Formulating a PICOT Question

Whether they’re finishing advanced studies in nursing school or working in a professional clinical setting, registered nurses (RNs) begin their research queries using an evidence-based practice framework developed from a well-constructed PICOT question. The word PICOT is a mnemonic derived from the elements of a clinical research question – patient, intervention, comparison, outcome and (sometimes) time. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer. “The question needs to identify the patient or population we intend to study, the intervention or treatment we plan to use, the comparison of one intervention to another (if applicable) and the outcome we anticipate,” Kathy A. Jensen, MHA, RN, wrote in EBSCO Health’s whitepaper, “7 Steps To The Perfect Pico Search.” “Once a well-structured question is formulated, researchers will be in a better position to search the literature for evidence that will support their original PICO question.” For RNs who are training in a doctor of nursing practice (DNP) program, including an online DNP program, learning how to develop a comprehensive PICOT question is essential to nurse manager competencies. DNP students study PICOT question examples to determine the best process for crafting a question and finding an answer.

Formulating a PICOT Question: Learning the PICOT Process

The PICOT process generally begins with a vague clinical query. Each element of the process helps develop a well-structured question. Once established, researchers can search for evidence that will help answer the inquiry. The elements of a PICOT question are:

P (Patient, population or problem)

Who or what is the patient, population or problem in question?

I (Intervention)

What is the intervention (action or treatment) being considered?

C (Comparison or control)

What other interventions should be considered?

O (Outcome or objective)

What is the desired or expected outcome or objective?

T (Time frame)

How long will it take to reach the desired outcome? Using the PICOT process helps develop a careful and thoughtful question that makes the search for evidence easier, the University of Oxford’s world-renowned Centre for Evidence-Based Medicine said. “The well-formed question makes it relatively straightforward to elicit and combine the appropriate terms needed to represent your need for information in the query language of whichever searching service is available to you,” the University of Oxford author said. “Once you have formed the question using the PICO structure, you can think about what type of question it is you are asking, and therefore what type of research would provide the best answer.”

Steps to the PICOT Process

In developing a PICOT question, researchers must identify a need or a reason for the study. In the EBSCO Health whitepaper, the general example used is this: A committee decides to conduct a case study to determine whether postoperative gum chewing for abdominal surgery patients can prevent postoperative ileus (lack of intestinal movement). With the scenario in mind, researchers use seven steps to the PICOT search:

Formulate the PICOT question in general terms: Based on the EBSCO Health example, the research question would be, “In patients recovering from abdominal surgery, is there evidence that suggests gum-chewing postoperatively, compared to not chewing gum, impacts postoperative ileus?”
Identify the keywords for the PICOT mnemonic: P – Patients recovering from abdominal surgery I – Gum chewing C – Not chewing gum O – Impacts post-operative ileus
Plan the search strategy: With the question in mind, researchers consider which databases and other search sites they might use to find information and answers. Researchers use strategies to maximize their search terms such as looking up synonyms and phrases that mean the same thing.
Execute a search: At first, researchers search each PICOT element individually. For example, when researching patients recovering from abdominal surgery, use the search terms “abdominal surgery,” but also consider the search terms “recovery and postoperative.”
Refine the results: Narrow the search results by limiting the works to pertinent content, such as articles from peer-reviewed journals or research documents.
Review the content: Review the research results to establish if they have the necessary information to answer the PICOT question.
Determine if research results meet standards: After reviewing the research results, determine whether they provide the best available evidence.

After the PICOT question is constructed and researched, the information garnered is used to determine which type of study is most appropriate. Study types include meta-analysis, systematic review, randomized controlled trial, cohort study, case-control study and case report. “The actual search for high-quality clinical research evidence can be overwhelming to many,” Jensen said in the EBSCO Health whitepaper. “By utilizing the PICO format, the search process will be streamlined and will yield the best available evidence to support clinical decisions and explore alternative treatments and procedures.”

