Evidence Based Practice in Nursing: PICO(T)

PICOT: Answerable, Searchable Question

Patient population of interest

Intervention of interest

Comparison of interest

Outcome of interest

Time (Sometimes used)

Source:

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia, PA : Evidence-based practice in nursing & healthcare: a guide to best practice. p. 10. Philadelphia, PA : Wolters Kluwer, [2015].

For example:

For hospitalized patients, are usual oral health measures OR bundling more effective in reducing the incidence of ventilator associated pneumonia?

Searching for Evidence

The USA Libraries provides access to several online databases useful for finding evidence-based literature.  PubMed and CINAHL are premier databases for nursing. The Cochrane Library and Joanna Briggs Institute provide access to systematic reviews, the highest level of evidence. NGC offers summaries of EBP clinical practice guidelines.

Database Search Tips and Techniques

• Limit Your Search to Academic or Scholarly Journals. Many databases offer an option to limit your search by selecting an option such as “peer-reviewed” or “scholarly”
• Boolean Search: Use connectors AND, OR, NOT. AND narrows your search, and OR broadens a search, NOT excludes unwanted terms. (Use Advanced Search in most databases for Boolean search.) For example:
  • Cats AND Dogs;
  • Cats OR Dogs;
  • Cats NOT Dogs.
• Parentheses: Use to group words together as a phrase in Boolean searches. i.e.  (stem cell) AND mouse
• Truncation: Common symbol is * (asterisk.) Use to search for variations in word endings, i.e. nurs* will find nurse, nurses, nursing.
• Set limiters for publication dates, population, source type, etc.
• You may need to revise your search terms if:
  • Your search results are not relevant
  • You get too many results
  • Apply limits such as age ranges or publication dates to help narrow searches
• If you get too few results, there may not be enough published evidence on your clinical question

Tips for PICO Searching

• Start out with a broad search, using your P and I terms. (For example, Population=Older adults, Intervention=Tai Chi)
  •  Combine them using AND. Include the O if you get a large number of results. The reason is that outcomes tend to be very specific and if you don’t use the exact wording that the researcher did, you could miss something.
  • Use AND to combine the P results set with the I results set. In the following example from CINAHL Plus with Full Text, search on older adults AND Tai Chi. Look for the C and O in the results from that search, or add the O (fall* prevention) if you get a lot of hits.
  • Find some relevant studies among your results, and examine the reference sections to find subject headings and keywords in the paper’s text and abstract that you can use as search terms.
• Look for terms such as Related Articles or  Find Similar to find other documents
• Look for keywords used in a document’s beginning or its abstract. For example:

PICO searching tips adapted from Florida Gulf Coast University PICO/EBP LibGuide, https://fgcu.libguides.com/EBP/pico
and University of Wyoming Libraries PICOT Tutorial LibGuide, https://uwyo.libguides.com/c.php?g=97822&p=632161

Controlled Vocabulary, Thesaurus, (or the way terms are indexed in the database)

For more information on CINAHL Subject Headings, see http://guides.lib.uw.edu/c.php?g=345599&p=2596668

For more on searching PubMed using MeSH (Medical Subject Headings), see PubMed 10 Tips, from UNC Health Sciences Library. Tip 7 is Using PubMed http://guides.lib.unc.edu/c.php?g=8404&p=637036