How to write a PICO(T) Question : A Nurse/Medical Student's Guide

Written by Brandon L.
August 17, 202319 min read
nursing-picot-question-guide

Nursing school or practice can throw many complex things at you to the extent of stressing you. But giving up is not an option, especially not because of a PICOT question!

Given that nursing is a science, specific best practices are structured. However, for a nursing student or a practicing registered nurse formulating a PICOT question is a mandatory baptism by fire one has to encounter, at least at some point.

Without knowledge of the process of generating sound PICO questions, you can struggle with writer's block and procrastinate writing papers. Not to worry, though; we have put together this guide to help you learn and master how to create PICOT questions. You are lucky because we have explored its definition, format, and process/steps.

Besides, we have included helpful PICOT question examples to help you understand how to formulate them.

You can use the shared PICOT question template to make things easier for you. However, you can trust our professionals if you are strapped for time and need someone to handle your PICOT.

Let's get started!

What is a PICOT Question?

Nursing is considered a science because it entails the use of evidence-based models. These models use a process for framing a question, locating, assessing, evaluating, and repeating, as needed, the PICO elements, a process called the PICOT process.

According to Polit and Beck, a PICOT question assists nurses in performing a systematic inquiry of literature to identify credible, reliable, and valid evidence that can be used in solving different nursing practice-related issues that impact patient care. It helps in a clinical inquiry that promotes evidence-based practice.

A PICOT question is not a research question. Rather, it is a technique that helps formulate foreground clinical or research questions. Majorly, you are not conducting an experiment to study, gather, or analyze quantitative or qualitative data. Rather, your focus when doing a PICOT question is to develop an evidence-based intervention.

The 5 Components of a PICOT Question

It is important to understand the components of a PICOT question to come up with an appropriate PICOT question formula.

PICOT is a mnemonic, meaning that it bears five main components.

  1. Population (P) - Who is the specific population? Where is the population? What is the clinical problem, issue, or health condition related to clinical care the population is facing?
  2. Intervention (I) - What is the evidence-based nursing practice intervention, treatment, or care management strategy?
  3. Comparison (C) - Who is the comparison population that will not receive the intervention?
  4. Outcome (O) - What are the anticipated consequences or clinical outcomes for the population that received the intervention?
  5. Time (T) - What length of time is the nursing intervention being performed for the patient/population to achieve the outcome?

For example, consider a question: Does handwashing among healthcare workers reduce hospital-acquired infections and associated risks compared to non-compliance to hand hygiene protocols?

The question above has the PICO elements. Let's explore it further:

P (problem, patient, or population)Healthcare workers

I (Intervention/Exposure) - handwashing

C (Comparison) - non-compliance with hand hygiene

O (outcome of interest) - reduced hospital-acquired infections and associated risks

Given the 5 components, which you can list on your PICOT question template, you can then convert the components into a PICOT formula in the format below:

In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T)?

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

The scope of the formula will depend on the type of pattern you choose, as we shall explore in the next section.

Pattern, Order, Style, or Formats of PICOT Questions

Once you have the components of your PICOT formula, you can frame your question in 6 different ways depending on the goal/target, the nursing practice problem, or the healthcare issue you are addressing. You can use these PICO formats as a template for asking PICOT questions.

1.      Examining a Diagnosis

These questions relate to or address the actions or processes of identifying or determining the cause and nature of a disease, injury, or disorder through evaluation.

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Example:

2.      Exploring Etiology

These are specific questions that address the origins or causes of a disease or disorder, such as the risk factors.

Are____________________ (P), who have ____________________ (I) compared with those
without ____________________(C) at ____________ risk for/of
____________________(O) over ________________(T)?

Examples:

3.      Investigating Intervention, Therapy, or Treatment

These are questions that address specific treatment approaches for illnesses or disabilities.

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

Examples:

4.      Investigating Meaning

These are questions that address how one experiences a given phenomenon.

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Examples:

5.      Discussing viable Prevention Strategies

These questions relate to preventing diseases, medical errors, or factors that impact health and healthcare services.

