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Evidence Based Practice in Nursing: PICO(T)

Guide to EBP in Nursing

PICOT Searching

Steps in the Evidence-Based Practice Process
0. Cultivate a spirit of inquiry
1. Ask the burning clinical question in PICOT format
3. Critically appraise the evidence
4. Integrate best evidence with clinical expertise, patient preference and values
5. Evaluate outcomes of practice decision or change based on evidence
6. Disseminate the outcome or change

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?
This question in PICOT format
Patient  Hospitalized Patient
Intervention Usual oral care
Comparison Bundling
Outcome Reduce VAP cases
Time Not Used

Other Resources

Using PICO in Literature Searching

Searching for Evidence Handout

Tips for Searching

Searching for Evidence

Houston Cole Library provides access to several online databases useful for finding evidence-based literature.  PubMed and CINAHL are premier databases for nursing. The Cochrane Library provides access to systematic reviews, the highest level of evidence.

  • CINAHL Ultimate
  • Cochrane Database of Systematic Reviews
  • PubMed/Medline

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