Introduction: The First Step In Doing Evidence-Based Practic ✓ Solved

Introduction The First Step In Doing Evidence Based Practice

The first step in doing evidence-based practice research is forming a researchable question. Questions that are too broad or too narrow can hinder research. Examples: Too broad: How do you control infection? Too narrow: At the Johns Hopkins NICU, what is the best way to control infection among Asian American babies born at 32 weeks? Just right: In the NICU, what is the effect of hand washing on infection control compared with hand sanitizers, over 6 months?

This module covers: using PICOT as a guide in developing a researchable question and turning your PICOT into search terms.

PICOT is a mnemonic for a well-focused question: P = Patient, Population or Problem; I = Intervention, Prognostic Factor, or Exposure; C = Comparison (optional); O = Outcome; T = Time.

Once you've identified each aspect of your PICOT, here is a formula you can use to turn it into a question: In ___________ (P), what is the effect of ___________ (I) compared to _____________ (C) on __________ (O) over _____________ (T)? For example: In the NICU, what is the effect of hand washing compared to hand sanitizers on infection control over 6 months?

Search terms: After you've developed a PICOT question, identify keywords or search terms to use in Library databases to find relevant articles. Strategies include brainstorming synonyms, expanding acronyms, and looking at subjects. Brainstorm synonyms: for each aspect, think of other words or phrases with similar meanings. For example, some synonyms for hand sanitizers could be: hand rubs; hand disinfection. Expand out acronyms: if your topic includes acronyms like NICU, search using both the acronym and the full phrase: NICU OR Neonatal Intensive Care Unit. Look at subjects: most databases assign item subjects based on the main topics covered in the item; these subjects often align with search terms.

Here is an example of how to find subjects in the CINAHL Plus with Full Text database: 1) In the database, enter an aspect of your topic in the first search box (e.g., Hand Sanitizers). 2) Run the search. Note: this search helps identify relevant subjects and you should not over-restrict with additional terms. 3) Under the citation information for each result, check the Subjects area to determine which subjects best fit your topic. For this topic, promising subjects might include: Handwashing Standards, Handwashing Equipment and Supplies, Antiinfective Agents, and Cross Infection Prevention and Control. For more guidance on selecting and combining search terms, please consult guides such as Keyword Searching: Keyword Search Strategy and Keyword Searching: Boolean; and institutional guides like Duke University Medical Center Library: Asking the Well Built Clinical Question, University of Oxford: Centre for Evidence-Based Medicine: Asking Focused Questions. You may also encounter references such as Moyer (2008) and Huang, Lin, & Demner-Fushman (2006) addressing PICO as a knowledge representation and a framework for searching literature.

Paper For Above Instructions

Developing a rigorous, answerable research question is the cornerstone of evidence-based practice (EBP). The PICOT framework helps clinicians and researchers articulate a question that is specific enough to yield actionable evidence while remaining broad enough to find relevant literature. A well-formulated PICOT question clarifies who or what is being studied (P), what intervention or exposure is of interest (I), what comparison or alternative is considered (C, optional), what outcome matters (O), and over what time period the observation occurs (T). This clarity is essential because it guides the subsequent steps of evidence appraisal, synthesis, and translation into practice (Sackett et al., 1996; Melnyk & Fineout-Overholt, 2015).

Understanding each PICOT element is critical. The Patient, Population, or Problem defines the group under investigation. The Intervention, Prognostic Factor, or Exposure identifies what will be implemented or observed. The Comparison establishes a baseline or alternative against which the intervention is judged. The Outcome specifies what effects or results will be measured. The Time component ensures the study captures an appropriate duration to observe meaningful changes. When these elements are clearly articulated, researchers can construct search strategies that efficiently retrieve relevant studies. A common formula—In [P], what is the effect of [I] compared to [C] on [O] over [T]—serves as a template to translate the question into database searches (Melnyk & Fineout-Overholt, 2015).

