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NURS 3030: Evidence-Based Practice in Nursing

This guide is designed to assist BSN students in the NURS 3030 course at The University of Toledo. It provides step-by-step guidance on formulating a PICO(T) question and implementing a database search strategy to find evidence in support of a PICO(T) que

What is a PICO(T) Question?

For your PICO(T) Question Assignment, you will develop a clinical question [using the PICO(T) template] for any clinical topic or issue of interest to you. 

Assignment details and instructions can be found in the NURS 3030 Blackboard course site. 

What is a PICO(T) question and why is it important? 

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:

PICO(T) Question Template

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 translating a clinical patient care issue into a focused, searchable, and answerable question. 

PICO(T) is a basic template for creating a well-built clinical question for evidence-based inquiry consisting of the following components:

P - Patient/Population/Problem

I - Intervention/Variable of Interest

C - Comparison (can be "standard care" or "usual care", or the opposite of I - "no meditation," "no exposure to smoke", etc.)

O - Outcome(s)

T - Time

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

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

Ideas for Your PICO(T) Question

Identifying a clinical problem that can be translated into a PICO(T) question takes some brainstorming, research, and planning.

The following recommendations can help in triggering ideas for your PICO(T) question:

Problem-Focused or Practice-Focused Triggers:

  • Patient cases you have encountered
  • Clinical scenarios you have observed
  • Personal healthcare experiences

Knowledge-Focused Triggers:

  • Conduct a database search to identify problems or practice recommendations
  • Identify interventions that have been proven effective by previous studies
  • Peruse the websites of various nursing organizations for hot topics or nursing issues
  • Clinical practice guidelines recommendations

Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, L. Q., et al. (2001). The Iowa model of evidence-based practice to promote quality care. Critical Care Nursing Clinics of North America, 13(4), 497-509.

Need some inspiration for PICO(T) questions?

Helpful resources for PICO(T) question inspiration and ideas can be accessed below: 

Building a PICO(T) Question

PICO(T) Elements How to Identify Each PICOT Element

P

Patient/Population/Problem

Who is your patient or population?

Consider the following:

  • Age group
  • Gender
  • Race
  • Healthcare setting

What is your patient/population's problem?

Consider the following:

  • Condition or illness
  • Disease process
  • Diagnosis
  • Life situation
  • Nursing diagnosis
  • Symptoms
  • Self-care deficits

I

Intervention/Variable of Interest

What intervention can you as a nurse implement for your patient/population? 

Consider the following:

  • Nursing interventions
  • Therapies
  • Alternative/complementary/holistic therapies
  • Medication administration/management
  • Pharmacologic interventions
  • Non-pharmacologic interventions 
  • Procedures
  • Patient education techniques

C

Comparison

What is your comparative intervention or your control?

Most commonly, the comparison is standard care or usual care. If your comparison is something specific other than standard/usual care, include the name of the specific intervention here. 

O

Outcome(s)

What is the desired outcome or optimal effect of the intervention?

Consider the following:

  • Improvement of [fill in the blank]
  • Prevention/prophylaxis of [fill in the blank]
  • Reduction in [fill in the blank]
  • Decreased rate of [fill in the blank]
  • Patient outcomes
  • Quality of life
  • Patient safety
  • Satisfaction
  • Knowledge

T

Time

How long would it take to reach a desired outcome? Or, what is the time frame of your patient scenario?

Consider the following:

  • Within [fill in the blank] weeks/months/year(s)
  • Preoperative/perioperative/postoperative period
  • Hospital length of stay
  • Patient's lifespan
  • Patient's treatment duration
  • Recovery period
  • These are only examples. The timeframe can be very specific or very broad. 

 

Example: PICO(T) Question and Search Terms

PICO(T) Question Example: 

"In adult cancer patients experiencing fatigue (P), what is the effect of meditation (I), compared with standard care (C), on improving 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 an initial list of keywords (including synonyms) to use in a database search. The most important parts of a PICO(T) question for searching are the P, I, and O. 
  • After developing a list of search terms, you can then begin brainstorming your search strategy for combining terms with OR or AND (this is called Boolean logic), and using other techniques such as truncation (i.e. a keyword search for letharg* will also find articles with the term lethargic or lethargy) or quotes (i.e. a keyword search for "guided imagery" will find articles with that exact phrase)
PICO(T) Elements Example List of Keyword Search Terms (include synonyms, related terms, broader or narrower terms, and spelling variations) Keyword Search Strategy

In

(P - Patient/Population/Problem)

 adult cancer patients experiencing fatigue

Cancer

Neoplasms

Oncology

Tumor

Tumour

Malignancy

Fatigue

Tiredness

Lethargy

Exhaustion

cancer* OR neoplasm* OR oncolog* OR tumor* OR tumour* OR malignan*

AND

fatigue* OR tired* OR letharg* OR exhaust*

what is the effect of

(I - Intervention/Variable of Interest)

 meditation

Meditation

Mindfulness

Breathing

Relaxation

Yoga

Guided imagery

 meditat* OR mindful* OR breath* OR relax* OR yoga OR "guided imagery"

compared with

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

 standard care Not needed as a search term  

on

(O - Outcome)

 improving quality of life

Quality of life

Quality of living

Life quality

Well-being

Wellbeing

Well being

 "quality of life" OR "quality of living" OR "life quality" OR well-being OR wellbeing OR "well being"

within

(T - Time)

 6 months Not needed as a search term