7 Steps To The Perfect PICO Search

7 Steps To The Perfect PICO Search

7 Steps To The Perfect PICO Search

OVERVIEW

Searching for high-quality clinical research evidence can be a daunting endeavor, but it is essential to the process of evidence-based practice. Utilizing the PICO search strategy is one method to expedite and enhance the research process for nurses and researchers of all types. PICO is a format for constructing an effective clinical research question prior to beginning research. It is a mnemonic used to define the four elements of a good clinical background inquiry (Cushing/Whitney Medical Library of Yale University).

In this white paper, we will discuss the significance of evidence-based nursing practice, delve deeper into the PICO process, and provide a case scenario demonstrating the PICO process in action. Whether you are a librarian, a nurse, or a nursing student, it is likely that you will gain new knowledge from reading 7 Steps to the Perfect PICO Search.

WHAT IS EVIDENCE-BASED NURSING PRACTICE AND WHY IS IT IMPORTANT?

“Evidence-based practice in nursing is using and carrying out nursing practices based on the best

available knowledge. Evidence-based practice integrates the nurse’s clinical expertise with the best external research evidence, and takes into account patient preferences to deliver quality nursing care.”

-Victoria Schirm, Director of Nursing Research

The foundation of evidence-based nursing is the acquisition, interpretation, evaluation, and incorporation of valid, clinically significant, and applicable research. It is not about developing new knowledge or validating existing knowledge; rather, it is about translating existing evidence so that it can be applied to clinical decision-making. Evidence-based nursing practice, the expected norm in contemporary healthcare systems, links research and theory to practice, providing clinicians with up-to-date, trustworthy research-based data to guide patient care decisions.
When health care is based on evidence from well-designed studies as opposed to tradition or clinical expertise alone, patient outcomes are significantly improved, according to research. Better patient outcomes result in increased performance, which is essential for hospitals with personnel issues.

HOW DOES THE PICO PROCESS WORK?
PICO is a format for constructing an effective clinical research question prior to beginning research. It is a mnemonic for the four components of a good clinical foreground query. (The Cushing/Whitney Medical Library at Yale University). The query must specify the patient or population we intend to investigate, the intervention or treatment we intend to employ, the comparison between interventions (if applicable), and the anticipated outcome. The PICO model consists of these four components: Patient/Problem, Intervention, Comparison, and Outcome.
The PICO procedure begins with a case scenario from which a query is formulated that is relevant to the case and is phrased in a way that makes it easier to find an answer. After formulating a well-structured question, researchers will be in a better position to search the literature for evidence to support their original PICO question.

Seven Steps to the Ideal PICO Search

1. Formulate the PICO Question

2. Determine Keywords for Each PICO Element

3. Formulate the Search Strategy
4. Carry out the Search

5. Refine the Outcomes
7. Evaluate the Literature
7. Examine the Evidence

STEP 1: FORMULATE THE PICO QUESTION
Case Scenario:

You are an RN working in the Urology unit. One of your patients is a 55-year-old male who recently underwent laparoscopic prostatectomy. The patient reports abdominal discomfort and nausea. He has a distended abdomen and no bowel noises. The physician suspects a paralytic ileus and verifies the diagnosis using clinical characteristics and imaging.
This case will be discussed at the next Evidence-Based Nursing Practice Committee meeting. The committee determines to conduct a case study to ascertain if there is evidence that a straightforward intervention, such as chomping gum after abdominal surgery, can prevent post-operative ileus.
Based on this scenario, our research question is: “Is there evidence to suggest that chewing gum post-operatively affects post-operative ileus in patients undergoing abdominal surgery as opposed to not chewing gum post-operatively?”

STEP 2: IDENTIFY KEYWORDS FOR EACH PICO ELEMENT
Population (P) – Which individuals or groups do we wish to examine?
Intervention (I) – What is the proposed course of action (intervention, treatment)?
Comparison (C) – To which other action (intervention, treatment) is the action under consideration compared?
What do we anticipate will occur as a result?
“Is there evidence that post-operative gum chewing affects post-operative ileus in patients who have undergone abdominal surgery?”

