Evidence-Based Nursing Practice
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
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OVERVIEW
Searching for high-quality clinical research evidence can be a daunting task, yet it is an integral part of the
evidence-based practice process. One way to streamline and improve the research process for nurses and
researchers of all backgrounds is to utilize the PICO search strategy. PICO is a format for developing a good
clinical research question prior to starting one’s research. It is a mnemonic used to describe the four elements
of a sound clinical foreground question (Yale University’s Cushing/Whitney Medical Library).
In this white paper, we will explore the importance or evidence-based nursing practice, take a deeper dive
into the PICO process and provide an example of the PICO process in action through a case scenario. Whether
you are a librarian, a nurse or a nursing student, the chances are good that you will learn something new as
you read, 7 Steps to the Perfect PICO Search.
WHAT IS EVIDENCE-BASED NURSING PRACTICE AND WHY IS IT IMPORTANT?
Evidence-based nursing is a process founded on the collection,
interpretation, appraisal, and integration of valid, clinically
signifcant, and applicable research. It is not about developing
new knowledge or validating existing knowledge, but rather
translating existing evidence so that it can be applied to clinical
decision making. The expected standard in modern healthcare
systems, evidence-based nursing practice links research and theory
to practice, providing clinicians with current, reliable researchdriven data to guide patient care decisions.
Research has shown that patient outcomes are substantially
improved when health care is based on evidence from welldesigned studies versus tradition or clinical expertise alone.
Better patient outcomes lead to more efcient performance,
which is crucial for hospitals with stafng challenges.
“Evidence-based practice in nursing is using and carrying out nursing practices based on the best
available knowledge. Evidence-based practice integrates the nurse’s clinical expertise with the best
external research evidence, and takes into account patient preferences to deliver quality nursing care.”
-Victoria Schirm, Director of Nursing Research, Penn State University
Evidence-Based
Practice
Best External
Research
Evidence
Nurse’s Clinical
Expertise
Patient
Preferences
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
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WHAT IS THE PICO PROCESS?
PICO is a format for developing a good clinical research question prior to starting one’s research. It is a
mnemonic used to describe the four elements of a sound clinical foreground question. (Yale University’s
Cushing/Whitney Medical Library). 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. These make up the four elements of the PICO model: Patient/
Problem, Intervention, Comparison and Outcome.
The PICO process starts with a case scenario from which a question is constructed that is relevant to the
case and is phrased in such a way as to facilitate fnding an answer. 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.
STEP 1: FORMULATE THE PICO QUESTION
Case Scenario:
You are a Registered Nurse working on a Urology unit. One of your patients is a 55-year-old man who is
recovering from abdominal surgery – specifcally a laparoscopic prostatectomy. The patient complains
of abdominal pain and nausea. His abdomen is distended, and he has no bowel sounds. The physician
suspects a paralytic ileus and confrms the diagnosis based on the combination of clinical features and
imaging.
At the next Evidence-Based Nursing Practice Committee meeting, you discuss this case. The committee
decides to do a case study to determine if there is evidence to suggest that a simple intervention such as
chewing gum post-operatively can prevent a post-operative ileus following abdominal surgery.
Based on this scenario, our research question is: “In patients undergoing abdominal surgery, is there
evidence to suggest that chewing gum post-operatively compared with not chewing gum post-operatively
affects post-operative ileus?”
1. Formulate the PICO Question
2. Identify Keywords for each PICO Element
3. Plan the Search Strategy
4. Execute the Search
5. Refne the Results
6. Review the Literature
7. Assess the Evidence
Review the
Literature
Assess the
Evidence
Refne the
Results
Execute
the Search
Plan the Search
Strategy
Identify
Keywords
Formulate the
PICO Question
7 Steps to the Perfect PICO Search
EVIDENCE-BASED NURSING PRACTICE: 7 Steps to the Perfect PICO Search
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STEP 2: IDENTIFY KEYWORDS FOR EACH PICO ELEMENT
Population (P) – What individual or group are we interested in studying?
Intervention (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?
“In patients undergoing abdominal surgery, is there evidence to suggest that chewing gum post-operatively
compared with not chewing gum post-operatively affects post-operative ileus?”
| PICO ELEMENTS | KEYWORDS |
| P (Patient or Population) | Patients undergoing abdominal surgery |
| I (Intervention) | Chewing gum |
| C (Comparison) | Not chewing gum |
| O (Outcome) | Affects post-operative ileus |
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