This article offers valuable insights to help you write a PICO question for your nursing change management project or capstone project. As a nursing student, writing excellent papers begin by questioning what is in literature. Therefore, nursing papers must be critical, well-argued, and profound.
Given the importance of developing PICO questions and writing PICOT statements, you have all the reasons to stick to this article to the end. However, if all you want is someone to write for you a PICOT question and an outline for your nursing research paper or term paper, we have the best. Our nursing term paper writers and capstone writers can take over the process from you.
We have already explained elsewhere in our nursing evidence-based paper guide the steps required to write an EBP paper. This guide takes you through the step-by-step process of writing a PICOT question for your EBP research project, as an assignment, part, or a short nursing essay. We aim to make it easy to understand and frame clinical research questions for nursing students.
A PICOT question refers to an elaborate, specific, and relevant clinical research question developed from analyzing the problems in practice or a patient case scenario.
On the other hand, A PICOT statement refers to a statement developed from the PICOT question detailing the direction of an intervention or an evidence-based practice. It narrows the scope of a PICOT question by specifying the evidence-based practice or change required in practice or to solve a clinical issue.
Making a good PICOT question means that you will develop an answerable, researchable, and evidence-based solution to a given issue.
PICOT stands for:
P : Population/patient : you can consider factors such as age, gender, ethnicity, individuals with a given disorder.
I : Intervention/Indicator : this is your variable of interest, such as exposure to disease, prognostic factor, or risky behavior.
C- Comparison or Control, which refers to the absence of a risk factor, placebo, or prognostic factor B
O : The Outcome such as accuracy of diagnosis, rate of occurrence of an adverse outcome, or risk of disease
T : Time refers to the duration for a given Intervention to achieve a desirable outcome or how long the particular participants are observed.
As outlined in the mnemonic analysis above, PICOT has five integral elements, which we now look at step-by-step.
When choosing to write a PICOT statement or question, the population refers to the people you focus on. For instance, it could be a population in a given geographical area with some condition, say diabetes, heart diseases, cancers, or psychological/mental diseases.
You can further narrow the population to gender, age, ethnicity, status, occupation, and the medical issue of interest. The commonality of these factors makes these groups considered a population for interest in a nurse change management plan.
When selecting a population, ensure that you narrow it down to the individual patient representing the entire population for the generalizability of the findings.
The interventions refer to the actions meant to improve the well-being or health of the patient. For instance, music or art therapy can be used to improve the well-being of patients with mental issues such as stress. You need to ask yourself:
The intervention can be pharmacologic such as medication, surgery, diagnostic testing/imaging, or non-pharmacologic action, such as patient education, pressure monitoring, or lifestyle change.
As the name suggests, you have to compare your population of focus to that which is its exact opposite. The aim is to prove if the proposed change, intervention, treatment approach, diagnostic testing, follow-up, patient education, or lifestyle change is effective.
It is the alternative that you are to compare with the intervention. Since the PICO process depends on every entry that comes as a step-by-step process, you need to use the information from the population and intervention to complete the comparison.
You can compare the intervention to other treatments, placebo, drugs, or diagnostic tests. As you compare, you can eliminate the chances of misjudgment or biasness.
You might realize that there is nothing to compare when developing a PICO question. But, if that is the case, you should not shiver; it is something that is expected.
After completing the study on a population with a given intervention versus those with no intervention and making a comparison, it is now time to report what you expect to see. The outcomes, therefore, refer to the desired action or action of interest. It is the stage that you give the results if you are conducting a study.
The outcome can be statistical findings or qualitative statements that have rigor, relevance, and authenticity. It can be in the form of risk of disease, risk of an adverse effect, rate of occurrence of an adverse outcome, or accuracy of a diagnosis.
When writing the outcomes, you can do so with the patient-orientation point of view or a disease-orientation point of view for accuracy. In other instances, you can combine the two for a conclusive finding.
in three months. Or in under a week.
In some guides, you will get them ending as PICO, cutting out the T that stands for time. The timeframe is not as much necessary a parameter as it measures the duration a given intervention produces a given outcome. It also refers to how long the participants are observed. Unless requested to omit the time, you should include it both in your PICO statement and the PICOT question.
Evidence-based research helps in drawing conclusions and making definitive decisions in clinical practice. Asking well-designed clinical questions helps in developing strategies that lead to finding relevant scholarly literature. Before writing the PICOT question, it is important to ask foreground and background questions.
The background questions are for general knowledge about the condition or behavior, whereas the foreground questions are specific about knowledge that informs clinical actions or decisions. In addition, these questions have different points of focus, as outlined below.
Therapy-related questions are questions about a treatment used to achieve a given outcome. It covers actions such as counseling, education, lifestyle changes, follow-up, surgical interventions, depending on the population of interest.
For example, in adult patients with SLE, is consuming turmeric tea more effective than Plaquenil at reducing joint pain?
The template for this is:
In(P)how does. (I) compared with (C) affect. (O) within. (T)
The prevention-related questions help establish how something can be prevented or how its consequences can be mitigated to curb the spread. Therefore, when using the PICO framework strategy, you have to explore the potential of having preventive measures against a patient's condition and report the expected outcomes.