PICO ELEMENTS KEYWORDS
P (Patient or Population) is the unit of analysis.undergoing abdominal surgery patients
Chewing gum I (Intervention) C (Comparison)No tobacco chewing
Fig. 1: O (Outcome) affects post-operative ileus

STEP 3: PLAN YOUR SEARCH STRATEGY
Plan a search strategy by: • Determining which databases to search • Identifying the main components of your query • Translating natural language terms to subject descriptors, CINAHL Headings, or synonyms
EBSCOhost® Research Databases Interface
Advanced Search Interface for the CINAHL® Complete

The use of synonyms, which are words or phrases with the same or nearly the same meaning as another word or phrase, can assist in expanding your search appropriately. When searching for the keyword “surgery,” for instance, you may overlook articles that describe a patient as “postoperative” or “in recovery.” Including synonyms for abdominal surgery will broaden your search results to include articles that are still relevant but may not contain the exact phrase. These are displayed as ‘Search Strategies’ in the following table.

PICO ELEMENTS KEYWORDS MATCHING TERMS SEARCH STRATEGIES
P (Patient or Population) is the unit of analysis. Undergoing abdominal surgery patients Abdominal Operations Abdominal surgery OR Postoperative care OR Recuperation
I (Intervention) Caffeine mouthwash Dental gum Chewing Gum OR Gum C (Comparative Analysis)No tobacco chewing
O (Outcome)Influences post-surgical ileus Postoperative Ileus Postoperative Ileus OR Paralytic Ileus OR Ileus
Fig. 2
Fourth Step: Conduct the Search
Before beginning your search, you must ensure that the Search Mode is set to Boolean/Phrase. This is significant because this option enables for “exact phrase” searches. For instance, if you conduct a search for the phrase Heart Disease, the system will search for records in which the terms heart and disease appear together, as a phrase, and not just records in which the terms appear separately.
To commence your inquiry, please refer to the above figure 2. Each PICO Element (P, I, C, and O) will be individually searched using the corresponding Search Strategy. After each search, the screen will be cleared and a new search will be initiated before the next search.
• P (Patient or Population): Begin your search with the Patients undergoing abdominal surgery, the Patient or Population. As stated previously, to improve your search results, try incorporating less-descriptive terms with the same meaning, such as Surgery, Postoperative, or Recovery.Note: Use the “Or” Boolean operator to ensure that each search result contains at least one of the search criteria. This search strategy is illustrated in Fig. 3 on EBSCOhost.

Fig. 3

• I (Intervention): Conduct a new search for the Intervention, which is Gum or Chewing Gum. Make careful to use the “Or” Boolean operator. Consider the quantity of outcomes.
You can now search for the Outcome, which is post-operative ileus. Add the alternative terms paralytic ileus and ileus. Your objective is to determine whether chomping gum has a positive or negative effect on postoperative ileus. Click the search button and count the number of results that appear.
• Combine pursuits: To complete your inquiry, you will combine the Population (patients undergoing abdominal surgery), Intervention (chewing gum), and Outcome (post-operative/paralytic ileus) fields. Using your database’s Search History, you should be able to aggregate these three queries into a single one containing the results of all three.
PHASE 5: FINE-TUNE YOUR RESULTS
Add limiters to your results to refine them. By applying limiters to your search, you will be able to narrow your results to the most germane and relevant content, saving you time spent sifting through content that may not be useful.
For instance, you may want to restrict your search results by Date and Type:

Use this option to search for articles published within a specific date range.
Evidence-Based Practice – You may desire to restrict your articles to only those that are supported by evidence. The Evidence-Based Practice limiter, when perusing an EBSCOhost database for instance, examines the Special Interest field for the value “Evidence-Based Practice.” This limiter allows you to restrict search results to: • Articles from journals devoted to evidence-based practice; • Articles about evidence-based practice.
• Articles of original research (including systematic reviews, clinical trials, and meta-analyses, etc.)
• Discussions of research investigations (practice-based research)

