Example Nursing Picot Questions

Example Nursing Picot Questions

Using PICO to Formulate Clinical Questions

PICO (alternately known as PICOT) is a mnemonic used to describe the four elements of a good clinical question. It stands for:

P–Patient/Problem
I–Intervention
C–Comparison
O–Outcome

Many people find that it helps them clarify their question, which in turn makes it easier to find an answer. 

Use PICO to generate terms – these you’ll use in your literature search for the current best evidence.   Once you have your PICO terms, you can then use them to re-write your question.  (Note, you can do this in reverse order if that works for you.)

Example:

Often we start with a vague question such as, “How effective is CPR, really?”  But, what do we mean by CPR?  And how do we define effective?  PICO is a technique to help us – or force us – to answer these questions.   Note that you may not end up with a description for each element of PICO. 

P –  our question above doesn’t address a specific problem other than the assumption of a person who is not breathing. So, ask yourself questions such as, am I interested in a specific age cohort? (Adults, children, aged); a specific population (hospitalized, community dwelling); health cohort (healthy, diabetic, etc.)   

I – our question above doesn’t have a stated intervention, but we might have one in mind such as ‘hands-only’

C – Is there another method of CPR that we want to compare the hands-only to?  Many research studies do not go head to head with a comparison.  In this example we might want to compare to the standard, hands plus breathing

O – Again, we need to ask, what do we mean by ‘effective’?  Mortality is one option with the benefit that it’s easily measured. 

Our PICO statement would look like: P – community dwelling adults I – hands only CPR C – hands plus breathing CPR O – mortality

From our PICO, we can write up a clearer and more specific question, such as:

 In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?

More on PICO & Clinical questions

We can use our PICO statement to list terms to search on.  Under each letter, we’ll list all the possible terms we might use in our search. 

P – Community Dwelling:  It is much easier to search on ‘hospitalized’ than non-hospitalized subjects.  So I would leave these terms for last. It might turn out that I don’t need to use them as my other terms from the I, C, or O of PICO might be enough.

community dwelling  OR out-of-hospital

P – adults: I would use the limits in MEDLINE or CINAHL for All Adults.  Could also consider the following depending upon the population you need:

adult OR adults OR aged OR elderly OR young adult

I – CPR

CPR  –  cardiopulmonary resuscitation

I – Hands-only

 hands-only OR compression-only OR chest compression OR compression OR Heart Massage

C – CPR

CPR  –  cardiopulmonary resuscitation

C – Hands plus breathing Breathing is a tougher term to match.

breathing OR mouth to mouth OR conventional OR traditional

O – Mortality:  If your outcomes terms are general, they may not as useful in the literature search.  They will still be useful in your evaluation of the studies.

mortality OR death OR Survival

Putting it together – a search statement from the above might look like this:

cardiopulmonary resuscitation AND (hands-only OR compression-only OR chest compression OR compression OR Heart Massage) AND (breathing OR mouth to mouth OR conventional OR traditional)

Note that the above strategy is only using terms from the I and the C of PICO.  Depending upon the results, you may need to narrow your search by adding in terms from the P or the O.  

The PICO Questions: Overview with Examples
Instances of PICO Questions
    PICO Questions for Emergency Nursing
    List of Pediatric PICO Questions
    PICO Questions for Oncology Patients
    PICO Questions for Cardiac Patients
    PICO Questions for Geriatrics
    PICO Questions for Stroke Patients
    PICO Questions for ICU Patients
    PICO Questions for Pressure Ulcers
    PICO Questions for Maternal Nursing
    PICO Questions for Mental Health
    PICO Questions for Psychiatric Nursing
    PICO Questions about Cancer
    PICO Questions for Cardiovascular Disease
    PICO Questions for Dementia
    PICO Questions for Depression
    PICO Questions for Med Surgery
    PICO Questions for Obesity
    PICO Questions for PACU
    PICO Questions for Physical Therapy
    PICO Questions for Pregnancy
    PICO Questions for Hypertension
    PICO Questions for Occupational Therapy
    PICO Questions Orthopedics
    PICO Questions Related to Sepsis
    PICO Questions Speech Pathology
Professional Help with Nursing Picot Question Topics

PICOT questions examples

Examples of PICOT questions are illustrated below

            In patients aging 45 years and above (P), how does the application of an influenza vaccine (I) related (compared) to not obtaining the vaccine © influence the possibility of contracting pneumonia (O) during the period of flu season (T)?