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Examples:

6.      Investigating Prognosis or Prediction

These are questions that address the prediction of the cause of a disease.

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

Examples:

PICOT Question Ideas

You can develop PICOT questions to address the following areas in clinical care. Then, as you brainstorm, the respective examples or sample picot questions will come in handy.

PICOT Question Idea

Examples of PICOT Questions

Diabetes type I and II


Emergency Department overcrowding

In Emergency Departments (P), does the application of overcrowding indices (I), compared to raw ED volumes, influence the prognostic accuracy for over-crowding related outcomes (increased error rates, length of stay, staff burnout), reliability, patient/physician satisfaction, and external validity (O)?

Neonatal Intensive Care Unit (NICU)

Among neonates in a neonatal intensive care unit (NICU) (P), does receiving Skin-to-Skin Care (SSC), compared to not receiving SSC (C), improve outcomes of emotional closeness between infant and the mother(O)?


For all neonates (P), should vitamin K prophylaxis (I) be given for the prevention of vitamin K deficiency bleeding (O)?


For neonates requiring prolonged resuscitation and at risk of HIE (P), should head or body cooling (I) be initiated to prevent death and sequelae (O)?


For term, preterm, and SGA neonates with hyperbilirubinemia (P), when should the options of exchange transfusion be performed or phototherapy be instituted (I, C), depending on the day of life (T), in preventing morbidity and sequelae (O)?


In children aged 2-59 months (P), what is the most effective antibiotic therapy (I, C) for severe pneumonia (O)?


In children with acute severe malnutrition (P), are antibiotics (I) effective in preventing death and sequelae (O)?


Check out other examples from the NCBI website to formulate a NICU picot for your paper or assignment.

Catheter-Associated Urinary Tract Infection (CAUTI)

In Post-Acute Care Unit adult patients with indwelling urinary catheters (P), how do Nurse-Led Initiative Interventions (I) compare to usual care affect (C) incidence and rate of CAUTIs (O) within six months (T)?

For hospitalized patients with an indwelling urinary catheter (P), does the use of a criteria-based reminder system (I) reduce the risk of CAUTs (O) compared to the use of no reminder system (C)?


Obesity or childhood obesity

In school-age children (P), what is the effect of a school-based physical activity program (I) on a reduction in the incidence of childhood obesity (O) compared with no intervention (C) within a 1-year period (T)?


Are kids with adoptive parents(I) at an increased risk for obesity (O) compared with kids without obese adoptive parents (C) during ages 5 and 8 (T)?

Central Line CLABSI

In hospitalized patients that have central line access (P), does the use of alcohol-impregnated port protectors (I) have a lower infection rate (O) compared to no alcohol-impregnated port protectors (C)?


Hourly Rounding

In an adult, inpatient hospital setting, does purposeful hourly rounding (PHR), compared to no rounding, reduce patient falls over a period of 30 days during the same time period from the previous year?


In modern healthcare facilities (P), does the hourly rounding technique (I), compared to the no hourly rounding approach (C), reduce patient falls (O) for a duration of 30 days from the preceding year (t)?


In the adult population in acute care settings (P), how does hourly rounding (I) compared to not rounding (C) affect the incidence of falls (O) over a thirty-day period (T)? The pilot project goal is to decrease fall rates by fifty percent at the end of a thirty-day period.


Covid 19

In patients with Covid 19 (P), does the performance or nutrition risk assessment(I) versus non-performance (C)improve clinical outcomes(O)?


In children recovering from Covid-19 (P), does supplemental nutrition (I), compared to ad-lib diet (C), improve growth and weight parameters (O)?


In patients with obesity who have had severe COVID-19 (P), does weight loss (I) vs weight maintenance or weight gain (C) improve metrics of recovery (O)?

Surgical Site Infection

In adult surgical patients (P), how does the use of a universal SSI bundle (I) compared to the usual standard of care (C) affect the

number of SSI (outcomes) within 30 days post-operation (T)?


In adult surgical patients (P), which elements of an SSI bundle(I) provide the best evidence (C) in preventing SSI (O) within 30 days post-operation (T)?


