Forming Focused Questions with PICO
Practice Your Skills
Practice writing out PICO components and then forming a focused question about one of the case studies below. Choose one or several that interest you.
Cancer Care and Peer Support
You have read that peer support interventions help individuals and families affected by cancer across the care continuum from prevention through survivorship and end-of-life care. You wonder about the characteristics of peer support programs and how peer support programs have been used to reduce disparities and barriers to care.
I: peer support programs
O: reduced disparities and barriers to care
For individuals and families affected by cancer, how have peer support programs been used to reduce disparities and their barriers to cancer care? What are the characteristics of peer support programs (e.g. who provides the support)?
Note that at times you may have several questions you want to address regarding your topic. Scoping reviews allow for this type of flexibility.
A multi-institutional research team explored these questions in a scoping review.
Cultural Awareness and Nursing Care
Nurses in oncology units interact frequently with adults with cancer who do not speak English as their primary language. You are curious whether cultural awareness among nurses improves these patients’ care and participation in the decision-making process.
I: cultural awareness
O: improved care of patients with limited English proficiency and increased participation in decision-making
For oncology nurses, how does their cultural awareness affect both the care of patients with limited English proficiency and the patients’ participation in the decision-making process?
Stephanie Betancur explored this PICO question in both an Honors Thesis and an article.
Labor & Delivery
You’re a new nurse on a labor and delivery unit. You’ve noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you’re sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum.. or did you? You want to find some literature to back up your claim.
I: positions other than the lithotomy position
C: lithotomy position
O: decreased incidence of assisted deliveries
In laboring women delivering in the hospital, do positions other than lithotomy position lead to a decreased incidence of assisted deliveries?
You work in the Big City Hospital ICU. Your mechanically ventilated patients sometimes contract nosocomial pneumonia, which leads to costly complications. You want to know if raising the head of the bed lowers the chance of the patient contracting pneumonia compared to letting the patient lie flat on their back.
I: semi-fowlers position
C: supine position
O: lower incidence of nosocomial pneumonia
In mechanically ventilated ICU patients, does positioning the patient in semi-fowlers result in a lower incidence of nosocomial pneumonia when compared to the supine position?
In the past few years, your hospital has installed antibacterial foam dispensers on all the nursing units. You’ve had nurses asking you if the foam is just as effective as washing their hands with water and soap.
I: using antibacterial foam
C: hand washing with soap and water
O: decreased bacteria count
In hospital nurses, does antibacterial foam decrease bacteria count on hands as much as hand washing with soap and water?
Shift change on your busy med-surg unit can be frustrating for you and your coworkers. Report at the nursing station takes up to 30 minutes, by the end of which you’re anxious to see your patients. You read something in a recent ANA newsletter about other hospitals switching to a bedside shift report, and you want to find out if staff liked that style of shift change better.
I: implementation of bedside shift reports
C: shift change reports at the nurses station/standard practice
O: greater satisfaction with care
Among staff nurses on a medical-surgical unit, do implementing bedside shift reports lead to greater satisfaction with care when compared to traditional shift change reports at the nurses station?
You’re the nurse manager of a NICU unit. One concern of parents of infants receiving tube feedings is being able to successfully breastfeed their child upon discharge. One of your staff nurses asks if it would be helpful to give the infants cup feedings instead of tube feedings during their NICU stay.
I: cup feeding throughout the hospital stay
C: tube feedings throughout the hospital stay
O: greater reported success with breastfeeding post-discharge
In infants in the NICU, will cup feeding throughout the hospital stay lead to greater success with breastfeeding post-discharge when compared to tube feedings?
It’s the last semester of your BSN students’ time in school and they’re excited.. and anxious! They’ve been asking you if they should take the NCLEX right after they graduate or wait for a while after graduation so they can relax and study.
