Nursing Research paradigm: the PICO question
Question Templates for Asking PICO Questions:
P: Population/disease ( i.e. age, gender, ethnicity, with a certain disorder)
I: Intervention or Variable of Interest (exposure to a disease, risk behavior, prognostic factor)
C: Comparison: (could be a placebo or “business as usual” as in no disease, absence of risk factor, Prognostic factor B )
O: Outcome: (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome)
For a therapy:
In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C)?
Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C)?
Diagnosis or diagnostic test:
Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?
For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?
Does __________ (I) influence ________ (O) in patients who have _______ (P)?
How do ________ (P) diagnosed with _______ (I) perceive ______ (O)?
Based on Melnyk B. & Fineout-Overholt E. (2005). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins.
Examples of Evidence-Based PICO Questions
1. Population: Bariatric adolescents considering or undergoing gastric bypass surgery.
Intervention: The nurse’s role as a primary member of the multidisciplinary team regarding perioperative care of the bariatric adolescent patient.
Comparison: The nurse’s role as a secondary member of the multidisciplinary team without any specialized training and is only involved in perioperative care of the bariatric adolescent patient.
Outcome: When the nurse is involved as one of the primary members in the multidisciplinary team approach, the bariatric adolescent patient has better continuity of care.
PICO Question: Does the bariatric adolescent patient considering or undergoing gastric bypass have better continuity of care when the nurse is a primary member of the multidisciplinary team versus when the nurse is a secondary member whose only role is in providing perioperative care and has no specialized training?
2. Therapy PICO Question: An Intervention example: In adult patients with total hip replacements (Patient population) how effective is PCA pain medication (Intervention of interest) compared to prn IM pain medication (Comparison intervention) in controlling post operative pain (Outcome)? Note: The IM pain medication would be called the control group. It would be unethical to have a control group that received NO pain medication. Many times the control group means they get “business as usual!” or the current standard of care.
3. Therapy PICO Question: A non-intervention example: What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C)?
4. Etiology PICO Question: Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C)?
5. Diagnostic PICO Question: Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)?
6. Prevention PICO Question: In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C)?
7. Prognosis PICO question: Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O)?
8. Meaning PICO Question: How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers?MORE information on PICO and evidence based nursing