Nursing

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 Templates
• Ideas for Your PICO(T) Question
• Tips for Building a PICO(T) Question
• Example: PICO(T) Question and Search Strategy

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 basic template for creating a well-built clinical question for evidence-based inquiry.

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)?

There are several templates for developing a PICO(T) question, depending on the nature of your clinical problem.

See the Template for Asking PICO(T) Questions document for examples. 

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
• Quality improvement data
• Other internal data specific to your organization

Knowledge-Focused Triggers:

• Conduct a search of the research literature to identify problems or practice recommendations
• Identify interventions that have been proven effective by previous studies
• 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 web resources for PICO(T) question ideas can be accessed below: 

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 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)
• VIDEO TUTORIAL: PICO(T) Question & CINAHL Search Tutorial (this video, originally created for DNP students, but applicable to all nursing students, demonstrates how to perform a database search for evidence to support a PICOT question using the CINAHL database as an example)