PICOT/PICo and practice questions

The focus for Week 2 is on questions: PICOT/PICo and practice questions.

• Using the area of interest from Week 1, identify the following.
• Will you be using a quantitative or qualitative approach for your EBP project proposal?
• Explain why this approach is the best one to provide information for your area of interest.

PICOT/PICo question using the PICOT/PICo format for quantitative and PICo for qualitative approaches.

• Identify your practice question, being sure to include the following.
• For a quantitative approach
• A questioning part such as “what is,” “what are,” “is there,” or “are there”
• Population being studied
• Variables being studied
• Suggestion of the relationship between variables
• For a qualitative approach
• Phenomenon or concept of interest
• Group or population of interest
• Suggestion of which qualitative research design is being used

Information given to me on this week assignment are below:

To develop an EBP PICOT/PICo question as well as a research question, numerous sources can trigger the spirit of inquiry, or to put it simply, the “I wonder . . . ?” The sources include, but are not limited to, the following.

Identification of a concern in a practice area (i.e., “I wonder how I can prevent . . . “)

Inconsistencies found in professional literature (i.e., Article A says I should do X, but Article B says that the preferred action is Y. I wonder which one is correct for my practice area.”)

Problems occurring with the practice area (i.e., “This has been a problem in the unit as long as I can remember; I wonder how I can improve the . . .  “)

Reviewing nursing theory (i.e., “I read that knowledge helps with self-care; I wonder whether it would help to foster patient compliance with . . .  )

Although the source of the EBPPICOT/PICo or research study question can vary based upon your practice area and its related events, the role of nursing theory is where this week begins.

How Do I Use a Nursing Theory With an EBP PICOT or Research Study Question?

It has been acknowledged that research studies and nursing or other theories have a reciprocal relationship that can occur in two directions. The two directions are theory-testing research and theory-generating research.

Theory-testing research

The first direction is theory-testing research, in which the researcher starts with a nursing theory. The research is then used to expand a theory as well as identify needed changes or modifications. Using a deductive thinking and reasoning approach, the researcher begins with an abstract thought or concept that comes from a theory and then moves toward more specific application. From this direction, theory stimulates and directs a specific research study that results in theory testing. In theory-testing research studies, theoretical statements or concepts are translated into research questions. The results from the study will either confirm (i.e., support) or contradict the theory. If the study confirms the theory, then the theory becomes stronger because the theory correctly reflects what is occurring in the real world. If the research study findings contradict the theory, then either additional research studies are needed to determine whether the research study was flawed or if the theory is wrong. Many times, the theory is revised or refined so that it now reflects the real world. With theory-testing research studies, the

researcher starts with a research question from a current theory and designs a research study with the intention of testing (or verifying) that the theory reflects the real world.

Evidence-based practice project coordinators evaluate the research study findings to determine if they apply to the practice question that has created the PICOT question.

Theory-generating research

The second direction is when a research study starts with an area of interest. The researcher then identifies and describes relationships about the area of interest or phenomena found from the research findings. Using an inductive thinking and reasoning approach, the researcher moves from facts to theory. Real-world observations or measurements of selected area of interest or phenomena using research study design develops theories based upon real-world research results.

Evidence-based practice project coordinators evaluate the research study findings to determine if this new theory applies to the practice question that has created the PICOT question.

Research studies create new information or facts and EBP projects utilize new information or facts and EBP projects utilize new information or facts to inform best practices through application within a specific environment or specific group or individual.

Theory can be used to define terminology or concepts used within a research study or EBP project. From the previous example, the concept of self-isolation should be defined using the definition from Beck’s theory rather than some other source.

Theory can help organize numerous research findings on the same area of interest or phenomena. For example, Beck’s theory could be used to organize all of the factors that contribute to postpartum depression. So all of the research study articles on self-isolation could be organized together.

With theory as well as other sources contributing to the spirit of inquiry, the lesson turns to developing questions from the area of interest using the PICOT/PICo format and writing research study questions. Comparing and contrasting these questions helps to clarify the differences between EBP projects and research studies.

How Do I Develop a PICOT/PICo Question?

The first step with evidence-based practice is identifying the area of interest which leads to the development of searchable, answerable EBP project question; the PICOT/PICo. Although the focus of the PICOT/PICo question will be clinical and use a quantitative approach, please know that the PICOT/PICo format is useful, but modified for a qualitative approach.

Clinical questions come from areas of interest that are often practice problems or concerns, with the goal frequently focusing on quality improvement. In other words, determine ways to improve patient healthcare outcomes (i.e., a better medication to control the pain). Clinical practice problems are often categorized into two types.

Problem focused: These often focus on quality concern, safety or risk management, or unsatisfactory patient outcomes.

