Nursing

This is a guide for GRC's nursing students.

PICOT

•    Use the PICOT template to construct the components of your research question 
•    You do not always need to include all components of PICOT if it does not make sense for your topic

P = Patient/Population/Problem

What are the patient or problem characteristics?
Identify a disease, health status, age, race, geographic region, sex, specific characteristic, clinical situation/problem

Example: middle-aged overweight female

I = Intervention/Indicator

What do you plan to do for or observe in the patient?
Identify a specific test, therapy, medication, management strategy or exposure

Example: increase in exercise

C = Compare/Control

What is the alternative to your plan?
Examples may include: no treatment or a different type of treatment.

Example: daily administration of ACE inhibitors (or option to have no comparison)

O = Outcome

What do you seek to accomplish, measure, improve or affect?
Identify possible outcomes/results of the intervention such as: less symptoms, no symptoms, change in measurement of function, comfort/better quality of life, confidence/anxiety, cost effectiveness, mortality...etc.

Example: lower blood pressure

T = Time/Type of Study or Question (This element is optional and not always included)

What is the time frame? OR What types of studies will most likely have the information you seek? 

Example: over a 6 month period (or option to have no time/type of study)

 

...Using the PICOT acronym

(P) = patient/population/problem
(I) = intervention/indicator
(C) = compare/control
(O) = outcome
(T) = time/type of study or question

...decide which type of research question you will pose (choose from below)

...write your research question using the PICOT acronym format (see formats below)

  • Example (intervention): In overweight women, how does an increase in exercise compared to ace inhibitors affect a reduction in blood pressure?
     
Diagnosis

What is the evaluative process of identifying or determining the nature and cause of a disease or condition?

Write your research question with this PICOT acronym format:

    In ________ (P) are/is ________(I) compared with ________(C) more accurate in diagnosing ________(O)?

Example: 

In patients at high risk for gallbladder dysfucntion (P) is a HIDA scan (I) compared with an ultrasound (C) more accurate in diagnosing gallbladder dysfunction (O)?

Etiology

What are the factors that produce or predispose an individual towards a certain disease or condition?

Write your research question with this PICOT acronym format:

Are ______(P) who have ______(I) compared with those without _______(C) at ________ increased/decreased risk for/of _______ (O) over ________(T)?

Example:

Are adopted children (P) who have parents with elevated BMI (I) compared with those without parents with normal BMI (C) at increased risk for obesity (O) over age 18 (T)?

Intervention / Therapy

Which treatments leads to the best outcome for the patient?

Write your research question with this PICOT acronym format:

In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T)?

Example:
In middle-aged Caucasian obese females (P), how do lifestyle interventions such as healthy diet and exercise (I) compared to daily administration of ACE inhibitors (C) affect blood pressure (O) over six months(T)?

Prevention

How do you reduce the chance of disease or complications by identifying and modifying risk factors?

Write your research question with this PICOT acronym format:

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

Example:
In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?
 

Prognosis 

What predicts the course, complications, or outcome of a disease or condition?

Write your research question with this PICOT acronym format:

In _______ (P), how does ________ (I) compared to ________ (C) influence or predict _________ (O) over _________ (T)?

Example:
In older patients with prostate cancer (P), how does choosing to undergo surgery (I) compared to not undergoing surgery (C) influence or quality of life (O) over _________ (T)?
 

Meaning/Patient Experience

How does a patient or group experience a phenomenon or event?

Write your research question with this PICOT acronym format:

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

Example:
How do elderly patients in orthopedic rehabilitation (P) with separation from family (I) perceive their motivation to progress (O) during their recovery (T)?
 

(examples from Evidence-based Practice in Nursing: A Guide to Best Practice by Bernadette Mazurek Melnyk and Ellen Fineout-Overholt)

  • Determine the most relevant primary search word(s) for each of the PICO element
  • Then brainstorm synonyms or related concepts.  As you research, add synonyms you learn about

Example:

 

Primary Search Word(s)

Synonyms or Related Concepts

P

 Overweight              female

 Obese, high BMI, fat                women

I

 exercise

 physical fitness, physical activity aerobic, cardio, strength training

C

 Ace inhibitors

 Angiotensin-converting enzyme, Benazepril (Lotensin)

O

 Lower blood pressure

 Reduce blood pressure, reduce hypertension

(T)

                -

                                       -

 

Case Scenario

1. There are several research questions this scenario might trigger in your mind.  Read the case and think of....

  • research questions around the patient and potential interventions for her and patients like her
  • research questions around nurses and how through their own practice they might improve care for the patient and patients like her

2. For the research question you decide to focus on:

  • identify each of the components of PICO
  • write a research question in the PICO format

 

Muslim Patient from Saudi Arabia wearing a light green headscarf and brown jacket

Nura is a 48-year-old premenopausal, multiparous Muslim female from Saudi Arabia suffering from urinary stress incontinence; she is really hindered by the problem and just wants her normal life back.

She has been doing pelvic floor exercises on her own to improve the symptoms, following instructions on a patient education handout she got from a nurse, but she is not sure if she is actually doing the exercises correctly because no one has personally counseled her or actually showed her how to know if she is doing them correctly.

She read about pelvic floor biofeedback on the internet and wonders if that would be another thing she could try in addition to her exercises to help improve her symptoms.

She has heard of surgery for this condition and knows it could help, but is reluctant to consider it because she is very fearful about going under anesthesia before the surgery.

She is very upset and embarrassed by her incontinence, but is unsure about being treated by the physicians and nurses at the clinic because they may not have the cultural sensitivity to her faith to make her comfortable as a patient.

(adapted from Evidence-Based Practice under a (CC BY-NC-SA 4.0) license)