In the prevention of SSIs (O), how does the use of chlorhexidine gluconate (CHG) (I) compared with povidone-iodine or other solutions (C) impact the development of SSIs (O) within 30 days postoperatively (T)?

Stroke

In patients 18 years and older coming into the emergency room (ER) (P), what new interventions in stroke protocol (I) compared to the current interventions (C) will produce better outcomes (O)?

What is the difference between the administration of t-PA and Heparin in patients diagnosed with stroke and success in the prevention of disabilities?


For a patient with stroke, is early rehabilitation impairment-based therapy intervention effective compared to usual care (UC) therapy?


In ischemic stroke patients, how does neurological rehabilitation differ for those who received tPA versus those who did not and proceeded with other anticoagulation therapies to reduce neurological and physical deficits for patients one-year and long-term post-stroke?

In elderly patients 65 years or older who have experienced an ischemic stroke, how effective is acupuncture compared to standard stroke therapy in improving mobility over a 12-week period following the event?

Nurse burnout

Do nurses, who practice stress management, have less burnout compared to nurses who do not practice stress management?


Do nurses who practice regular stress management strategies versus quitting the profession have better outcomes for nurse burnout within six months?


For ED nurses, how does a nurse education program addressing coping skills for work-related stress impact job satisfaction, patient satisfaction scores and reduce nurse desensitization?

For critical care nurses (P), how does burnout education, assessment, intervention, and support (I), compared to no education, assessment, intervention, and support (C), affect nurse-reported burnout and professional wellbeing (O)?

Smoking Cessation


Pressure Ulcers

To be updated

Opioids

In people likely to witness opioid overdose (P), does the provision of naloxone, and training in its administration in the management of opioids (I), compared to treatment, as usual, reduce adverse outcomes (mortality, complications, withdrawal, and morbidity)

Medication Errors

In healthcare settings (P), does wearing the 'do not disturb signs' when administering medications(I) compared to a regular nurse working outfits (C) to patients reduce medical errors (O)?


In a nursing facility (P), does the wearing of 'drug round in progress' tabards during drug rounds (I) compared to standard work uniforms(C) reduce medical error rates (O)?

Among the elderly patients receiving care at Med/Surg floor (P), who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit (I) reduce polypharmacy and its associated adverse reactions (O), compared to no intervention (C)?

Alarm fatigue

Does alarm management education decrease the occurrence of alarm fatigue in critical care nurses?

Do nurses respond to critical alarms more effectively when unnecessary alarms are reduced versus the nurse responding to all false-positive alarms, thereby reducing alarm fatigue and improving responses by nurses?


In telemetry nurses, how does a cardiac/telemetry alarm management policy, guidelines, and education, compared to the current state, affect the reduction of false or non-actionable alarms within six weeks?

Hospital-acquired pressure injuries (HAPIs)

In Patients in an adult clinical care unit at risk of HAPIs (P), does the implementation of a pressure injury prevention (PIP) bundle compared to lack of standardized practice (C) decrease HAPIs (O)


Would the implementation of an evidence-based checklist better(I) compared to no standardized procedure (C) prevent the progression of pressure ulcers (O) in adult Med-Surg patients (P)?


You can formulate a perfect HAPIs PICOT question for your next project based on the PICO questions.

