LibGuides: Nursing, BSN and MSN (EBP Toolkit): Asking Your Question

PICO: mnemonic device used to describe the four elements of a good clinical foreground question.

P = Population/Problem

I = Intervention

C = Comparison

O = Outcome

Jump to sample search in CINAHL Ultimate, & additional resources

Background vs. Foreground Questions

Background questions ask for general knowledge about a condition or thing.

Forest
The Forest

Broad in scope - "The Forest"
Provides basics for a a greater grasp of concepts
Typically found in textbooks, encyclopedias and reviews
Have two essential components: Example: What causes migraines? or How often should women over the age of 40 have a mammogram?
- A question root (who, what, when, etc.) with a verb
- A disorder, test, treatment, or other aspect of healthcare ask for specific knowledge to inform clinical decisions or actions.

Foreground questions ask for specific knowledge to inform clinical decisions or actions.

Tree

The Trees

Focused in scope - "The Trees"
Requires a grasp of basic concepts to fully comprehend
Typically found in journals and conference proceedings
Have 3 or 4 essential components (see PICO below)

PICO Question Formats

Fill in the blanks with information from your clinical scenario:

THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?

PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?

ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________

with/without______________?

MEANING
How do _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

PICO Examples

Element of the clinical question	Patient Describe as accurately as possible the patient or group of patients of interest.	Intervention (or cause, prognosis) What is the main intervention or therapy you wish to consider? Including an exposure to disease, a diagnostic test, a prognostic factor, a treatment, a patient perception, a risk factor, etc.	Comparison (optional) Is there an alternative treatment to compare? Including no disease, placebo, a different prognotic factor, absence of risk factor, etc.	Outcome What is the clincial outcome, including a time horizon if relevant?
Example	In patients with COPD,	does guided imagery	standard treatment alone	improve client-reported quality of life
Example	In children with cancer	does prescribed, structured journaling	unstructured journaling	result in improved reported self-confidence
Example	Among family-members of patients undergoing diagnostic procedures	does listening to tranquil music, or audiotaped comedy routines	standard care	make a difference in the reduction of reported anxiety

Types of PICO Questions

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

PEO Examples

For qualitative nursing research, Patient—Exposure—Outcome (PEO) is one way of “Asking Your Question.” Research that uses a PEO question often looks for themes or patterns. Here are some examples of PEO questions:

(P) For a sibling (E) whose brother or sister is chronically ill (O) what is their self-reported lived experience on family dynamics
(P)For school-age children with type I diabetes (E) who use an insulin pump (O) what are their self-reported day-to-day difficulties encountered in school
(P) Pregnant high school students (E) who stay in school (O) what are their reported psychosocial difficulties