Nursing & Health: Establishing a PICO(T) Question

There is no one way to figure out what topic you want to research, but there are some strategies you can try. Below is a not exhaustive list of ways you can get started:

• Listen to, read, or watch reputable news outlets, trade journals, and other media for nursing and health related stories that spark your interests. If you are listening to an interview with a professor or health care practitioner, do a quick search on that person, where they work, what their research areas are, and things they have published. 
• Do some self-reflection: "What do I like about nursing? What areas of nursing would I like to see improved (for nurses and/or patients)? What communities do I want to work with?", etc. Your answers to these questions will likely lead you to  areas of research to explore and can help generate keywords for your searches. 
• Flag course readings and jot down notes from class discussions
• Talk to a librarian or your professor

A concept map is a brainstorming activity that can help you figure out what you already know about a concept, what you might want to know more about, and what relationships with subconcepts exist. Concept mapping is a great way to provide yourself with a visual representation of a broad concept, subconcepts related to it, and main ideas that relate to the subconcepts. This is a tool that can be used to narrow down a concept and idea that you can build into a research question. Concept maps can have many related subconcepts and relationships, but try not to overwhelm yourself with figuring them all out. Concepts maps can be used to start any research project and some might be bigger or smaller depending on the discipline. A PICOT concept map might look something like this:

A PICOT question is a question format that is used in nursing and other health sciences fields to develop a questions that is researchable and answerable.

PICOT questions can be formulated to center specific aspects of evidence based practice such as intervention question, therapy questions, prognosis or prediction questions, etiological questions, and meaning questions. The PICOT question worksheet below illustrates the different types of PICOT question formulations, their meanings, and some examples of each type. Feel free to download a copy of the worksheet for your own use as you try to formulate a PICOT question.

Once you have your PICOT question, you will want to start creating a search strategy to find research. The main components of creating a search strategy are:

• knowing the kind of scenario (intervention/therapy, etiology, diagnosis, prevention, prognosis, or meaning) your PICOT question is addressing
• figuring out what kind(s) of peer-reviewed research articles (cohort studies, case studies, qualitative studies, randomized control trial, etc.) you need for your assignment that would best address your PICOT question
• creating keyword search strings (synonyms, controlled vocabularies, etc.)
• figuring out which database(s) might be the most useful

Let's use a PICOT question example from the PICOT question template worksheet:

• Are 30- to 50-year-old women (P) who have high blood pressure (I) compared with those without high blood pressure (C) at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

What kinds of keywords can we generate from this question? Here are some questions you can ask yourself to start figuring out synonyms for each PICOT element:

• What are other ways to describe a cohort of 30-50 year old women?
• Are there alternative names or terms for high blood pressure? What about those without high blood pressure?
• Are there other terms we can use for the term acute myocardial infarction? Is there a way to search for that term specifically?

After generating your synonyms, you might have a result like this:

Here are some a couple of tutorials for using controlled vocabularies in PubMed and CINAHL

• Use MeSH to Build a Better PubMed Query
• How to use CINAHL subject headings

Now that you have your search terms, you can combine them as search strings using phrase, Boolean operator, and wildcard searching. Boolean operators might be the first best effective strategy. 

While search strings can be pretty complex, you don't need to get very complex with your keyword search strings. The idea is that you have some options and combinations to try out to find the materials you need to conduct your research. You should try different combinations of search terms and move around or remove operators, quotation marks, and parentheses depending on what your results are so another could look like this:

• (middle age women OR middle age females OR 30-50 year old women) AND (hypertension AND normotension) AND hysterectomy 

Keyword searching takes time and can be exhausting so you'll want to give yourself plenty of time to search and take breaks when needed. If you get stuck, be sure to book an appointment with the nursing librarian.

You can use the worksheet below to create a search strategy of your own.