Evidence Based Practice (NUR 4169)

After first identifying an information need, the next step in evidence-based practice is to re-frame the problem by posing a clearly stated and searchable question. EBP practitioners use a structure called PICO to advance their thoughts from fuzzy and generalized to crisp and precise. 

PICO is a framework for structuring a clinical question by separating it into four components. Framing PICO helps you identify some of the keywords you will use in searching databases.

P = What are the significant characteristics of the patient or the population?

I = What intervention are you considering?

C = Are you considering another intervention as a comparison to the first?

O = What is the desired outcome of the intervention(s)?

(Time is sometimes a fifth element of PICO.)

(T) = How much time does it take for an intervention to reach an outcome?

From John Moritiz Library's EBP LibGuide.

Need a few good examples of PICO in action to get you started? The following websites take you through short, easy-to-follow examples on how to formulate good research questions using the PICO framework of Patient, Intervention, Comparison, and Outcomes:

PAY CLOSE ATTENTION:  You will need to turn your PICO framework into a clinical research topic.

Why?

Although the PICO framework is an excellent framework to get at the root of a clinical problem, it is NOT a good format to search a database.

Why not?

Let's look at this PICO example for a patient:

• Are probiotics a more effective treatment for C --diff- associated diarrhea in a 45-year-old hospitalized male than x, y, z treatments?

You may be tempted to find search terms with using the exact PICO terms, like this:

• Are probiotics (Intervention) a more effective treatment for C --diff- associated diarrhea in a 45-year-old hospitalized male (Patient) than x, y, z treatments (Comparison)? [What's the Outcome? In this case, the outcome is implied = a reduction in diarrhea.]

Unfortunately, searching for medical literature in a database isn't that specific. If so, you'd be looking only for a matching case study! Instead, you need to turn your PICO statement into a clinical research topic that you can search for.

In this case, you clinical research topic is:

• "Probiotics as a treatment for diarrhea caused by Clostridium difficile infections."

And your search terms might look like this:

• Probiotics as a treatment for diarrhea caused by Clostridium difficile inflections.

Here are a few search tips to keep in mind successful database searching, with PICO elements for your search terms:

1. Keep in mind you're better off translating the PICO framework into a clinical research topic! (See PART 1 on this page for an explanation.
2. Start your search using only one or two PICO elements in combination: try the P and the I elements first. Combine them using "AND."
3. Do not include the O element in your initial search unless you must. For instance, if the number of results from the P and I search is too huge to peruse. (Why? Outcomes can be described in very specific terms. If you do not happen to choose the exact words that a researcher/author happened to use, you just might eliminate a valuable study.)
4. Once you find a few relevant studies, examine the database's bibliographic references (the summary page that tells about the article) to identify two items:
   1. ​Subject headings the database indexers used to describe the studies 
   2. Any keywords in the article's abstract. 
5. Now ​use those same subject headings or keywords to help you search for similar relevant articles.
6. You might also want to try limiting your search results by design study, working your way down the evidence pyramid. (You'll probably need to be in the database's "advanced search" feature to do this. Look around for ways to limit your search results. It may be a drop down menu next to "document type," or "publication type," etc.)

Partially adapted from John Moritiz Library's EBP LibGuide.