What Is PICOT? - Evidence-Based Medical and Nursing Practice
Evidence-Based Medical and Nursing Practice
Evidence-based practice (EBP) is the current approach to addressing a patient’s needs through the combination of the latest research evidence, the nurse’s professional experience, and the patient’s preferences. This approach boasts improved patient outcomes and increased medical personnel efficiency when compared to the use of traditional treatments or practical experience alone. As a result, EBP is considered an industry standard and has become a requirement for new registered nurses (RNs), advanced practice registered nurses (APRNs), and nurses pursuing administrative, research, or teaching positions. And learning how to write a PICO question and other types of research questions is the first step to discovering research evidence necessary for EBP.
Background vs. Foreground Questions
In EBP, all questions are either background or foreground.
The background questions elicit general, basic, or broad information about a particular issue. You can find answers to these questions in guides, handbooks, textbooks, etc. Examples of background questions include:
How often should women under 40 undergo breast cancer screening?
What is the primary transmission mode of Covid-19?
The foreground questions elicit specific, detailed information about an issue necessary for making the right clinical decisions. You can use scientific publications, conference proceedings, etc., to find answers to these questions. A foreground question requires several components to be effective, and the PICO question format is the most common model used in clinical practice.
Level of evidence
Levels of evidence are a way to classify the strength and quality of research studies. They are used to determine the level of confidence that can be placed in the results of a study and to help guide clinical decision-making.
The most commonly used levels of evidence include:
Level I: Evidence from well-conducted, randomized controlled trials (RCTs)
Level II: Evidence from well-conducted controlled trials without randomization, cohort or case-control analytical studies, multiple time series, and dramatic results from uncontrolled experiments
Level III: Evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Level IV: Evidence from case series or expert opinion
Level V evidence is considered the strongest and most reliable, while level IV evidence is considered the weakest.
It's important to note that different organizations, fields, and disciplines may have their own levels of evidence or grading system. For example, the Centre for Evidence-Based Medicine (CEBM) has different levels of evidence based on study design.
The level of research that is appropriate refers to the classification of the strength and quality of the research study. The level of evidence is determined by evaluating the study design, sample size, and other factors that can influence the validity and reliability of the study results.
What Is the PICO Model?
PICO is an acronym meant to help nurses and nursing students remember the components of a good foreground question. When you look at a PICO paper example nursing studies may omit some elements of the question, but most should be present:
- P stands for problem, patient, or population, depending on the focus of the study or issue
- I stand for intervention used to resolve the issue
- C stands for comparison indicator or an alternative intervention for evaluating intervention efficacy
- O stands for the outcome or goals of the intervention
- T stands for a time frame if it factors in resolving the issue or improving intervention efficacy
How to Write a PICO Question?
Your first PICO question may seem intimidating at first, but it’s easy to put together if you follow four simple picot question format steps:
- Make sure the PICO method is right for your research. It works for clinical scenarios, but it is useless for purely theoretical research.
- Choose the PICO question type. Based on research goals, the PICO questions are divided into five types: treatment, prevention, diagnosis, prognosis, and etiology. For example, an etiology question is perfect for a pathophysiology paper.
- Identify the core components. Write the PICOT vertically and note each component independently, accounting for your question type.
- Fit the components into a single question. Combine the PICOT elements into a clear, unambiguous question. See examples below for good questions to model.
PICO Question Examples
We’ve devised a handful of PICO question examples to help you come up with your own for your intervention paper, case study, or capstone project.
PICOT Questions for DNPs
Most undergrad nursing students rarely face the need to develop PICOt questions. However, Doctor of Nursing Practice and Master of Science in Nursing programs usually require an evidence-based capstone project or thesis. And the PICO model is ideally suited to develop a research question for both paper types. Experience designing PICO questions comes in handy for DNPs and MSNs pursuing advanced practice, administrative, and research positions.
PICO Tools
Using PICO in research makes your study fast and efficient, especially if you employ the free online tools tailored for these queries, such as
- How to search MEDLINE/PubMed using the PICO format
- TRIP (Turning Research into Practice) search (Pick the PICO tab above the search box)
- Cochrane Library PICO search
- Educational Prescription Form