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.
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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.
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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.
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PICOT Statement vs. PICOT Question
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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.
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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.
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Making a good PICOT question means that you will develop an answerable, researchable, and evidence-based solution to a given issue.
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PICOT stands for:
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P : Population/patient : you can consider factors such as age, gender, ethnicity, individuals with a given disorder.
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I : Intervention/Indicator : this is your variable of interest, such as exposure to disease, prognostic factor, or risky behavior.
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C– Comparison or Control, which refers to the absence of a risk factor, placebo, or prognostic factor B
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O : The Outcome such as accuracy of diagnosis, rate of occurrence of an adverse outcome, or risk of disease
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T : Time refers to the duration for a given Intervention to achieve a desirable outcome or how long the particular participants are observed.
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How to write a Good PICOT question and Sound Professional
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As outlined in the mnemonic analysis above, PICOT has five integral elements, which we now look at step-by-step.
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Population
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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.
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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.
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When selecting a population, ensure that you narrow it down to the individual patient representing the entire population for the generalizability of the findings.
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Intervention
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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:
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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.
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Comparison
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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.
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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.
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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.
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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.
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Outcome
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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.
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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.
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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.
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Time frame
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in three months. Or in under a week.
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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.
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Types of PICOT Statement or Questions
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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.
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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.
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1. Therapy
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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.
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For example, in adult patients with SLE, is consuming turmeric tea more effective than Plaquenil at reducing joint pain?
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The template for this is:
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In(P)how does. (I) compared with (C) affect. (O) within. (T)
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2. Prevention
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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.
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The template for this is:
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In. (P) using a given preventive method Y. (I) compared to. (C)lead to reduced loss of days at work (O), over. (T)
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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)?
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3. Diagnosis
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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.
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The template for this is:
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In(P)are/is. (I)compared with. (C) more accurate in diagnosing. (O)
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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.
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4. Prognosis
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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
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The template for this is:
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In(P) how does(I). compared with(C). influence (O). over. (T)
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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)?
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5. Etiology/Harm
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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.
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The template for this is:
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Are (P) who have(I) compared to those without. (C) at. risk for. (O) over (T)
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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)?
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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.
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Components of various PICOT Questions/Statements
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Examples of PICOT Questions
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- In patients with elective procedures, what is the effect of non-NPO compared to NPO for 8 hours prior to the procedure on recovery complications within 4 days after procedure?
- In people with type 2 diabetes, is bariatric surgery is more beneficial than medical intervention to manage blood sugar?
- In adults (18-55) diagnosed with obesity, does fasting for 3 months reduce weight compared to a calorie-restricted diet?
- In patients who are 65 years or older, what is the effect of a nurse-patient education intervention in comparison to no nurse-patient education intervention on the rate of flu vaccination?
- In patients 65 or older, what is the effect of home care nurse visits in comparison to no home care nurse visits on the rate of falls?
- In primigravid women who had a miscarriage, what is the effect of the implementation of a clinical guideline for compassionate follow-up care, in comparison to no implementation of a clinical guideline, on anxiety three months after the miscarriage?
- In Adult Diabetic Patients with Depression, Does Integrated Treatment Reduce Symptoms of Depression?
- In patients aged 65 years and older with heart failure, how does RE-AIM discharge screening and follow-up, compared with usual self-care, affect unplanned re-admission in 30-days? Using the RE-AIM framework, what are the perceptions of the patients and the registered nurse utilizing the protocol?
- Can patients age 18 to 55 with type 2 Diabetes improve their A1C with the introduction of a 4-week class on Diabetes versus no class?
- Does the use of Ventilator-associated pneumonia (VAP) bundle decrease the incidence of ventilator-associated pneumonia in critically ill patients admitted to the Intensive care unit?
- In adults with chronic neck pain, what is the minimum dose of manipulation necessary to produce a clinically important improvement in neck pain compared to supervised exercise at 6 weeks?
- In post-partum women, how does screening for postpartum depression at their two-week newborn appointment compared to waiting to screen for depression at their six-week postpartum appointment affect the outcome of treatment for postpartum depression?
- Can patients age 18 to 55 with type 2 Diabetes improve their A1C with the introduction of a 4 week class on Diabetes versus no class?
- In patients, age 18 to 55 with type 2 Diabetes improve their A1C with the introduction of a 4 week class on Diabetes versus no class?
- Does physical exercise intervention in managing the signs and symptoms of Colorectal Cancer reduce body pain in CRC patients? (more of an EBP question)
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Evidence-Based PICOT Question Examples
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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.