Knowledge focused: These focus on learning information to change standards or guidelines or develop new philosophies or applications of care.

Clinical questions that focus on the quantitative approach are formulated in a structured, specific way.

The PICOT Parts

P: Patient, population, or problem—describe the patient, population, or problem succinctly; may be useful to include characteristics such as age, gender, and/or symptoms

Example: age, gender, ethnicity, certain disorder

I: Intervention—focus on treatment or intervention

Example: therapy, exposure to disease, prognostic factor A, risk behavior

C: Comparison with other interventions, though not all questions will have comparison group or comparison intervention

Example: alternative therapy, placebo or no intervention or therapy, prognostic factor B, absence of risk factor

O: Outcomes that are measurable—note outcome of interest; such methods to measure results

Example: outcome expected from therapy, risk of disease, accuracy of diagnosis, rate of occurrence of adverse outcome

T: Time—specify time frame for investigating influence and impact upon identified outcomes

Example: time it takes for the intervention to achieve the outcome; time over which populations are observed for the outcome to occur given a certain condition

But qualitative research questions have a different format (recall the differences between quantitative and qualitative approaches presented in Week 1). The format is as follows.

The PICo Parts

P: Participants—in qualitative approach, the “subject” is referred to as a participant

Example: individuals who are receiving chemotherapy

I: Interest—the phenomenon or area of interest to the EBP project coordinator; the EBP project coordinator identified event, activity, experience, or process

Example: sense of encouragement

Co: Context—the circumstances or setting surrounding an event

Example: taking oral chemotherapy medications in the privacy of one’s own home

*Note that in all EBP projects individuals that are the focus of the project are called “participants” and in research studies the individuals that are the focus of the project are called “subjects”.

To help develop PICOT questions, different formats have been developed to accommodate clarification of different types of areas of interest. Questions templates for asking specific PICOT questions include the following.

Intervention

In _____ (P), how does _____ (I) compared to _____ (C) affect _____ (O) within _____ (T)?

Prognosis/Prediction

In _____ (P), how does _____ (I) compare to _____ (C) influence or predict _____ (O) over _____ (T)?

Diagnosis or Diagnostic Test

In _____ (P) are/is _____ (I) compared to _____ (C) more accurate in diagnosing _____ (O)?

Etiology

Are _____ (P), who have _____ (I) compared to those without _____ ( C) at risk for/of _____ (O) over _____ (T)?

Meaning

How do _____ (P) with _____ (I) perceive _____ (O) during _____ (T)?

How Can a PICOT/PICo Question Lead to a Research Question?

Most times when conducting a comprehensive literature review will produce the answer to your PICOT/PICo question. But there are times, especially when the research studies are lacking the necessary information, provides conflicting information, or fails to fit the specific situation, then a research study must be designed. (Note here that if you discover tat there is little or no research to answer the EBP PICOT question, then a research study must be developed. Master’s-prepared nurses are qualified to initiate, lead, and complete EBP projects; only individuals with doctoral degrees may be the principle investigator for research studies). Turning a spirit of inquiry resulting from an area of interest to an EBP PICOT that does not have sufficient research study support into a research study question requires consideration of the following elements.

Is it feasible?

Does the researcher have time and resources ( e.g., money, available subjects)?

Is it interesting?

Would other members of the profession be interested in your answer?

It is ethical?

Would harm to subjects be avoided?

Perhaps the strongest evaluation of any research question is, ” Does it pass the ‘so what’ test?” To answer this question, reflect on the following: Would someone or an organization be helped by determining the answer to the question?

If you can answer yes, then your question has passed the “so what” test!

For example, you, as the EBP project coordinator, are interested in presenting to the school district board that the requirement for daily 30 minutes of physical activity be extended to include disabled students. After presenting your request, the school district board asks for additional information, but you are unable to find a specific research study. You then consider that contacting a researcher to research study question that would determine the impact of physical activity with disabled students is required.

The “so what” question would be answered in the above fictitious example.

So the next step in this lesson is to develop a research study question (that would be completed by a doctorally-prepared researcher).

How Do I Research Question?

A research study question guides the research study and collected data will answer the question. The wording is a concise, interrogative question that is present tense. The specific wording varies with the type of research study.

For a quantitative research study, the purpose is frequently identified as the ability to describe, explain, or predict something. The research question has several parts.

A questioning part such as “what is,” “what are,” “is there,” or “are there”

The population being studied

The variables being studied

A suggestion of the relationship between variables

A quantitative research study question would be written as follows.

What is the correlation between social isolation and obesity in teenagers living in rural areas?