            Are children (P) who are taken care by obese adoptive guardians or parents (I) at more risk of being affected by obesity (O) related to children (P) without obese adoptive guardians or parents © during the ages between 5 and 18 (T)?

            The Above examples illustrate how a question can be constructed by applying the PICOT format and determines how it affects the research for outcomes and evidence.

Example Nursing Picot Questions

PICO Questions for Emergency Nursing

1. Electronic medical record (EMR) system is an organized method of collecting, encoding, and storing patient and hospital information digitally. Evidence shows that EMR can improve patient outcomes by increased staff productivity, improved communication, improved quality of care, and reduced medical errors.

P: Staff nurses in the emergency department (ED) of a tertiary academic hospital in District A
I: electronic medical record system
C: Staff nurses in the ED of a tertiary academic hospital in District B
O: Patient admission time

Question: Does the use of an electronic medical record system in a tertiary academic hospital have an effect on patient waiting time?

1. Intussusception is a medical emergency among pediatric patients where the intestines telescope into a distal portion causing bowel obstructions. If left undiagnosed and untreated, this condition can be fatal within five days. Surgical intervention is a conservative way of treating intussusception, however, improved patient recovery is observed among pediatric patients who are treated with surgery and water enema.

P: Pediatric patients who were admitted in the ED because of intussusception
I: Surgical intervention alone
C: Pediatric patients who were admitted in the ED because of intussusception and who received both ultrasound-guided water enema reduction and surgical intervention
O: Recovery time

Question: In pediatric patients who were admitted in the ED because of intussusception, how effective is surgical intervention alone compared to ultrasound-guided water enema reduction and surgical intervention in the patient’s recovery (time)?

List of Pediatric PICO Questions

1. Croup treatment among pediatric patients usually includes the use of dexamethasone combined with nebulized epinephrine for the relief of airway constriction relief. The conventional dose of nebulized epinephrine is 0.5mg/kg of 1:1000 in patients to treat moderate to severe croup. However, research shows that the use of 0.1 mg/kg nebulized epinephrine also relieves airway constriction.

P: Pediatric patients aged 6 months to 5 years old diagnosed with severe croup admitted in three pediatric emergency departments
I: Use of 0.1 mg/kg dose of nebulized epinephrine as an adjunct to dexamethasone
C: Pediatric patients aged 6 months to 5 years old admitted in three pediatric emergency departments who were nebulized with 0.5 mg/kg conventional epinephrine dose
O: Relief of severe airway constriction

Question: In pediatric patients aged 6 months to 5 years old diagnosed with severe croup admitted in three pediatric emergency departments, how does the use of 0.1 mg/kg dose of nebulized epinephrine in combination with dexamethasone relieve severe airway constriction compared to the 0.5 mg/kg conventional epinephrine dose?

1. Stress ulcer prophylaxis is considered standard care among critically ill patients in the intensive care unit. Scientific evidence demonstrates that the use of proton pump inhibitors as prophylaxis help prevent the development of stress ulcers among ICU pediatric patients.

P: Pediatric patients admitted in the critical care unit of one medium-sized public hospital
I: Use of proton pump inhibitors as prophylaxis to stress ulcers
C: Pediatric patients admitted in the critical care unit of one medium-sized public hospital receiving histamine-2-receptor antagonists as prophylaxis to stress ulcers
O: Shorter ICU stay

Question: Does the use of proton pump inhibitors as prophylaxis to stress ulcers compared to those who are receiving histamine-2-receptor antagonists shorten the ICU stay of pediatric patients admitted in the critical care unit of one medium-sized public hospital?

PICOT Questions