Going in the

1
Going in the Write Direction Amy Curry, MS,
CCLS Texas Childrens Hospital Lindsay Heering,
CCLS, CTRS Childrens Hospital of
Michigan Jennifer Fieten, MA, CCLS Evidence Based
Practice Committee Child Life Council
27th Annual Conference on Professional
Issues Boston, Massachusetts
What are PICO questions?
PICO Question Worksheet
A method for creating a clearly defined,
searchable, answerable question to help
effectively search for evidence. PICO is an
acronym that comes from the components of the
question P Patient characteristics/Population
of interest I Intervention of interest C
Comparison intervention of interest O
Outcome of interest
Applying PICO Questions to Child Life
1. Develop your PICO question A PICO
question will help you determine your search
strategy.
PICO questions lead you to precise and high
quality evidence. They are vital to implementing
evidence-based decisions. In (population of
interest) Is (intervention of interest) Better
than (comparison of interest) At (outcome of
interest)?
Patient/Population Infants
Intervention NICU
Comparison Intervention Not being in NICU (no comparison)
Outcome Attachment
Write your question In infants, what is the effect of being in the NICU on attachment compared with not being in the NICU?
How do PICO questions fit within evidence-based
practice?
There are five steps in evidence-based practice
1. Ask the question 2. Search the evidence 3.
Analyze the evidence 4. Apply the evidence to
practice 5. Evaluate the evidence The PICO
method assists the professional in creating a
well-defined question to effectively search the
evidence to answer the practice question.
Population or Patient Characteristics The patient population or disease of interest Illness/diagnosis/injury Chief complaint/main symptom Behavior Age Gender Ethnicity Other factors
Intervention The intervention of interest Intervention A (i.e. preparation, oral sucrose, non-pharmacological pain management) Procedure Treatment or medication Having a disease
Comparison Intervention The comparison intervention of interest Intervention B No intervention (i.e. standard care) Placebo No disease Single method versus a combined approach (i.e. A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children) A comparison intervention may not be necessary for all questions.
Outcome The outcome or goal being measured Pain scores Anxiety level (i.e. heart rate/blood pressure) Understanding of disease
2. Identify the type(s) of study to include
in your search (check all that
apply) ? Systematic review ?
Cross-sectional study ? Meta-analysis ?
Review of qualitative studies ?
Quantitative study ? Randomized control trials
? Qualitative study ? Controlled trial
without randomization ? Case control ?
Expert opinions ? Cohort ? Textbooks,
non-EBP guidelines 3. List alternative
search terms for the various parts of
your PICO question
How can PICO questions fit within research
projects and setting?
Evidence-based practice relies on research for
evidence, and evidence-based practice can point
to gaps in the research that need investigation.
When developing the literature search for the
research project, the PICO method can be used to
locate an increased number or better quality of
results.
P Infants, neonates, newborn, pre-mature
I NICU, neonatal intensive care unit
C (no comparison)
O Attachment, parental bonding, parent-child interaction
Accessing Evidence Utilize Your Resources
4. Define limits for your search

• Use your medical library
• A medical librarian can save you time by
  searching multiple sources for information
• Request your medical librarian to in-service your
  department
• 2. Use the Internet many databases are
  available online

Human, English language, no time limits
5. List the databases you intend to search
PubMed, CINAHL, Cochran, PsycInfo, Scopus
Searching the evidence using a PICO question
References
Cochrane Reviewers Handbook (2003). Section 4
Formulating the problem. Found at
http//www.cochrane.dk/cochrane/handbook/hbook.ht
m. Accessed February 8, 2009. Counsell, C.
(1997). Formulating questions and locating
primary studies for inclusion in systematic
reviews. Annals of Internal Medicine, 127,
380-387. Melnyk, B. Fineout-Overholt, E.
(2005) Evidence-Based Practice in Nursing and
Healthcare. Philadelphia Lippincott, Williams
Wilkins. Miller, S. (2001). PICO Worksheet and
Search Strategy, National Center for Dental
Hygiene Research. Stone, P. (2002). Popping the
(PICO) question in research and evidence-based
practice. Applied Nursing Research, 16,
197-198. Stratus, S. Sackett, D. (1998) Getting
research findings into practice Using research
findings in clinical practice. British Medical
Journal, 317, 339-342.
1. Determine the search terms from the PICO
question 2. Identify alternatives/synonyms for
search terms 3. Select the databases that will
contain the information that you want to
find 4. Enter search terms and alternative
search terms in databases to find relevant
materials