Formulating a PICOT Question: DNP and PICOT Question

To take a deep dive into advanced nursing practice, many RNs seeking a DNP must submit a final project. At Duquesne University, online DNP program students undertake a DNP Practice Project, which must focus on patient outcomes, quality improvements and clinical practice. Through the project, Duquesne University DNP candidates will identify a specific problem in patient care or clinical practice and present solutions. Students use a PICOT question to guide the project topic. The online DNP program at Duquesne University teaches RNs nurse manager competencies as well as other essential leadership skills. The university offers three distinct DNP tracks:

Clinical Leadership DNP
Post-Bachelor’s Executive Nurse Leadership DNP
Post-Master’s Executive Nurse Leadership DNP

About Duquesne University’s Online DNP Program Duquesne University, a leader in online education, prepares RNs for clinical leadership positions as DNPs. The university’s curriculum builds on existing experiences and knowledge so graduates can implement evidence-based practice in clinical settings. Duquesne University’s online DNP program provides RNs an opportunity to continue their professional career and maintain family responsibilities while earning an advanced degree.

NURS 414 Nursing Research: Research Strategies – PICO(T)

7 Steps to the Perfect PICO Search

Formulating a PICOT Question – Framing the Research Question

Any empirical research—quantitative or qualitative—should be guided from the outset by a question or set of questions. The question defines precisely what is being examined and how an assessment of the results will be undertaken. The research question begins with a research problem, an issue someone would like to know more about or a situation that needs to be changed or addressed, such as:

Areas of concern
Conditions that could be improved
Difficulties that need to be eliminated
Questions seeking answers

Characteristics of a good research question:

The question is feasible.
The question is clear.
The question is significant.
The question is ethical.

The feasibility of the question should guide not only the expression of the question but its conception. Feasibility should be foremost in the researcher’s mind in the earliest stages of any project. Reviewers will always evaluate the feasibility of a question (possibly before other elements). Clear expression signals clear thinking. Not only must the question be clear in the mind of the research, it must be articulated clearly. Again, reviewers of a manuscript will insist upon clear question so that the potential audience will be able to understand the question and, thus, follow the write-up of the project. Significance may be said to be in the eye of the beholder. One way to gauge significance is to ascertain whether a reading audience will be able to take away a lesson from the project. Work that is very limited—say, to a single organization—may not be looked upon with favor by reviewers. If the question and the project are important enough that readers learn from the work, then it generally passes the significance test.

Research Designs for Nursing and Midwifery

Quantitative Sousa, V. D., Driessnack, M., & Mendes, I. A. C. (2007). An overview of research designs relevant to nursing: Part 1: quantitative research designs. Revista latino-americana de enfermagem, 15(3), 502-507. http://doi.org/10.1590/S0104-11692007000300022 Qualitative

Driessnack, M., Sousa, V. D., & Mendes, I. A. C. (2007). An overview of research designs relevant to nursing: part 2: qualitative research designs. Revista latino-americana de enfermagem, 15(4), 684-688.https://doi.org/10.1590/S0104-11692007000400025

Mixed-methods Martha, D., Sousa, V. D., & Mendes, I. A. C. (2007). An overview of research designs relevant to nursing: Part 3: Mixed and multiple methods. Revista latino-americana de enfermagem, 15(5), 1046-1049. https://doi.org/10.1590/S0104-11692007000500025

PICO (T)

Problem / Patient / Population (P) – What individual or group are we interested in studying? Intervention / Indicator (I) – What is the action (intervention, treatment) we are considering taking? Comparison (C) – To what other action (intervention, treatment) are we comparing the considered action? Outcome (O) – What do we anticipate as an outcome? Time / Type of Study (T) – What time element or type of study are you looking for? Example of a PICO(T) Does hand washing among healthcare workers reduce hospital acquired infections?

P (Problem or Patient or Population): hospital acquired infection
I (intervention/indicator) : hand washing
C (comparison): no hand washing; other solutions: masks
O (outcome of interest): reduced infection
T (type of study) qualitative / qualtitative / case study

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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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.

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. Formulating a PICOT Question

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.