutes of Health Research and Canadian Chiropractic Research Foundation. Dr. Riva is funded by an award from the NCMIC Foundation. Drs. Burnie, Busse, Malik and Riva are members of the McMaster Chiropractic Working Group, which receives in-kind support from the Canadian Chiropractic Association.

Competing Interests: None.

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MFT 204: MFT 204: INDIVIDUAL AND FAMILY LIFE CYCLE DEVELOPMENT Bosley 2024

  • Literature review
  • Using PICO to Determine Search Terms
  • Find Articles
  • Search strategies
  • Quantitative vs. Qualitative Research
  • Evidence Based Practice
  • Find Journals
  • Citation: APA 7

What is PICO

Practitioners of EBP Research often use the PICO format to help define and answer your research question. 

By organizing a research question using PICO, a researcher can determine specific terms that will help find relevant evidence in professional literature. These terms become the search terms used when searching the databases. 

  • PICO is a Research Strategy

PICO Searches in CINAHL/ PNW Library

nursing research questions using pico

  • POPULATION:  What are the characteristics of this patient population and the problem/ question that is being addressed?
  • INTERVENTION:  What is the treatment or course of action typically taken being considered?
  • COMPARISON:  What is the alternative (or standard course of action) to the intervention to compare it to?
  • OUTCOME:  What is the hoped for accomplishment/ improvement/ or affect for the stated population?

Framing Different Types of Clinical Questions

Intervention/therapy.

Questions addressing how a clinical issue, illness, or disability is treated.

"In__________________(P), how does__________________(I) compared to_________________(C) affect______________(O)?"

Questions that address the causes or origin of disease, the factors which 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)?" 

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)?

Prognosis/Prediction:

Questions addressing the prediction of the course of a disease.

In_________________(P), how does_________________(I) compared to_________________ (C) influence_________________(O)?

Questions addressing how one experiences a phenomenon or why we need to approach practice differently.

"How do_________________(P) with_________________(I) perceive_________________(O)?" 

Adapted from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

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COMMENTS

  1. PICO Questions

    Your full PICO question is: "Among hospitalized chronic smokers, does a brief educational nursing intervention lead to long term smoking cessation [when compared with no intervention]?" PICO Question Examples Cardiology ICU Infection Control Labor & Delivery NICU Oncology Pediatrics Psychiatry Wound Care

  2. Forming Focused Questions with PICO: PICO Examples

    Labor & Delivery You're a new nurse on a labor and delivery unit. You've noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you're sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum.. or did you?

  3. LibGuides: School of Nursing: Asking Your Question (PICO)

    The first step in doing this is to determine the type of question: background or foreground. The type of question helps to determine the resource to access to answer the question. Background questions ask for general knowledge about a condition or thing. Broaden the scope - "The Forest". Provides basics for a a greater grasp of concepts.

  4. The impact of patient, intervention, comparison, outcome (PICO) as a

    In addition to acting as a conceptualizing tool for asking clinical and research questions, the PICO model can be used as a tool for developing search strategies. ... Curtis K. Evidence based emergency nursing: designing a research question and searching the literature. Int Emerg Nurs. 2017 May; 32:78-82. doi: 10.1016/j.ienj.2017.02.001 ...

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  6. PICO(T) and Clinical Questions

    PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. It stands for: P --Patient/Problem I --Intervention C --Comparison O --Outcome Many people find that it helps them clarify their question, which in turn makes it easier to find an answer.

  7. Formulating a researchable question: A critical step for facilitating

    This paper also describes PICO (population, intervention, control, and outcomes) criteria in framing a research question. Finally, we also assess the characteristics of a research question in the context of initiating a research project. Keywords: Clinical research project, PICO format, research question Go to: INTRODUCTION

  8. LibGuides: Nursing: PICO(T) Questions

    If nurses never asked questions about how to improve patient care based on scientific research evidence, then no beneficial changes or advancements in nursing practice would occur. Cultivating a spirit of inquiry is essential for evidence-based practice implementation.

  9. PICO (T) Format

    A clinical question that is composed using the PICO or PICOT format will help you to focus your search and help you to develop your research skills which are essential in finding the best available evidence. The most common PICO (T) elements are: P - Population How you would describe a group of people with a similar problem or complaint.

  10. Finding the evidence

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  11. Asking Research Questions

    One of the keys to effective database searching is to ask focused, specific questions. You also need to choose your search terms carefully, and combine them in ways that give you control over your search results. The PICO model, described below, provides a framework for constructing questions and search strategies for clinical research questions.

  12. 180 Plus PICO (T) Question Examples for Nursing Research

    A good PICOT question possesses the following qualities: A clinical-based question addresses the nursing research areas or topics. It is specific, concise, and clear. Includes all the tenets of a PICOT question including: Patient, problem, or population. Intervention. Comparison. Outcome.

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  14. LibGuides: NRS 302

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    Answerable clinical question: P - In males (independent subject variable) I - Does drinking carrot juice (independent variable) C - Compared to not drinking carrot juice (independent variable) O - Reduce the incidence of prostate cancer (dependent variable) Bhandari, P. (2022, December 02).

  16. PICO/Research Question Development

    PICO is an acronym for. Patient; Intervention; Comparison; Outcome; PICO is used to create a researchable question based on a clinical situation you have encountered. Based on your PICO question, you will identify keywords and/or subject terms to use in database searches.. You can use PICO to develop your clinical question. P - Patient or population/disease: Which population are you studying?

  17. Formulating a PICO(T) Question

    PICO (T) is a template for creating a well-built clinical question for evidence-based inquiry. P - Patient/Population/Problem I - Intervention/Variable of Interest C - Comparison ("standard care" or "usual care") O - Outcome (s) T - Time In _____ (P), what is the effect of _____ (I), compared with _____ (C), on _____ (O) within _____ (T)?

  18. Developing a Research Question

    A "foreground" question in health research is one that is relatively specific, and is usually best addressed by locating primary research evidence. Using a structured question framework can help you clearly define the concepts or variables that make up the specific research question. Across most frameworks, you'll often be considering:

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  20. Formulating a PICOT Question

    The elements of a PICOT question are: P (Patient, population or problem) Who or what is the patient, population or problem in question? I (Intervention) What is the intervention (action or treatment) being considered? C (Comparison or control) What other interventions should be considered? O (Outcome or objective)

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    In evidence-based nursing, it's important to have an answerable question. The PICO framework can help you identify the major elements of your topic so that y...

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    Education and assessment of EBP competencies into the DNP curriculum, particularly formulation of PICOT questions, provide guidance and evaluate mastery of students' individual skills and group work. Utilization of a PICOT template is an approach to aid large cohorts of students in writing healthcare-specific PICOTs to guide them in search of ...

  23. What is your research question? An introduction to the PICOT format for

    Turning an idea into a good research question requires it to be feasible, interesting, novel, ethical and relevant. 18 This feasibility refers to, not only, resources (time and money), but also to whether there is agreement on the meaning of the research question and to whether everything that needs to be measured can be measured by the study ...

  24. Using PICO to Determine Search Terms

    Practitioners of EBP Research often use the PICO format to help define and answer your research question. By organizing a research question using PICO, a researcher can determine specific terms that will help find relevant evidence in professional literature. These terms become the search terms used when searching the databases.