The first step of the EBP process is to ask an answerable question. How do you come up with a question? Let's see, you may be frustrated with ineffective procedures and you ask yourself, is there a better way? Or you want to help a stroke patient with her balance and gait recovery, and you wonder if newer therapies, such as the use of VR (virtual reality), have shown improvements with stroke patients? A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.
An answerable question has a format that follows the PICO concept. The acronym translates to:
P=Patient/population
I =Intervention
C=Comparison
O=Outcome
T=Time
Initially only four components were included. Later, Melnyk and Fineout-Overholt (2010) added a fifth, representing time (i.e., the time it takes for the intervention to achieve an outcome, or how long participants are observed).
PICO Example 1
Does feeding via the transpyloric route vs. the gastric route improve feeding tolerance, and growth and development without increasing adverse consequences?
Patient/population : Pediatric patients admitted to the PICU who are mechanically ventilated
Intervention : Placement of postpyloric feeding tubes for all mechanically ventilated patients
Comparison : Postpyloric feeding tubes versus gastric feeding tubes
Outcome : Decreased incidence of aspiration pneumonia in the PICU patients receiving long-term mechanical ventilation
adapted from Fast Facts for Evidence-Based Practice in Nursing.
PICO Example 2
Will the emphasis of nursing assessment regarding need for and the early removal of indwelling catheters decrease the number of catheter device days and the incidence of CAUTIs?
Patient/population : Patients with indwelling catheters and increased number of CAUTIs
Intervention : Nursing assessment regarding need for and the early removal of indwelling catheters
Comparison : Without the emphasis of nursing assessment
Outcome : Decreased incidence of CAUTIs and decreased length of hospital stay
adapted from Maryland Hospital Association.
Godshall, M. (2016). Fast Facts for Evidence-Based Practice in Nursing (2nd ed.). New York: Springer Publishing Company.
Melnyk B. M. & Fineout-Overholt E. (2019). Evidence-based practice in nursing & healthcare (4th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.