How to Use the PICO Model for Evidence-Based Nursing Practice

The #PICO model is a framework for developing clinical questions that can be answered by evidence-based practice (EBP). #EBP is the process of using the best available research evidence, clinical expertise and patient preferences to make decisions about patient care. EBP can improve patient outcomes, reduce costs and enhance nursing practice.

The PICO model consists of four elements:

Patient/Problem, Intervention, Comparison and Outcome.

These elements help to define and refine the clinical question and guide the search for relevant research articles. The PICO model can be applied to different types of #clinical #questions, such as therapy, #diagnosis, prognosis, etiology and prevention.

How to Use the PICO Model

The following steps can help to use the PICO model effectively:

1. Identify the patient or population of interest. This can include characteristics such as age, gender, diagnosis, setting or risk factors.
2. Identify the intervention or exposure of interest. This can include treatments, tests, procedures, exposures or behaviors that are being considered for the patient or population.
3. Identify the comparison intervention or exposure, if applicable. This can include alternative treatments, tests, procedures, exposures or behaviors that are being compared with the intervention or exposure of interest.
4. Identify the outcome of interest. This can include the effects or consequences of the intervention or exposure on the patient or population, such as symptoms, quality of life, morbidity or mortality.
5. Formulate a clear and focused question using the PICO elements. The question should be specific and answerable by research evidence.
6. Search for relevant research articles using the PICO elements as keywords. The search can be refined by using filters such as date range, language, study design or publication type.
7. Appraise and synthesize the research evidence using critical appraisal tools and methods. The quality and relevance of the research articles should be assessed and the results should be summarized and integrated.
8. Apply and evaluate the research evidence in relation to the clinical question and context. The applicability and feasibility of the research evidence should be considered and the impact on patient care and practice should be evaluated.

Download 7 Steps to the Perfect PICO Research White Paper PDF

Example of Using the PICO Model

The following is an example of using the PICO model to answer a clinical question:

• Clinical scenario: You are a nurse working in a primary care clinic. You have a patient who is a 45-year-old male smoker with hypertension and dyslipidemia. He wants to quit smoking but has failed several attempts in the past. He asks you for advice on how to quit smoking successfully.

P: 45-year-old male smoker with hypertension and dyslipidemia

I: Nicotine replacement therapy (NRT)

C: No nicotine replacement therapy

O: Smoking cessation rate at 6 months

• Question: In 45-year-old male smokers with hypertension and dyslipidemia, does nicotine replacement therapy compared with no nicotine replacement therapy increase smoking cessation rate at 6 months?
• Search: Using PubMed database, you enter the following keywords: ("nicotine replacement therapy" OR NRT) AND ("smoking cessation" OR "quit smoking") AND (hypertension OR dyslipidemia) AND (male OR men) AND ("45 years" OR "middle aged"). You apply filters such as English language, randomized controlled trials and publication date within 5 years.
• Appraisal: You find 10 relevant articles that meet your inclusion criteria. You use a critical appraisal tool such as CASP (Critical Appraisal Skills Programme) to assess the quality and validity of each article. You find that most of the articles have high quality and low risk of bias.
• Synthesis: You use a method such as GRADE (Grading of Recommendations Assessment, Development and Evaluation) to synthesize the results and assign a level of evidence and strength of recommendation. You find that there is moderate quality evidence that nicotine replacement therapy increases smoking cessation rate at 6 months compared with no nicotine replacement therapy in 45-year-old male smokers with hypertension and dyslipidemia.
• Application: You discuss the findings with your patient and explain the benefits and risks of nicotine replacement therapy. You consider his preferences and values and help him to make an informed decision about his smoking cessation plan. You provide him with resources and support to quit smoking successfully.
• Evaluation: You follow up with your patient at regular intervals and monitor his progress and adherence to nicotine replacement therapy. You measure his smoking status using objective methods.

Conclusion

The PICO model is a valuable tool for nurses to develop clinical questions that can be answered by evidence-based practice. By using the PICO model, nurses can identify the key elements of their clinical question and search for the best available research evidence to inform their decision making. The PICO model can also help nurses to appraise and synthesize the research evidence and apply it to their clinical context and patient preferences. The PICO model can enhance the quality and effectiveness of nursing practice and improve patient outcomes.

References

1. Conner, Brian T. (June 2014). Differentiating research, evidence-based practice, and quality improvement.

American Nurse Today, Vol. 9 No. 6.

2. Houser, J. (2018). Nursing Research: Reading, Using And Creating Evidence. Burlington, Massachusetts: Jones

& Bartlett Learning.

3. Melnyk, B.M. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA:

Lippincott Williams & Wilkins. pp. 3–7.

4. Schub, E. B., & Walsh, K. C. (2017). Evidence-Based Nursing Practice: Implementing. CINAHL Nursing Guide.

5. Yensen, J. (2013). PICO Search Strategies. Online Journal of Nursing Informatics (OJNI), 17 (3).