Evidence-Based Practice

To understand the clinical problem, you first need to:

• Assess the situation: What does your patient need? What is their clinical problem or question?
• Ask the question: Construct a well-built question based on your assessment.

Case Example

Rita is an RN who works in a nursing home. One of her patients complains of arthritic pain that is worsening. Her medication doesn't seem to be helping. Rita wonders whether massage therapy would present an effective means of treatment for her patient.

Before Rita can look for sources of literature on the subject, she needs to form a question that will:

• Address all the elements of the problem
• Yield relevant results

Constructing the Question using PICO

The PICO format helps you form an answerable questions that identifies the patient problem, the treatments or tests that are being considered, any alternative treatments or tests (if any), and the desired outcome of the treatment(s).

P = Patient or Problem: Who is your patient? What patient population do they belong to? Are there problems endemic to this population?

I = Intervention or Exposure: Which intervention or treatments are you going to research? What do you want for the patient (a prescription, a test, surgery, etc.)?

C = Comparison or Control: What is the main alternative to compare with the intervention? Is your patient already receiving an intervention? Or none at all (control)?

O = Outcome: What do you hope to accomplish, improve, or achieve? What are you trying to do for the patient?

Case Example Revisited

After assessing the problem and constructing a question using the PICO format, Rita comes up with the following question:

P = Geriatric patients with arthritic pain

I = Massage therapy

C = Patient's prescribed NSAID or similar anti-inflammatory drugs

O = Reduced arthritic pain

Complete clinical question: Do geriatric patients with arthritis who receive regular massage therapy have lessened arthritic pain compared to those that do not?

Another Example

Let's look at another example. You're working with an elderly client who is in a nursing home and experiencing social isolation. You're interested in exploring options to help them cope and connect with their loved ones. While doing some quick background research, you discover the potential for digital communication technology to have an impact on social isolation. Before you can proceed with this, you need to find evidence to support your decision, so forming a PICO question will help you effectively search for relevant literature.

Using what we know from our scenario, let's break it down:

• P: nursing home residents (population) with social isolation (problem)
• I: videoconference program with family (intervention to be explored)
• C: normal family visitation at the nursing home (comparison to the new intervention)
• O: lessened social isolation (our ideal outcome)

If we piece these components into a complete question, it might sound something like this:

Would a videoconference program (I) improve social isolation (O) amongst nursing home residents (P) compared with traditional visitation (C)?

The type of question you want to ask depends on your desired clinical outcome. Your PICO should fit one type of question. Try using the templates to plug in concepts from your topic.

Diagnosis

• Questions identifying the nature and cause of a disease/injury through evaluation.
• How good is this diagnostic test at confirming or excluding a particular diagnosis?
• Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Etiology/Harm

• Questions identifying the causes of conditions
• What disease or condition could result from exposure to this potentially harmful thing?
• Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Prevention

• Questions regarding how to reduce the chance of disease/injury by identifying and modifying risk factors and how to diagnose early.
• Is this a risk factor for developing a particular disease or condition?
• For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Prognosis

• Questions predicting the course of a disease or condition
• What is the patient's likely clinical course over time and what are likely complications of a particular disease or condition?
• In__________ (P) how does ________ (I) compared to _______(C) influence _______ (O) over ______ (T)?

Intervention/Treatment

• Questions relating to how a clinical issue is treated
• Will this treatment do more good than harm? How does it compare to other treatment(s)?
• In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

See the "Acquire" tab to find match the type of question to the level of evidence that is appropriate for answering the question.

Templates adapted from Sonoma State University.