Heart Failure

To be updated

Hypertension

To be updated

Falls

To be updated

Patient Safety

To be updated

Pregnancy and pregnancy complications

  1. For a pregnant person having an induced surgical abortion, is the provision of cervical priming using osmotic dilators or medication by a traditional and complementary medicine professional, associate/advanced associate clinician, midwife, nurse or auxiliary nurse/auxiliary nurse midwife a safe, effective and satisfactory/acceptable alternative to the provision of cervical priming by a physician?
  2. For a pregnant person having a surgical abortion (D&E), is the provision by a traditional and complementary medicine professional, associate/advanced associate clinician, or midwife a safe, effective, or satisfactory/acceptable alternative to the provision of care by a doctor?
  3. For Nurses and Medical Assistants in the OB office, do education sessions on early signs of pregnancy-induced hypertension, comparing the knowledge gained from the pretest to the posttest after the sessions, improve early detection of pregnancy-induced hypertension and reduce complications in pregnant patients in an eight weeks´┐Ż period?
  4. In pregnant women, what is the effect of practicing prenatal yoga during pregnancy compared to no prenatal yoga during pregnancy on lower pain levels during birth?
  5. In pregnant women above 25 years, how does early prenatal care, as compared to no or late prenatal care, increases the chances of successful delivery of the fetus in 10 months?
  6. In pregnant women 25 years and above, how does prenatal suggested daily exercises or activity compared to a sedentary lifestyle reduce pregnancy complications in the antepartum period?
  7. In pregnant women aged 25 years and above, how does following prenatal recommended diets compared to taking marketed prenatal supplements and vitamins decrease the chances of neonatal neural tube defect in the antepartum period?
  8. In first-time pregnant women, how does prenatal education, compared to no education or personal research impact severe pregnancy complications within the 9 months of pregnancy?
  9. Does the provision of education to nurses on the prevention of postpartum hemorrhage in healthcare facilities help reduce its incidences?
  10. For postpartum African-American women, does the use of a hemorrhage response team reduce the future risk of mental death compared to standard care?

ICU PICOT Questions

  1. In mechanically ventilated ICU patients, does positioning the patient in a semi-fowlers position result in a lower incidence of nosocomial pneumonia compared to laying them in a supine position?
  2. In adult intensive care unit (ICU) patients, is early mobilization more beneficial to patient outcomes than maintaining complete bed rest?
  3. Among mechanically ventilated patients in the ICU aged 45 years and above, does the use of oral chlorhexidine compared to no chlorhexidine help reduce the incidence of ventilator-associated pneumonia (VAP) within 8 weeks?
  4. For patients in an adult intensive care unit (ICU), does the use of a nurse-initiated, non-pharmacological sleep-enhancement protocol versus no sleep-enhancement protocol reduce the incidence of ICU delirium over a period of 8 weeks?
  5. What is the best practice that ICU nurses can implement to decrease the incidence of delirium in critically ill patients?
  6. In patients in the ICU settings, does the use of the ABCDE bundle versus standard nursing care and interventions reduce the incidence of delirium?
  7. In patients admitted to the pediatric intensive care unit, how does using the standardized tool for delirium screening compared to no screening tool affect the recognition of delirium
  8. For patients admitted to the intensive care unit with delirium, intubation, or psychosis, would the use of restraints, compared to no restraints, provide staff safety and patient safety, and reduce the risk of self-harm and self-extubation?


These PICOT question nursing ideas can come in handy as you try to gather facts and write a perfect question. If you are stuck, reach out to us or place your order, and a professional will assist you. Caution: there is no PICOT question generator; you must work hard to get the best and most unique question.

Must A PICOT Question be written in Order?

Ideally, most nursing students ask whether a PICOT question must be in the Order of the mnemonic PICOT. An ideal answer would be that although writing a PICOT question in order is preferred, there is nothing wrong with writing it in any order because the format can vary. However, you are good to go if your clinical research question has all the PICOT components and addresses an evidence-based nursing issue. Besides, the goal of writing and the type of study you are doing will most likely determine how you organize your PICOT question.

Below are examples of PICO questions that do not follow the conventional linear arrangement.

  1. Does metformin have high efficacy (I) compared to rosiglitazone (C) when used for glycemic control (O) for children with type 2 diabetes (P)?
  2. Is handwashing (I) among nurses attending to patients in the burn unit minimize (P) hospital-acquired infections (O) compared to alcohol-based hand sanitizers (C)?
  3. Can brief intervention (I) be used as an effective smoking cessation technique(O) for teenagers (P) in high school compared to smoking bans and educational programs (C)?

As you can see from the PICO examples above, you don't necessarily have to write a PICO question in the Order. Rather, if you are asked, for instance, to write a question relating to harm or etiology, swap the I for an E, where E stands for the exposure that a patient experiences.