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- In the adult patient with diabetes type 2 [p], can a four-week diabetes self-management education program delivered from a patient portal to a web-enabled device in an SMS platform[I]improve the patient’s self-care knowledge and behaviors and SMBG daily average compared to usual care[C] within three months [T]?
- In adults diagnosed with type II diabetes, does a more comprehensive and multidisciplinary approach to patient education achieve higher compliance with blood glucose control compared to traditional patient education?
- In patients with type II diabetes, does the Diabetes Self-Management Education (DSME) give the newly diagnosed patients the tools to control their disease and self-management behavior compared to no DSME at all?
- Are diabetic adults who have low SES at increased risk for diabetic complications or poor clinical outcomes compared to diabetic adults from higher SES?
- In patients with diabetic foot ulcers, does age play a role in the efficacy of healing when undergoing negative pressure wound therapy?
- In hospitals with patients with foot ulcers, why isn’t NPWT the standard, as opposed to standard saline wound therapy?
- Do statins, as primary prevention, improve mortality or morbidity in Diabetes Mellitus patients with LDL already over 1000 compared to no statin prescription or Placebo
- In surgical patients, does listening to music in the perioperative setting have an impact on anxiety and postoperative pain?
- In hospitalized pediatric patients does medical barcoding decrease medication administration errors compared to standard/no barcoding?
- In pediatric code teams managing simulated pediatrics anaphylaxis scenario, will the use of epinephrine autoinjector device decrease medication errors (dose, concentration, site) and decrease time to medication administration during pediatric anaphylaxis compared with standard administration of epinephrine from code cart
- In patients over 65 years in residential care, does receiving medication from RCAs reduce rates of medical errors compared to receiving medication from RNs?
- For Nurses in acute care settings, do approaches to prevent distractions during medication pass reduce medication administration errors MAEs compared to non-protected passes?
- For nurses administering medications during 9 Am medication pass time (p), will the implementation of a Quiet Zone (I) as compared to no intervention (c) reduce interruptions and distractions, as well as decrease medication pass time and improve medication safety (o).
- In adult patients with total hip replacements (p), how effective is PCA pain med (i) compared to PRB IM med © in controlling postoperative pain (o).
- In a 72-year-old woman with osteoarthritis of the knee, can COX-2 inhibitor use decrease the risk of GI bleeding compared to other NSAIDs?
- In stroke patients with aphasia (P), does early initiation of aphasia treatment (SLP services) (I) compared to aphasia treatment after initial or spontaneous recovery time (c) achieve functional communication abilities (O).
- In patients with hypertension, how does medication teaching compared to no medication teaching increase medication adherence and lowered blood pressure?
- In pregnant women, will periodontitis compared to no periodontitis, increase the risk of miscarriage or poor pregnancy outcome?
- Among the postpartum mothers, does post-partum depression assessed by the PPD Questionnaire predict the health status of the children by age of 5 years compared to depression measured through child health inventory scale at 5 years?
- In adolescents with depression or major depressive disorders does the use of SSRIs and CBT/Psychotherapy compared to the exclusive use of CBT/psychotherapy reduce depression or improve mental health outcomes?
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Template for Developing PICOT Question/Purpose Statement
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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.
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Step 1: Define elements or clinical question using PICO:
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Step 1: Define elements or clinical question using PICO:
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P = Patients or population to target:
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P = Patients or population to target:
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Problem or condition to address:
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Problem or condition to address:
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Pilot area (e.g., unit/clinic):
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Pilot area (e.g., unit/clinic):
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I = Intervention (assessment or treatment):
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I = Intervention (assessment or treatment):
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C = Comparison:
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C = Comparison:
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O = Outcomes:
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O = Outcomes:
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T = Time frame (optional):
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T = Time frame (optional):
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Step 2: Purpose statement:
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Step 2: Purpose statement:
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Step 3: Determine what your question is about (circle one):
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Step 3: Determine what your question is about (circle one):
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Therapy
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Therapy
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Diagnosis
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Diagnosis
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Etiology
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Etiology
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Prognosis
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Prognosis
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Meaning
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Meaning
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Step 4: Identify study types that best address your question (circle one or more):
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Step 4: Identify study types that best address your question (circle one or more):
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Experimental studies
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Experimental studies
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Observational studies
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Observational studies
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Qualitative studies
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Qualitative studies
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Systematic review or meta-analysis
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Systematic review or meta-analysis
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Case reports
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Case reports
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Other
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Other
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Step 5: List the key terms and synonyms for your purpose statement. A typical number of concepts per question is two to three.
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Step 5: List the key terms and synonyms for your purpose statement. A typical number of concepts per question is two to three.
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Concept 1:
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Concept 1:
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Concept 2:
