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Evidence based practice picot question related to nursing

This article has been cited by other articles in PMC. Abstract Developing a researchable question is one of the challenging tasks a researcher encounters when initiating a project. Both, unanswered issues in current clinical practice or when experiences dictate alternative therapies may provoke an investigator to formulate a clinical research question.

This article will assist researchers by providing step-by-step guidance on the formulation of a research question. This paper also describes PICO population, intervention, control, and outcomes criteria in framing a research question. Finally, we also assess the characteristics of a research question in the context of initiating a research project. The underlying questions of a research project provide important information to decide whether the topic is relevant, researchable, and significant.

A well-formulated research question needs extreme specificity and preciseness which guides the implementation of the project keeping in mind the identification of variables and population of interest. Here we will present a clinical scenario and see how clinical questions arise and help us in finding the evidence to answer our question.

He has a history of recurrent ear infections, and his mother expresses a concern that he has been on the antibiotic amoxicillin for the past few weeks. She is worried about the consequences of the long-term antibiotic use.

She is also concerned about the outcome associated with recurrent ear infections. She wants to know if the prescribed amoxicillin is effective, or it can be substituted with another antibiotic because of its side effects such as frequent diarrhea. Several questions arise from this case which can be broadly classified into background and foreground questions. These types of questions can be answered by going through review articles or text books. The patient-oriented questions involving interpretation of a therapy or disease and consideration of risk vs.

These questions mostly evidence based practice picot question related to nursing the two, either two drugs or treatments or two diagnostic methods, etc. Feasibility Suffi cient resources in terms of time, staff, and funding Use of appropriate study design Manageable in scope Adequate sample size Trained research staff I: Novel Thorough literature search New fi ndings or extension of previous findings Guidance from mentors and experts E: Relevant Open in a separate window Population or problem- addressing a specific population, its important characteristics and demographic information.

From the above case, you can identify pediatric population with otitis media, the age range, sex, presenting complaint, and history. Intervention or treatment of interest- the intervention can be a treatment, procedure, diagnostic test, and risk or prognostic factors.

In this case, the intervention will be your plan to treat the patient which can be a new therapy, a diagnostic test, prognostic factor, or a procedure. For example, based on your observation in clinic, cefuroxime is another better treatment option as compared to amoxicillin in treating otitis media but you are not sure about its efficacy in pediatric population with otitis media.

Comparator or control-when a new therapy is compared with the existing one. Outcome- is the effect of the intervention. For example, its effectiveness in controlling pain. Therefore, the outcome in the above case can be the relief of pain, the resolution of infection, or decreasing the risk of developing resistance.

Formulating a researchable question: A critical step for facilitating good clinical research

A good primary outcome should be easily quantifiable, specific, valid, reproducible, and appropriate to your research question. Once background questions are answered, more complex questions are addressed.

The clinical questions arise from the central issues in a clinical work. After determining a foreground question, the PICO approach is followed. Dissecting the question into parts makes it easy and searchable. As evident in this case, there are several relevant questions, for example: Now if you gather all the information from PICO approach, the following researchable questions can be formulated.

In children with acute otitis media Pis cefuroxime I effective in reducing the duration of symptoms O as compared to amoxicillin C?

In children suffering from otitis media, will cefuroxime result in the improvement of symptoms and reduction in developing resistance? Does treatment with amoxicillin increase the risk of developing resistance in children suffering from otitis media? Does surgical procedure has better outcome for the treatment of otitis media in children after repeated antibiotic therapy? Further, we need to consider the feasibility of finding the evidence in a short period. The following points should be considered while assessing a research question.

Determining the required resources The feasibility of conducting a research project is based on the research question and should be considered early in the process in order to avoid waste of resources and intellectual energy.

This is sometimes difficult for a new investigator and they need guidance from their mentors. Also, consider expanding your inclusion criteria and modifying exclusion criteria if it is difficult to enroll the intended number; and Consider cost of each element of the study design, research staff, and resources. Significance of making it interesting and relevant An important question may not seem interesting the way it is presented.

It is a challenge to present a research question clearly and engage the interest and attention of the reviewers. Research is too much work to not have a passion for what you are investigating. You will have more support for your study, and it will be easier to publish if the topic is novel and also interests your collaborators, colleagues, and the community at large.

  • If it is a well-defined research question, it will lead to an appropriate study design and methodology;
  • You will have more support for your study, and it will be easier to publish if the topic is novel and also interests your collaborators, colleagues, and the community at large.

It is important to pursue a research question evidence based practice picot question related to nursing a passion of getting the truth out of the matter. If your question can explain a given problem while pointing toward a specific aspect which is missing then your project can get a great deal of support.

Conducting literature review The innovation of any research question is determined by a thorough literature search. Any replication of the study already existing in the literature is not worth repeating as it is. Depending upon the research question, sometimes the study can be replicated if your question approaches an existing problem in a refreshing way.

This can be achieved by using a different populations, different techniques, new conceptual approaches, or linking two different studies in which outcomes did not solve the problem.

The goal of the literature review is to determine what research has been conducted on the topic of interest? PubMed clinical query is an easy and user-friendly database to search for evidence related to clinical practice. This also provides information to search MEDLINE by doing categorical searches, for example, therapeutic, diagnostic, etiological, and prognostic. Other search engines such as OVID has a large selection of texts and journals which provides access to other databases such as Cochrane library in getting full text articles and systematic reviews.

Systematic reviews are rigorous methods of collecting and synthesizing the results of many high-quality studies. Conducting a thorough literature search also helps in finding information on the methodology, calculating the sample size, and also the type of analysis as we are looking to find a difference. This information is necessary to help structure a new study and to identify gaps in the knowledge base of the scientific community. Refining research question A focused research question leads to a systematic planning of a research project.

The difficulty in framing a research question is not due to the lack of ideas. The challenge is to transform a novel research question into a valid study design which is the next step in refining a research question. SUMMARY Asking a well-formulated research question is a starting point in conducting a quality research project and in evidence-based clinical practice. The framework presented in this paper can be helpful for a clinician to formulate a question and search for an answer and for a researcher to develop a new research project.

If it is a well-defined research question, it will lead to an appropriate study design and methodology. Discussing your research question with knowledgeable peers, department chair, mentor, and the biostatistician from the start will lead to the completion of a successful project.

Other steps such as type and phase of the clinical trial, budget, informed consent, sites, resource constraints of both personnel and facilities, and timeline should also be considered while formulating a research question.

Two Types of Clinical Questions

We have introduced the concept of background and foreground questions and also the types of different questions that can arise therapy, harm, diagnosis, and prognosis. We have described several strategies here while highlighting the major steps that will help investigators in framing a question with the goal of finding an answer based on evidence or initiation of a new research project.

In short, a researchable question is what leads toward the facts rather than opinion[ 7 ] and is clearly linked to the overall research project goal. Acknowledgments The authors would like to acknowledge Dr. Eknath Naik, and Dr. Ambuj Kumar for their time in reviewing the paper and providing useful insights. Footnotes Conflict of Interest: From question to proposal. Basic steps in planning nursing research. Jones and Bartlett Publishers; 2006. How to practice and teach EBM.

Elsevier Churchill Livingstone; 2005. How to practice and teach evidence based medicine. Posing the research question: Lippincott Williams and Wilkins; 2007. Applications in dietetic practice. J Am Diet Assoc. Writing the researchable question. J Wound Ostomy Continence Nurs.