Translating PICOT into search terms begins with breaking down each component into keywords, synonyms, and related terms. Brainstorming synonyms expands the vocabulary and increases the likelihood of capturing relevant articles. For instance, hand sanitizers can be expressed as hand rubs or hand disinfection, and the NICU can be represented as Neonatal Intensive Care Unit to capture variations in terminology (Huang, Lin, & Demner-Fushman, 2006). Expanding acronyms helps ensure retrieval across different databases and indexing terms (CEBM, n.d.).

Examining database indexing and subject headings is another critical step. Many databases assign subjects that reflect core topics within an article. Identifying appropriate subject terms—for example, Handwashing Standards, Handwashing Equipment and Supplies, Antiinfective Agents, and Cross Infection Prevention and Control—facilitates more precise retrieval than keyword searches alone. Guides from established institutions emphasize starting with a PICOT question, then translating each component into keywords, synonyms, and controlled vocabulary (Duke University Medical Center Library, n.d.; University of Oxford CE BM, n.d.).

Developing search strategies also involves using Boolean operators and database-specific features. Boolean logic (AND, OR, NOT) allows you to combine terms to refine searches, while truncation and phrase searching can broaden or narrow results as needed. Educational resources highlight creating iterative search strings: begin with a broad query and progressively refine it with related terms, synonyms, and subject headings. Scholarly guides and professional resources—such as Moyer (2008), Huang et al. (2006), and systematic-review handbooks—advise documenting search strategies for transparency and reproducibility (Booth, Sutton, & Papaioannou, 2016; Melnyk & Fineout-Overholt, 2015).

Practically, a novice researcher might start with a PICOT question in a clinical context, then map each element to terms that can be searched in databases such as CINAHL, PubMed, or Embase. For example, a search for hand hygiene in neonatal care could combine terms like “hand washing” OR “hand hygiene” AND “infection control” AND (NICU OR “Neonatal Intensive Care Unit”). The aim is to identify high-quality studies, systematic reviews, and clinical guidelines that address the outcomes of interest within the specified population and time frame. Throughout this process, it is essential to consult reputable guides and evidence-based practice resources, which provide templates, examples, and checklists to ensure methodological rigor (Sackett et al., 1996; Guyatt et al., 2008; Oxford CE BM, n.d.).

Ultimately, the integration of PICOT-driven questions with structured search strategies enables practitioners to gather robust evidence that informs clinical decisions. The iterative nature of this process—refining the question, expanding search terms, and evaluating the quality and applicability of findings—reflects the core principles of evidence-based practice. By adhering to established frameworks and leveraging authoritative guides, researchers can produce well-grounded, practice-relevant conclusions that improve patient outcomes (Melnyk & Fineout-Overholt, 2015; Booth et al., 2016).

References

  • Sackett, D. L., Rosenberg, W. M. C., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal, 312(7023), 71-72.
  • Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (3rd ed.). Wolters Kluwer.
  • Guyatt, G., Rennie, D., Meade, M. O., & Cook, D. (2008). Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice (2nd ed.). McGraw-Hill Education.
  • Centre for Evidence-Based Medicine (CEBM). (n.d.). How to ask focused clinical questions. Retrieved from https://www.cebm.net/
  • Moyer, V. A. (2008). Weighing the Evidence: PICO Questions: What Are They, and Why Bother? AAP Grand Rounds, 19(1). doi:10.1542/gr.19-1-2
  • Huang, X., Lin, J., & Demner-Fushman, D. (2006). Evaluation of PICOT as a Knowledge Representation for Clinical Questions. AMIA Annual Symposium Proceedings, 359–363.
  • Duke University Medical Center Library. (n.d.). Asking the Well Built Clinical Question. Retrieved from https://library.duke.edu
  • University of Oxford Centre for Evidence-Based Medicine. (n.d.). Asking Focused Questions. Retrieved from https://www.cebm.ox.ac.uk
  • Booth, A., Sutton, A., & Papaioannou, D. (2016). Systematic Approaches to a Successful Literature Review. Sage.
  • O'Leary, Z. (2017). The Essential Guide to Doing Your Research Project. SAGE Publications.

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