Discussion: Nursing Research and Evidence-Based PracticeIn your practice as a nurse, you may use procedures and methods that did not necessarily originate in evide

Evidence-Based Practice Research: Clinical Question Anatomy

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• Evidence-Based Practice

• Clinical Question Anatomy

  • Introduction

  • PICOT

  • Search terms

  • Additional resources

• Levels of Evidence Pyramid

• Evidence Types

• CINAHL Search Help

• MEDLINE Search Help

• Joanna Briggs Institute Search Help

Introduction

The first step in doing evidence-based practice research is forming a researchable question. Questions that are too broad or too narrow can make your research difficult, if not impossible. For example:

• Too broad: How do you control infection?

  • This topic is so broad that you'd have difficulty wading through all of the results.

• Too narrow: At the Johns Hopkins Neonatal Intensive Care Unit, what is the best way to control infection among Asian American babies born at 32 weeks? 

  • This question is so specific that there probably hasn't been anything published on that specific location regarding that specific population.

• Just right: In the NICU, what is the effect of hand washing on infection control compared with hand sanitizers, over 6 months?

On this page we will cover:

• using PICOT as a guide in developing a researchable question

• turning your research question into search terms

PICOT

PICOT is a mnemonic that helps you remember the key components of a well-focused question. It stands for:

• P = Patient, Population or Problem

• I = Intervention, Prognostic Factor, or Exposure

• C = Comparison (optional)

• O = Outcome

• T = Time

PICOT examples:

Intervention/therapy

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)? 

In the aged population, what is the effect of exercise programs on accidental falls, as compared with no exercise?

Etiology

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are adult smokers with a history of childhood asthma at increased risk of COPD compared to adult smokers with no history of asthma?

Diagnosis or diagnostic test

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)? 

Is the Hemoglobin A1C test more accurate in diagnosing diabetes as compared with fasting blood sugar levels?

Prevention

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)? 

For people with type 2 diabetes, does zinc supplementation reduce the future risk of foot ulcers compared with placebo?

Prognosis/Predictions 

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)? 

In adults with osteoarthritis, does low vitamin D levels in the bloodstream predict the rate of future hip fractures?

Meaning 

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)? 

How do cancer patients diagnosed with alopecia perceive their self-esteem during and after chemotherapy?

Search terms

Once you've developed a PICOT question, it's time to find keywords or search terms that you can use in the Library databases to find articles relevant to your question.

Here are a few strategies that will help you turn each aspect of your topic into relevant search terms:

• Brainstorm synonyms

• Expand out acronyms

• Look at subjects

Brainstorm synonyms

For each aspect of your topic, think of other words or phrases that have a similar meaning. For example, some synonyms for hand sanitizers could be:

• hand rubs

• hand disinfection

Expand out acronyms

If your topic includes acronyms, like NICU, you'll want to search using both the acronym and the actual phrase:

NICU OR Neonatal Intensive Care Unit

Look at subjects

Most of the Library databases assign articles or other resources subjects based on the main topics covered in that item. These subjects make great search terms, since they will help you search for the terms the database uses to categorize your topic.

Here is an example of how to find subjects in the CINAHL Plus with Full Text database:

1. Once you are in the database, enter an aspect of your topic in the first search box. For example:
    

Hand Sanitizers

1. Then run your search by clicking on the Search button.
    

Note: This search is just to help you identify relevant subjects, so you don't want to add additional search terms or limits to your search.

1. Under the citation information for each result, look at the Subjects area to determine which subjects best fit your topic. For this topic, a few promising subjects are: Handwashing Standards, Handwashing Equipment and Supplies, Antiinfective Agents, and Cross Infection Prevention and Control.
    

To learn more about picking and combining appropriate search terms, please see our guides:

• Keyword Searching: Keyword Search Strategy

• Guide: Keyword Searching: Boolean