The template for this is:
In. (P) using a given preventive method Y. (I) compared to. (C)lead to reduced loss of days at work (O), over. (T)
Example: 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) at the time of surgery (T)?
The diagnosis-related PICO questions focus on the identification of a disorder in a patient. The diagnosis or diagnostic test is done on a patient with specific symptoms. It is an initial basis of your research as it specifies the niched-down disease of focus. It helps narrow down to a specific disease, given the symptoms that could be experienced with patients having a spectrum of diseases. The PICO for diagnosis or diagnosis test examines which test is accurate and precise in diagnosing a condition.
The template for this is:
In(P)are/is. (I)compared with. (C) more accurate in diagnosing. (O)
Example: 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)? Time is implied in two weeks and 24 hours old.
The prognosis-related, also known as prediction-related PICO questions, are used to determine the clinical course over time, including the likely complications of a given condition. Primarily, understanding the progression of a disease is critical for clinical decision-making. It is valuable to inquire about the possibility of a disease occurring, how far it has come, and its predicted effects over time. It helps in planning therapy and making treatment plans
The template for this is:
In(P) how does(I). compared with(C). influence (O). over. (T)
Example: For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to those who have not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?
Finally, etiology-related questions are used to determine the greatest risk factors or the causes of a condition. These questions help clinicians identify the starting point when assessing what works well for a given population of patients and which does not work. It also helps in developing a new treatment plan following the failure of previous interventions.
The template for this is:
Are (P) who have(I) compared to those without. (C) at. risk for. (O) over (T)
Example: Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?
Read more from: Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
| Type of Question | Patient/Population | Intervention/Exposure | Comparison | Outcome Measures |
|---|---|---|---|---|
| Treatment/Therapy | The patient's disease or condition | A therapeutic measure such as lifestyle change, education, counseling, surgery, or medication | Standard of care, other interventions, or placebo. | Mortality rate, days lost from work, or disability. |
| Prevention | Patient's risk factors and general health condition | A preventive measure such as medication or a lifestyle change | Incidence of disease, mortality rate, days lost from work. | |
| Diagnosis | The target disease or condition | A diagnostic test or procedure | Measures of the test utility such as sensitivity, specificity, or odds ratio. | |
| Prognosis | The main prognostic factor, clinical problems in terms of duration and severity | The exposure of interest is usually time, sometimes expressed as watchful waiting. | Survival rates, mortality rates, rates of disease progression | |
| Etiology/Harm | The patient's risk factors, current health disorders, or general health condition | The intervention of exposure of interest includes indicating the strength of the risk factor and the duration of exposure. | It does not apply here | Disease incidence, rate of disease progression, or mortality rate. |
Having known the proper PICOT Question format, let's look at some of the examples. We have generalized, etiology, therapy, diagnostic, meaning, prognosis, and intervention PICOT question examples. You will also find examples of PICOT questions on hypertension, pregnancy, mental health/psychiatry, surgery, and heart diseases.
Describe each PICO element addressing the topic of interest. Identify the outcome before considering interventions; interventions may evolve after reading the evidence. Write a purpose statement and determine the kind of question.
Step 1: Define elements or clinical question using PICO: | |||||||||
P = Patients or population to target: | |||||||||
Problem or condition to address: | |||||||||
Pilot area (e.g., unit/clinic): | |||||||||
I = Intervention (assessment or treatment): | |||||||||
C = Comparison: | |||||||||
O = Outcomes: | |||||||||
T = Time frame (optional): | |||||||||
Step 2: Purpose statement: | |||||||||
Step 3: Determine what your question is about (circle one): | |||||||||
Therapy | Diagnosis | Etiology | Prognosis | Meaning | |||||
Step 4: Identify study types that best address your question (circle one or more): | |||||||||
Experimental studies | Observational studies | Qualitative studies | |||||||
Systematic review or meta-analysis | Case reports | Other | |||||||
Step 5: List the key terms and synonyms for your purpose statement. A typical number of concepts per question is two to three. | |||||||||
Concept 1: | Concept 2: | Concept 3: | |||||||
Step 6: List inclusion and exclusion criteria: | |||||||||
Step 7: Keywords or concepts for organizing literature: | |||||||||
We borrowed ideas from this list of nursing schools and institutional guides. They can as well help in your research process when writing a nursing term paper based on a PICOT question.
When assigned to write a PICO essay, follow the steps above to develop an outstanding PICOT question. Nevertheless, the process usually begins with identifying a nursing area of interest. Although meant for capstone projects our list of the latest nursing topics and ideas can help you determine an area of focus.
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With the identification of the area of focus and your patient population, you have to identify an issue that is prevalent in the area, where you seek to develop solutions or implement change.
When developing the background of your problem, ensure that you used evidence-based studies that were published in the last five years. It is also vital to develop gap, which is the basis for formulating a PICOT statement to test a new invention or implement some change to solve the problem. You have to be very keen when developing your nursing literature review because it carries so much weight.
In most instances, you might be required to select scholarly nursing articles such as meta-analyses, systematic reviews, literature reviews, RCTs, longitudinal studies, and other scholarly sources to complete a literature evaluation table that analyzes each article.
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