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Evidence Based Practice Tutorial

Step 1: Ask

  • The first step in the evidence based practice process is developing a research question. It's important to be flexible with this step because the first question you think of is rarely the final one you'll use. Sometimes you'll have to go back to the drawing board to develop a new question and that's totally normal and fine!

How can I develop an EBP research question?

  • The PICO(T) process for developing a research question outlined below is most commonly used in medicine, especially in Nursing, but can actually be used in any field and will almost always produce a very solid question that can help effectively guide your research. If deciding on a topic or research question is hard for you, this is an excellent guided way of developing one.
  • It can be hard to conceptualize what each part of PICO(T) means, so this guide includes multiple examples for each part for both health sciences questions and questions in other fields. 

What is a PICO(T) question?

  • PICO(T) stands for Patient/Population, Intervention, Comparison, Outcome, and Time Frame. 
  • Including a Time Frame is always optional.
  • PICO(T) is often tricky for students to understand, so here's a further breakdown of each part with examples.

Patient/Population

  • What are the most important characteristics of the patient or population you're interested in for the purposes of your research? These characteristics can be the categories we'd commonly think of like race, ethnicity, gender identity, sexual orientation, etc., but can also include things like users of a particular website, people with certain diagnoses, patrons of a service, etc.
  • While it's important to be precise, it's also possible to be too precise. You'll be able to find many studies about Black single mothers in America, but you won't find as much research about Black single mothers in Milwaukee who are also Nursing students at Alverno. You will always have to generalize your population at least a little bit to find relevant research, but we'll talk more in Step 4 about how you can narrow back in on more specific populations.

Intervention

  • What treatment, service, or procedure are you researching? This can be a drug, a kind of therapy, a website design, changing the location of a service desk, adding new language to signage, changing operating hours, etc.
  • This is the part of the PICO(T) question that covers what you are directly changing about the work you're doing. If it helps, you can think of this as your independent variable.

Comparison

  • What are you comparing your intervention to? This is usually going to be the way things are currently done, so if you're considering changing where a desk is located, the comparison would be the current location of the desk. If you're considering trying a new drug therapy for a patient, the comparison is whatever treatment the patient is (or is not) currently receiving. 
  • This can be the trickiest part of PICO(T) to include when searching for articles because it can be pretty hard to find the perfect studies that had your exact current conditions and used the exact intervention you're looking to use. If those studies exist, fantastic, you should definitely use them, but it can be very helpful in some cases to search for information about your comparison separately from information about your intervention.
    • For example, lithium used to frequently be the first drug given to patients presenting with symptoms of bipolar disorder. We've since developed new drugs that are safer and more tolerable to patients than lithium and most clinicians have moved away from prescribing it, but some clinicians still prescribe it as a first line treatment.
    • A clinician using evidence based practice to potentially make the switch to recommending a different drug might have trouble finding studies that directly compare the effectiveness of lithium and the new drug.
    • Instead, they might look for studies about the effectiveness of the new drug (Intervention) and look for separate studies about the effectiveness of lithium (Comparison,) then compare the results across the two types of studies.
  • A Comparison doesn't need to be included in a PICO(T) Meaning question.

Outcome

  • What are you trying to achieve with your Intervention? This could be improved patient satisfaction, higher library book circulation rates, more clicks on your website, fewer people asking navigational questions at service desks, better management of a patient's symptoms, etc.
  • Sometimes it's easy to get your Intervention confused with your Outcome. Keep in mind that the Outcome is the change you're hoping to see, but isn't something you have direct control over - in other words, your dependent variable. If it's something you are directly changing, it's an Intervention, and if it's something that changes as the result of something you did, it's an Outcome. 

Time Frame

  • Again, you don't always need to include a time frame in your PICO(T) question, only when it makes sense to. 
  • A real world and currently relevant example of the Time Frame part of a PICO(T) question would be how long a person with COVID-19 is able to spread the virus to other people. 

Fillable PICO(T) table

  • Click on any box in the following table to change its contents and start to build keywords and search strategies for your own PICO(T) question.
  • Search strategies can include what database you'll search in, which search terms you'll use, or more advanced search techniques like nesting and Boolean operators. Basic keyword searches have come a long way and Boolean operators are no longer as necessary as they once were, though they are still powerful search techniques.
  • ***Note that this table will not be saved. If you'd like to keep a copy for yourself, take a screenshot after you fill it in.

Sample PICO(T) question: “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(T) Keywords and synonyms Search Strategies
Population abdominal surgery, postoperative, recovery preliminary search in PubMed: abdominal surgery ileus gum
Intervention chewing gum, gum
Comparison not chewing gum
Outcome post-operative ileus, paralytic ileus, ileus
Time (Optional)  

Sample question taken from CKN's Evidence Based Nursing guide.