The questioning part: “What is”

Population being studied: “teenagers living in rural areas”

Variables being studied

Independent variable: social isolation

Dependent variable: obesity

Suggestion of relationship between variables: correlation

Research Variables

If you would like a review regarding the types of research study variables, click here (Links to an external site.)Links to an external site..

Transcript

Research study questions for qualitative research studies are formatted differently. Qualitative researchers who use the phenomenological design are interested in meaning or the lived experience. The researcher who uses grounded theory is interested in process. Lastly, the ethnographers ask descriptive questions about cultures. The qualitative research study question generally has three components.

Phenomenon or concept of interest

Group or population of interest

Suggestion of which qualitative research design is being used

For example: What is the lived experience of individuals taking oral chemotherapy in their home setting?

Please note that the suggestion of which qualitative research study design is being used does not identify the actual name of the design (phenomenological, grounded theory, etc.), but identifies it by the wording associated with the qualitative research design.

For phenomenological designs, the suggested wording may include terms such as “meaning” or “lived experiences.”

What is the lived experience of children who integrate hearing loss into their lives?

For grounded theory designs, the suggested wording may include terms such as “process.”

What is the process of reimaging after the loss of two or more extremities?

For ethnographic designs, the wording may include terms such as “description of a culture.”

What Is a Hypothesis and Why Does a Research Study Need One?

A research study hypothesis is present in quantitative research studies because there is a prediction about the relationship between variables. Qualitative research studies do not have a hypothesis because there is too little known about the area or phenomenon of interest to predict a result. By not predicting a result, the qualitative study researcher is guided by the participant’s viewpoints and experiences.

A hypothesis is the predicted answer to the research study question. The key word is testable. The hypothesis is what the researcher expects to happen in the study and the testing occurs by analysis of collected data. Hypotheses can be either directional or nondirectional. A directional hypothesis is one that specifies the expected direction of the relationship between the independent and dependent variables.

A null or statistical hypothesis states that there is no relationship between the independent and dependent variables. It is this type of hypothesis that the results of statistical tests support or reject based upon the numbers produced from data.

How Do I Locate Information to Support my EBP Project Proposal?

In order to make accurate decisions regarding person-centered care, quality improvement, or any practice concern, a comprehensive search of the research literature is needed. The search results will tell you what is known and unknown about an area or phenomenon of interest. In addition, you will need to evaluate the level of the evidence and its quality. Remember: garbage in, garbage out. When focusing on healthcare decision making, garbage out is just not an option!

All PICOT questions require searching multiple, appropriate databases. When individuals explore only one database and no information is found, an incorrect decision can be made that no evidence is available. In addition, the level of evidence should not be overlooked. For example, although randomized controlled trails (RCTs) maybe not be available, a case study may be present. Although the case study maybe not be able to fully answer the clinically based question, it may be able to provide insight into additional interventions.

Applying What You Have Learned to Your Program Track

Once again, it is time to apply this week’s information to your program specialty track. Fortunately, the formatting of a PICOT/PICo question and research study question are the same no matter which specialty track you are enrolled in. The difference comes in the area of interest. In Week 1, you were to select the area of interest for your EBP project proposal. This week, you need to develop the PICOT and an example of a research study question. Start this process with the following.

Identify the population that you are interested in looking at and applying the information to. The use of the words adults or children may be too broad. You may want to consider a more narrow term such as middle-aged adults or school- aged children. Consider your area of interest—is it broadly stated, such as chronic illness? Is it too broadly stated?

Determine whether using a quantitative or qualitative approach would have the best opportunity of producing a quality outcome in order to answer your PICOT question. Remember, you will not be conducting the EBP project at this time; only designing it. (This EBP project proposal with some modifications can be your template for your capstone project for all except the FNP tracks).

If you select a quantitative approach, you will need to identify the independent and dependent variables. (Notice that a well written PICOT question identifies these). Consider whether there are extraneous variables that need to be controlled so that they do not adversely impact the quality of the project.

If you find that there is not enough research and you would need to recommend a research study using a quantitative study design, you will need to identify a research question as well as a hypothesis.

If you find that there is not enough research and you would need to recommend a research study using a qualitative study design, you will need to select which qualitative research design tradition you are using, because the wording of the research question suggests the type of design.

Remember This

Remember that with a quantitative research approach, the terms are generally more narrowly or precisely stated, whereas with a qualitative approach, the terms are stated in a broader manner. Below is an example.

A quantitative project question may state, “In hypertensive males over sixty-five years of age (P)that require medication for blood pressure control (I), compared to those not taking medication (C) have the highest risk for death (O) during the first four months after diagnosis or prescription(T)”.

Compared to a qualitative project question on the same topic: “In hypertensive males over sixty-five years of age that require either an ACE inhibitor or Beta-blocker for blood pressure control what is their lived experience during the first four months after prescription?”