Nursing: PICOT

Evidence-based models use a process for framing a question, locating, assessing, evaluating, and repeating as needed. PICOT elements include: Problem/Patient/Population, Intervention/Indicator, Comparison,  Outcome, Time.

  1. Frame the question: write out your information need in the form of a question, for example:

   Does hand washing among healthcare workers reduce hospital acquired infections? 

  The question above includes the PICO elements:
 

    2. Plan a search strategy by identifying the major elements of your question, and translate natural language terms to subject descriptors, MeSH terms, or descriptors. 

TIP: As you conduct an initial scoping search, start with the P and the I only and keep initial search results broad:
 

A simple database search strategy should begin with the P AND I:   

cross infection AND  (Handwashing OR Hand disinfection) 
 

Start with both  CINAHL and Medline/PubMed as initial article databases for a scoping search for most health sciences questions.

   3. After viewing the initial search results you may decide to narrow your search with terms for the Comparison, Outcome, Time factors or Type of study. Or you may view results, abstracts, and full text of articles to view the comparison and outcome elements. Use database filters, explained in Filtering the Evidence.

*Heneghan, C., & Badenoch, D. (2002). Evidence-based medicine toolkit. London: BMJ Books.

Retrieving too few articles?  Below are ways to expand (broaden) your search:

• Harvest added search terms (synonyms for one or more of your search terms) by viewing the records retrieved in your initial search. For example, a search for health care reform may retrieve citations described with added terms you can "harvest" for an expanded search:

  health care reform bill OR health care bill OR (Patient Protection and Affordable Care Act) OR Affordable Care Act OR PPACA OR Health Care Reform/legislation & jurisprudence [MeSH] OR Obamacare

• Use the online thesaurus.  Each database has an online thesaurus of controlled vocabulary terms.

o       In CINAHL, use the CINAHL Headings link to explore the tree structure of terms; EXPLODE to include narrower terms

o       In PubMed, do a search using the MESH dropdown option; explore the tree structure of terms; using a broader term automatically EXPLODES to include narrower terms

• Truncate one or more of your search terms

o       Truncation symbols in a database, such as * or ?  allow you to search on a root word and include plurals

• Diab* (to retrieve diabetes, diabetic, diabetogenic)
• Autis* (to retrieve autism, autistic)
• Nurs* (to retrieve nurse, nurses, nursing, etc.). 

o       Warning! Truncation may also retrieve false hits.  A search on nurs* retrieves  “nursery school”

• "Citation pearl growing" uses a relevant source to lead to more sources on a topic.
   
  • Look for a link to "Related" articles or “find similar results."  Also known as "snowballing."
  • From a relevant article, follow up on citations in the bibliography (the "ancestry" method)
  • Use the "cited references" feature if available.

• Try another database.  Often the scope of the database doesn't match your search needs.
   
• Pre-evaluated, pre-synthesized sources (including “systematic reviews”) aggregate the best evidence for a given topic.  They may appraise the quality of studies and often make recommendations for practice.

Retrieving too many articles?  Below are ways to narrow a search:

• View the online thesaurus. Select a narrower, more specific term for your topic, for example:
   
  • in PubMed, search the MeSH thesaurus on infection and notice narrower MeSH terms such as  catheter-related infections [MeSH]
  • In the CINAHL thesaurus, Education, Nursing is a broad term, with narrower headings for 
       Education, Nursing, Baccalaureate
       Education, Nursing, Graduate

• Narrow with subheadings (restrict your search to a subtopic of interest) 

  • e.g., in PubMed:  Hand hygiene/standards

  • e.g., in CINAHL:  Management Styles/trends
     
• Apply LIMITS. Use the feature that allows you to edit or limit search results:

• LIMIT by article type/publication type, by level of evidence

• • Are you looking for an overview of a topic?  "Review" articles synthesize a review of the literature that an author conducts at a certain point in time.  A good quality review article may provide a useful overview and starting point.
     
• LIMIT by Age group if appropriate.
   
• LIMIT results by year of publication, language, etc.

• Limit by using tools that apply preformulated filters to search topics, for example:

o       PubMed Clinical Queries http://www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical (PubMed research methodology filters are explained here)

o       CINAHL Clinical Queries (click on “Show More, Search Options, to locate limits for clinical queries filters)

• Pre-evaluated, pre-synthesized sources (including “systematic reviews”) aggregate the best evidence for a given topic.  They may appraise the quality of studies and often make recommendations for practice.
   

Thanks goes to Susan Kaplan Jacobs for allowing me to base this LibGuide on her library guide for NYU.