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Evidence-Based Practice (EBP)

In addition to the basics of EBP and PICO, this guide answers questions about primary vs. secondary sources, where to look for evidence, and how to search to get the best results.

The PICO(T) Chart

When searching for evidence-based practice studies in the Nursing and Medical databases, you must first develop a well-built clinical question. Below is a chart to guide you in formulating a question by breaking it down to its most important parts.

Students sometimes have difficulty incorporating classroom skills into the clinical setting. The PICO(T) Chart provides an easy framework for integrating clinical information into the development of a research question. Students can complete the following worksheet, incorporating detailed information into each response.

Decide what your research interest or topic is and then develop a research question to answer it.

PICO(T) Your PICO(T) Elements ⇒ Search Terms
P PATIENT PROBLEM
What is the patient population? What is the primary problem?
                                                                                                                                                                                                                 
I INTERVENTION, PROGNOSTIC FACTOR, OR EXPOSURE
What is the main intervention, diagnostic test, or treatment you wish to consider?
 
C COMPARISON (optional)
Is there an alternative intervention or treatment to compare? 
(Examples: Different treatment; placebo; continuation of current standard of care; lack of a risk factor)
 
O OUTCOME(S) (optional)
What is(are) the ideal clinical outcome(s)?
 
 
T TIME (optional)
How much time does it take to demonstrate the clinical outcome(s)?
 

Design a question that incorporates the most salient piece of information from each of the above categories.

My literature search question is:                                                                                                                                                              


 

PICO Template Questions

You may find it helpful to use one of the following templates when creating your PICO question. Remember, the time (T) piece is usually optional and therefore can be omitted.


Therapy or intervention (questions addressing the treatment of an illness or disability):

In _______(P), how does _______(I) affect _______(O) compared with _______(C) within _______(T)?

Ex: In African American female adolescents with hepatitis B (P), how does acetaminophen (I) affect liver function (O) compared with ibuprofen (C)?
 

Etiology or harm (questions addressing the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder):

Are _______(P) who have _______(I) at _______(increased/decreased) risk for/of _______(O) compared with those with/without _______(C) over/during _______(T)?

Ex: Are 30- to 50-year-old women (P) who have high blood pressure (I) at increased risk for an acute myocardial infarction (O) compared with those without high blood pressure (C) during the first year after hysterectomy (T)?
 

Diagnosis or diagnostic test (questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation):

In _______(P) is/are _______(I) more accurate in diagnosing _______(O) compared with _______(C)?

Ex: In middle-aged males with suspected myocardial infarction (P), are serial 12-lead ECGs (I) more accurate in diagnosing an acute myocardial infarction (O) compared with one initial 12-lead ECG (C)?
 

Prognosis or prediction (questions addressing the prediction of the course of a disease):

In _______(P) how does _______(I) compared to _______(C) influence _______(O) over/during _______(T)?

Ex 1: In patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?
Ex 2: In patients who have experienced an acute myocardial infarction (P), how does being a smoker (I) compared with being a non-smoker (C) influence death and infarction rates (O) during the first 5 years after the myocardial infarction (T)?
 

Meaning (questions addressing how one experiences a phenomenon):

How do _______(P) with _______(I) perceive _______(O) compared with _______(C) during/over _______(T)?

Ex: How do 20-something males (P) with a diagnosis of below-the-waist paralysis (I) perceive their interactions with their romantic significant others (O) during the first year after their diagnosis (T)?