PICO (T) Question

Applying evidence-based practice (EBP) in nursing is not always easy.

Although it is one of the most important skills in nursing, its application particularly among nursing students maybe challenging.  

It raises several questions.

Do you have a suitable evidence-based nursing topic?  

What good evidence-based practice examples can you reference?  

How do you compile evidence?

How do you ask the PICO (T) question?

What PICO (T) question examples can you use as a guide?

Note that at the core of EBP, is the PICOT question.

EBP and PICO (T) Question

The PICO (T) question is part of EBP.

It is clear that applying evidence in practice demands a systematic approach.

Such application occurs within the evidence cycle framework that incorporates several steps.

These steps are defined by 5 A’s that include:

1. Assess
2. Ask
3. Acquire
4. Appraise
5. Apply  

The PICO (T) question falls under step A (Ask) and entails asking the right question to help guide research, identify the best place to look, gather what is available, assess the results, and use collected evidence to inform patient care.

The PICO (T) Question

As earlier indicated, the PICOT question seeks to identify the best available evidence for the purposes of improving healthcare outcomes.

The nurse is supposed to apply this evidence in the decision-making process.

Findings made using the PICO question can be used to make:

1. Changes in patient’s treatment
2. Alterations of patient’s lifestyle
3. Improvements in quality of life

Application of the PICO (T) Question

The PICO (T) question is both applicable in nursing school and professional practice.

Nursing students and registered nurses search for evidence using the PICOT question.

The question is derived from the elements of a clinical question that include:

1. Patient (P)
2. Intervention (I)
3. Comparison (C)
4. Outcome (O)
5. Time (T)

Asking the question is preceded by a clinical scenario, and the question is constructed in a way to find the answer.

The question should identify:

1. The patient or population to be studied (P)
2. The intervention or treatment to be used (I)
3. The comparison of one intervention to another (when applicable) (C)
4. The outcome to be expected (O)
5. The time the intervention takes (not always included) (T)

The PICO (T) Process

The PICO (T) process starts with a vague clinical question.

Each element of the process is included to help come up with a well-structured question.

The resulting PICO (T) question is used to search relevant evidence.

Elements of the PICOT question are:

P (Patient, population, or problem)

Question to ask:

Who or what is the patient, population, or problem being studied?

I (Intervention)

Question to ask:

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

C (Comparison or control)

Question to ask:

What other interventions should be considered?

O (Outcome or objective)

Question to ask:

What is the expected or desired outcome or objective?

T (Time frame)

Question to ask:

How long will it take to attain the desired outcome?

PICO (T) Process Steps

The PICO (T) process starts by identifying a reason or need for the study.

With the need identified, the research should apply seven steps to the PICO (T) search:

These steps are:

1. Formulating the PICO (T) question in general terms

The question should incorporate the different elements.

2. Identifying the keywords

This would entail establishing the keywords for each PICOT mnemonic.

P

I

C

O

T

3. Planning the search strategy

The research should use the question to evaluate databases and other websites to look for information and answers.

This would entail using synonyms and phrases with the same meaning.

4. Executing the search

The research should begin by searching each PICOT element individually.

Later, words and phrases can be combined to broaden the search.

5. Refining the search

The research should then narrow the results by limiting the works found to important content, including peer-reviewed articles and documents.

6. Reviewing the content

The researcher should review the search results by establishing whether they have information relevant to the PICOT question.

7. Determining whether the results meet standards

Once the research results have been reviewed, the researcher should determine whether they contain the best available evidence.

The information gathered from the search can be used to identify the appropriate type of study.

Nursing PICO (T) Question Examples

A PICO (T) question can cover different areas of nursing practice, including:

1. Intervention
2. Diagnosis
3. Etiology
4. Prevention
5. Prognosis/ prediction
6. Meaning/ quality of life
7. Therapy

You can use suitable PICOT question templates to explore each area.

Note that depending on the issue or condition under study, not all elements of the PICO (T) question are applicable.

Mostly, the elements likely to be omitted are Comparison (C) and Time (T).

Nursing PICOT question examples are as explored below.

Intervention

PICOT question examples on intervention may include:

In middle-aged children (P), what are the effects of school-based exercise programs (I) on reduction in the incidence of childhood obesity (O) compared to no intervention (C) within a 2 year period (T)?  

Etiology

PICO question examples on etiology may include:

Are women 50 years old and above (P) with a history of 2 years of smoking or less (I) suffer the risk of developing esophageal cancer (O) compared to women 50 years and above (P) without a smoking history (C)?

Diagnosis

PICO question examples on diagnosis may include:

Is colonoscopic examination combined with fecal occult blood testing (I) more accurate in colon cancer detection (O) compared with colonoscopic examination alone (C) in adults above 50 years (P)?

Prevention

PICO question examples on prevention may include:

For adults above 65 years (P) does a 30 minutes daily exercise regimen (I) lower the risk of heart attack (O) compared with no exercise regimen (C)?

Prognosis

PICOT question examples on prognosis may include:

Does daily monitoring of blood pressure at home (I) impact compliance with hypertension medication regimens (O) in adults above 60 years old with hypertension (P) during the first year of being diagnosed with the condition (T)?  

Meaning

PICOT question examples on meaning may include:

How do middle-aged children (P) diagnosed with cancer (I) view radiation and chemotherapy treatments (O) within the first 12 months of diagnosis (T)?

PICO (T) Question Search Example

How do middle-aged children (P) diagnosed with cancer (I) view radiation and chemotherapy treatments (O) within the first 12 months of diagnosis (T)?

Patient or Problem = Middle-aged children

Keywords: Middle-aged children, school age children, 6- 12 years children

Intervention = Cancer

Keywords: cancer, neoplasia, tumor, neoplasm

Outcome = Views about radiation and chemotherapy treatments

Keywords: Views/ feelings/ perceptions about radiation treatment, chemotherapy, radiotherapy, radiation therapy, irradiation, x-ray therapy, antineoplastic drugs, anticancer, cytotoxic

Timeframe = first 12 months

Keywords: 12 months, one year