If you find that limiting your results to Evidence-Based Practice leaves you with too few articles, you can select any or all of the following publication types:

Case Study 1.
2. Clinical Trial
3. Meta-Analysis
4. Controlled Randomized Trial
5. Research 6. Comprehensive Analysis

Step 6 is to examine the literature.
After adding limiters to your combined search and rerunning the results, select and evaluate the articles that are most pertinent to your PICO question. If you discover a particularly relevant article that is not available in full text, consult with your library to see if they can locate it for you.

Determine the level of evidence in Step 7.

Determine the level of evidence contained in each relevant article as the final step of a perfect PICO search. There exists a hierarchy regarding the level and intensity of evidence when seeking for the finest available evidence (see Figure 4). Select the journal articles that are based on the highest level of evidence, such as a Meta-Analysis or Systematic Review, as you review them.

Fig. 4

Structure of Evidence

STUDIES DEFINED
Meta-Analysis: A systematic review that synthesizes and summarizes results using quantitative methodologies.
Systematic Review: A summary of the medical literature that employs explicit methods to conduct a comprehensive literature search and evaluate individual studies critically.
Randomized Controlled Trial: Participants are randomly assigned to experimental or control groups and their variables/outcomes of interest are monitored over time.
Cohort Study: Identifies participants who presently have a specific condition or are receiving a treatment, then follows them over time and compares them to a separate group of individuals who do not have the condition.
Identifies participants who have a particular outcome (cases) and those who do not (controls) in a case-control study.
A report on one or more participants with a particular outcome. (From Centre for Evidence-Based Medicine – CEBM)

Conclusion

Fostering a culture of evidence-based nursing practice in a hospital is a difficult endeavor. It entails integrating clinical expertise, patient values, and the finest available research evidence (Sackett, D., 2002). The search for high-quality clinical research evidence can be overwhelming for many individuals. By utilizing the PICO format, the search procedure will be streamlined and the best available evidence will be uncovered to support clinical decisions and investigate alternative treatments and procedures

References

Brian T. Conner (June 2014). Research, evidence-based practice, and quality improvement are distinguished.
American Nurse Today, Volume 9, Issue 6.

(2018). Houser, J. Evidence-Based Nursing Research: Reading, Applying, and Generating Evidence. Massachusetts: Jones & Bartlett Learning, Burlington.

3. Melnyk, B.M. (2011). A manual for evidence-based practice in nursing and healthcare. 3–7 pages. Philadelphia, PA: Lippincott Williams & Wilkins.

4. Schub, E. B., & Walsh, K. C. (2017). Implementing Evidence-Based Nursing Practice. CINAHL Nursing Guide.

5. Yensen, J. (2013). PICO Search Techniques. Online Journal of Nursing Informatics, volume 17, issue 3 (OJNI).

7-Steps-to-the-Perfect-PICO-Search-White-Paper

ADDITIONAL INSTRUCTIONS FOR THE CLASS

SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS – 7 Steps To The Perfect PICO Search

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score. 7 Steps To The Perfect PICO Search

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

• Guarantee

  

• Zero Plagiarism
• On-time delivery
• A-Grade Papers
• Free Revision
• 24/7 Support
• 100% Confidentiality
• Professional Writers

• Services Offered

• Custom paper writing
• Question and answers
• Essay paper writing
• Editing and proofreading
• Plagiarism removal services
• Multiple answer questions

We will process your orders through multiple stages and checks to ensure that what we are delivering to you, in the end, is something that is precise as you envisioned it. All of our essay writing service products are 100% original, ensuring that there is no plagiarism in them. The sources are well-researched and cited so it is interesting. Our goal is to help as many students as possible with their assignments, i.e. our prices are affordable and services premium.

Looking for a Similar Assignment? Order a custom-written, plagiarism-free paper