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Subject guides

Nursing: PICO and clinical questions

A subject guide for nursing.

Using PICO

PICO is a tool that can help you deal with clinical scenarios where you don't know the answer to a patient's question, or know the answer but need evidence to support you.

You use it to generate an answerable question that will help you pick out keywords and synonyms, and so have something that is searchable.  PICO is used in professional practice, and is strongly advocated as a tool in the NHS.  You should also find it an important tool when developing a question for your final year project.

You may have heard of similar methods of developing answerable clinical questions, such as SPICE, but we mainly refer to PICO.

P I C O

PICO stands for:

P - patient, population, or problem.  What is the disease or condition you need to research?  What characteristics of the patient or population are important?  Do you need to consider age, gender, or any other characteristics?  Does the patient have any other conditions or medications that they take?

I - intervention.  What is the plan for the patient?  Usually this will be a form of treatment, but it may also involve monitoring the patient to check diagnosis.  It may also need consideration of the frequency or strength of treatment.

C - comparison.  Is there a comparitive action to the intervention?  Sometimes there will be an alternative treatment, sometimes you will have no administered comparison and would use non-treatment as an alternative.

O - outcome.  What are the intended and potential outcomes?  There may be successful treatment, but there may also be potential side effects or problems to consider.  You may also need to look at cost effectiveness, or other organisational outcomes.  Outcomes should also be measurable where possible, in terms of speed and scale of improvements, or the number/severity of side effects, in order to assess whether the intervention was an improvement on the comparison.

Examples

[Examples modified and drawn from Glasper, A. and Rees, C. (2013) How to Write Your Nursing Dissertation]


The following examples may help you put PICO into practice.  Suggestions in the brackets are just extra ideas for what you might want to consider.

1) Isobel is a 45 year old woman who asks you for advice on natural ways of resolving her depression.  She's particularly interested in whether she'd gain any benefits to her mental health from exercising.

P - 40 plus year old woman with depression (but also ask whether you need to know the severity of her depression, and whether she has any other health conditions that may suffer or benefit from exercise)

I - Exercise (but what type and how strenuous?)

C - Antidepressants (what strength and for how long?)

O - Reduced or eradicated depression.

So your question might be:

  • How does the use of exercise compare to medication in treating depression in middle-aged women?


2) Fred is 72, and is undertaking therapy for recovery from a stroke which affected his mobility.  His daughter is a strong advocate of acupuncture, and has suggested he ask about it at his next appointment with you.

P - Men in their 70s who have suffered from stroke

I - Acupuncture (but duration, frequency etc?)

C - Fred's current therapy

O - Higher recovery rate (in terms of time of recovery and level of improvement to mobility)

So your question could be:

  • How effective is accupunture in improving mobility in elderly male stroke patients in comparison to standard stroke therapy?

Your questions might not match these exactly, but they should contain all the elements from your PICO answers, and your choice of comparison and outcome will modify your question somewhat.  For example, you might modify your question to include specific brands/types of therapy such as light jogging versus a specific drug in the depression scenario.

Using PICO to aid searching

Once you've attributed each element of your scenario to PICO, you can then start to look at formulating a list of synonyms to use in searching.

Using the depression and exercise example above, we could look at it like this (we are sure you can think of many more alternative terms though!):

PICO answer Synonym 1 Synonym 2
40 year old woman middle aged woman middle aged female
Exercise physical therapy physical exertion
Antidepressants [name of antidepressant]    medication
Reduced depression    treatment of depression   management of depression