And because after writing your question, you need to conduct a search strategy, you need to break down every component further. In this case, add two Ts to the PICO mnemonic. So, now for your search strategy, you will have the components below:

Patient (population or problem), Intervention (prognostic factor or exposure), Comparison, Outcome, Type of Question, and Type of Study (PICOTT).

7 Steps for Formulating a PICOT Question

For professional accuracy, we will follow the 7 Steps to the perfect PICO Search Evidence-Based Nursing Practice, an EBSCO Health white paper authored by Kathy A. Jensen, MHA, RN.

You can follow these simple steps to help formulate a good PICOT question for your project, capstone, thesis, or regular class assignment.

1. Write a broad Clinical Question

The PICOT process always begins with stating abroad clinical question. Alternatively, you can start with a nonspecific inquiry. We can use the example below:

What is the effectiveness of early ambulation, compared to bed rest, on decreasing post-op DVTs in adult patients with total hip replacements?

Related Article:

2. Determine the Components of the PICOT formula

Once you have your general question, you can sift the content to develop specific components or keywords for your PICOT formula. In short, you will be structuring your question, beginning with identifying the keywords for the PICOT mnemonic.

P - Adult patients with total hip replacements

I - Early ambulation

C - Bed rest

O - Decrease post-operation deep vein thromboses (DVTs)

Note that we do not have a time limit for the intervention and must drop it.

When finally formulated, your PICOT question will read:

In adult patients with total hip replacements (Patient population), how effective is early ambulation (Intervention of interest) compared to bed rest (Comparison intervention) in decreasing post-op DVTs (Outcome)?

3. Develop an appropriate search strategy

With the PICO question you formulated, you can narrow it down to specific databases and other search sites where you might get information and answers.

Note that you should only lean towards accredited scholarly nursing databases.

You should then formulate a search strategy to maximize the search terms. For instance, you can look up synonyms and phrases related to the intervention.

4. Conduct a search

When searching the databases, begin by searching the PICOT element individually.

For example, when researching post-op patients with DVTs, use the search term "post-op DVTs", but you can also consider "early ambulation post-op-" or "bed rest post-op" as viable search terms.

Note that you can combine searches into one search to get better results.

Remember, you will be looking for qualitative or quantitative articles to help answer your PICOT question.

5. Refine the Results

The next step is to refine the results yielded from the search. You can do so by adding limiters. Limiters are control parameters that allow you to focus your results on the most important and relevant content without going through outdated, invalid, or irrelevant evidence to answer the PICO question.

 Some limitations can include the publishing date, evidence-based study, or type of study.

Using the Evidence-based Practice limiter ensures that you get evidence-based journals, articles focusing on EBP, and research articles (case studies, meta-analyses, RCTs, systematic reviews, clinical trials, and research papers on EBP.

6. Review your literature

Check the results for credibility, validity, and relevance in answering your PICOT question. Then, choose the studies that have met your search threshold or limit.

If there are articles viable to your study that are not available in full-text, check whether the librarian could locate them for you. You can also search the web for PDF copies of the same, in case someone is generous enough to upload the article to their website or blog.

7. Assess the strength of the evidence

As a matter of completing your PICO search, you should be able to categorize the articles based on the hierarchy of evidence. The hierarchy of evidence determines the strength of evidence. Therefore, select the journal articles based on the highest level of evidence, such as systematic reviews and meta-analyses, and use them to answer your PICO question.

Those who have adopted the seven-step PICO framework have found the search process easy. You can then fill out the PRISMA diagram to document your search and write up your nursing project, dissertation, capstone paper, or thesis. Next, look at our guide on how to write a change project.

Summing Up

Check out the video by Binghamton University Libraries to further internalize the concept.

Related Articles:

This guide can be used by healthcare and medical sciences students and practitioners, such as those pursuing pharmacy, nursing, public health, and medicine, to formulate and format a PICOT question.

If you have questions, concerns, or need clarifications, reach us through our CHAT system. You can also place an order and have your PICOT question written based on your interest, practice problem of preference, or the research direction you intend to take. We are here to nurse your grades!

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