I: Sitting for the NCLEX within 2 months of graduation
C: Sitting for the NCLEX after 2 months from graduation
O: Higher pass rates
Among BSN students, does taking the NCLEX within 2 months of graduating result in a higher pass rates when compared to sitting for the exam later?
It’s winter at your family practice, and you have a lot of patients coming in with runny noses and general malaise. Brenda, a 35 year old working mother in for a checkup states, "I’m so busy between work and home that I definitely don’t have time to get sick! Can those vitamin C or zinc pills prevent colds?"
I: taking daily vitamin C or zinc supplements
C: no intervention
O: incidence of the common cold
In adult females, will daily vitamin C or zinc supplements reduce the incidence of the common cold when compared with no intervention?
The main concern for most of your patients coming out of anesthesia in your PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.
I: soft music as an adjunct to standard care
C: standard care alone
O: lower reported pain scores
In PACU patients, will playing soft music in the PACU as an adjunct to standard care result in lower reported pain scores when compared to standard care alone?
You work in a pediatrician’s office and give patients their routine vaccinations. The younger children are often fearful of needles, and some of the staff use toys to distract the patients. You want to know if this technique actually has an effect on the children's pain response.
I: distraction techniques during immunization
C: no intervention
O: lower pain scores rated by the Faces pain scale
In young children, do distraction techniques during immunization administration using toys result in lower pain scores when compared to no intervention?
You work on an inpatient psychiatric unit. One of your patients with chronic schizophrenia, Joe, normally mumbles to himself, but will occasionally speak to others when residents play games together. Noticing this, you say to a coworker that maybe social skills group training sessions would bring out Joe’s conversational skills. Your coworker shakes her head and says "I don’t think so. Joe is in and out of this hospital, he’s a lost cause."
I: social skills group training sessions
C: standard care
O: increased conversational skills as evidenced by greater number of interactions with peers
In inpatient chronic schizophrenia patients, do social skills group training sessions increase conversational skills when compared to standard care?
You coordinate health education programs and have been holding seminars for teenagers about STI prevention. You’ve been found that they’re hesitant to open up to you during classes to ask you questions. You’re wondering if recruiting peer educators closer to their age will encourage them to actively participate and get more satisfaction out of the classes.
I: a peer-led STI prevention class
C: a nurse-led STI prevention class
O: greater client participation and satisfaction
For adolescents, will a peer-led STI prevention class result in greater participation and client satisfaction when compared to a nurse led class?
On your pulmonary unit, many of your COPD patients receive injections of heparin to prevent pulmonary emboli, and patients find the bruises associated with heparin injections unsightly. You’ve had nursing students shadowing you lately, so you’ve been particularly concerned with injection technique. You want to find out if the duration of injection has any effect on the extent of bruising.
I: heparin injection duration of thirty seconds
C: heparin injection duration of ten seconds
O: decreased circumference of bruising
In COPD patients receiving prophylactic heparin, will a heparin injection duration of thirty seconds lead to a decreased circumference of bruising when compared to an injection duration ten seconds?
You’re a school nurse and one aspect of your job is counseling pregnant teens with the aim of enabling them to complete high school. You’ve even been conducting home visits on top of your normal in-school meetings as part of their preparation-for-motherhood counseling. You want sources to backup the effectiveness of these home visits.
I: nurse home visits adjunct to in school interventions
C: in school interventions alone
O: decreased drop out rate
In pregnant high-school adolescents, do nurse home visits adjunct to in-school interventions decrease drop out rate when compared with in-school interventions alone?
A diabetic patient from a nursing home has recently been admitted with a stage III pressure ulcers on his heels. The unit nurses have called you in for a wound consult. You have to choose between standard moist wound therapy and using a wound vac.
I: negative pressure wound therapy
C: standard moist wound therapy
O: improved wound healing as measured by pressure ulcer grading system guidelines
In elderly diabetic patients with stage III foot ulcers, does negative pressure wound therapy lead to improved wound healing when compared to standard moist wound therapy?