As a practice scholar, the interdisciplinary team you are leading develops the below two practice questions in PICOT format to drive practice change.
Practice Question 1: Does motivational interviewing during a regularly scheduled well-child visit for children between 5-19 years with a BMI of 30 and above as compared to practice as usual, influence BMI, BP, quality of life, and daily physical activity over 8-10 weeks?
- Identify the PICOT elements.
- What are key search terms identified in the practice question?
Conduct a library search using these search terms to locate a research study addressing this practice problem and consider the following.
- What is the research-evidence based intervention addressed in the study?
- What is the quantifiable outcome(s)? How will the outcome(s) be measured? What potential reliable and valid measurements/tools may be used to measure this quantifiable data?
- Is this practice question answerable within 8-10 weeks? Why or why not?
Practice Question 2: In the adult critical care population, does a research-based skin care integrity bundle, compared to standard care, influence the incidence of hospital-acquired pressure injuries over an 8-10 week time period?
- Identify the PICOT elements.
- What are key search terms identified in the practice question?
Conduct a library search using these search terms to locate a research study addressing this practice problem and consider the following.
- What is the research-evidence based intervention in the study?
- What is the quantifiable outcome(s)? How will the outcome(s) be measured? What potential reliable and valid measurements/tools may be used to measure this quantifiable data?
- Is this practice question answerable within 8-10 weeks? Why or why not?
Formulate PICOT/PICoT questions relevant to advanced nursing practice
Reflection on Learning
Purpose
The purpose of this activity is to deepen learning through reflective inquiry. It will allow for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals.
Course outcomes: This assessment enables the student to meet the following course outcomes.
- Compare and contrast differences and similarities of qualitative, quantitative, and mixed method designs. (POs 3, 9)
- Analyze qualitative and quantitative data for the purposes of critical appraisal of evidence. (POs 3, 9)
- Appraise systematic reviews for translation science. (POs 3, 5, 9)
- Differentiate selected statistical methods for the purposes of translation science. (POs 3, 5, 9)
- Evaluate selected statistical methods for the purposes of critical appraisal of evidence. (POs 3, 5, 9)
- Synthesize literature relevant to practice problems. (POs 3, 5, 9)
- Formulate PICOT/PICoT questions relevant to advanced nursing practice. (POs 3, 4, 5, 6, 9)
Hello, and welcome to Week 7! You’ve almost made it to the end of the course, but there’s still more to learn. Over the past weeks, you searched for and critically appraised qualitative and quantitative research as well as summaries of multiple studies to lend support to a national practice problem. Now, you’re ready for the next step. Are you familiar with PICOT formulation? I thought I was when I started this course. Although I knew this important mnemonic, I came to realize that I wasn’t skilled at writing a focused, answerable practice question. It looks easier than it is! But with practice, I learned to be proficient in writing answerable questions. You will too! You’ll have lots of opportunities to develop and evaluate PICOT-formatted questions this week. Ready to get started? Let’s begin!
Week 7: Student Lesson Plan for Learning Success
Outcomes, Objectives, and Concepts
| Weekly Outcomes | Weekly Objectives | Main Topics and Concepts |
| Formulate PICOT/PICoT questions relevant to advanced nursing practice (PO#3, 4, 5, 6, 9). | Develop a PICOT question using key search terms.Construct a focused answerable question. | Clarify the Elements of a PICOT-Formatted Practice QuestionIdentify the Central Role of a Synthesis of Research Evidence to the Articulation of a Compelling and Answerable Practice |
Foundations for Learning
LibGuides PICOT presentation – (Links to an external site.) Select PICOT under EBP resources.
Student Learning Activities
| Learning Activities | This week, you will complete the following. PrepareAssigned ReadingsExplore Interactive LessonTranslate to PracticeReflection on LearningDiscussion Question ReflectReflection on Learning |
| Additional Resources | Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=18053122&site=eds-live&scope=site Dang, D., & Dearholt, S. (2018). Johns Hopkins nursing evidence-based practice model and guidelines (3rd ed.). Sigma Theta Tau International. Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. http://chamberlainuniversity.idm.oclc.org/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000446-201003000-00028&LSLINK=80&D=ovft |
Learning Success Strategies
- Review key terms in Resources to ensure you understand the articulation of a practice question using the PICOT formatting tool.
- As you review weekly content, consider how each aspect of the practice question (PICOT) needs to be supported by a synthesis of research evidence.
- Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
- You have access to a variety of resources to support your success. Click Resources on the home page to access program and project resources.
- Your course faculty is here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions.
Dang, D., & Dearholt, S. (2018). Johns Hopkins nursing evidence-based practice model and guidelines (3rd ed.). Sigma Theta Tau International.
- Chapter 4: The Practice Question
Week 7: Writing a Clear, Concise, One-Sentence Practice Question
Practice Question
Let’s take a moment to place the practice question in context. A practice question is not a research question.
A gap in knowledge guides the PhD researcher in writing a research question that includes making a prediction.
A practice question emerges from the research you read, review, and critically appraise to articulate and support your practice problem. A clear and concise practice question is always supported by research evidence. Alongside the research evidence that lends support to a practice question, the unique practice needs of the local practice setting is reflected in the practice question.
Developing an Answerable Practice Question Exploration
- Return to Your Practice Problem
- Take this opportunity to review your research evidence. Embedded in the research used to articulate a compelling practice problem is the beginning of your practice question.
- Practice Setting
- Take this opportunity to reflect on your practice problem through the lens of your local practice setting. What does your practice problem look like in daily practice? Reflect on conversations shared with key stakeholders in practice. What is going on in practice related to the identified practice problem?
- PICOT is a mnemonic for a formatting tool that serves two purposes. Each purpose is of equal importance to the practice scholar as the practice change project is designed.
- Assists with writing a clear, concise, one-sentence practice question.
- Assists with searching and retrieving relevant evidence in the robust scientific search engines. The formatting tool PICOT lends itself to the identification of keywords from each segment of the practice question. The ability to break a practice question into keywords is what makes searching for evidence.
| Element | Description | |
| P | Patient/Population | The practice scholar states the relevant patients/individuals. What does the research literature say about the age, gender, specific characteristics, social that would be important in this practice problem? The concise articulation of the population is supported by a synthesis of research evidence. |
| I | Intervention | The practice scholar states the research-evidence based intervention to be translated to practice. The research-evidence based intervention is supported by research evidence. The practice scholar translates/transfers the research-evidence based intervention as it was tested and empirically proven across research studies. Note: The practice scholar does not alter the research-evidence based intervention. Implementation fidelity requires no changes be made to the empirically proven research intervention. |
| C | Comparison | The practice scholar describes current practice. In a practice change project, the comparison is practice as usual. |
| O | Outcome | The practice scholar’s intention is to learn if the translation of a research-evidence based intervention influences local practice outcomes. Practice change projects are not intended to design or test an intervention, therefore, a prediction is not made as outcomes are identified. The practice outcome may be singular or several stated outcomes. The practice scholar returns to research studies where the research-evidence based intervention was tested. These studies describe how study outcomes were measured. The practice scholar confirms that identified outcomes in the practice change project are numerical and are captured using reliable and valid measures. Reliability in statistics and psychometrics is the overall consistency of a measure. A measure is said to have a high reliability if it produces similar results under consistent conditions. For example, measurements of people’s height and weight are often extremely reliable. Validity in statistics and psychometrics refers to the extent to which an assessment accurately measures what it is intended to measure. |
| T | Timeframe | The timeframe for the DNP Practice Change Project is 8–10 weeks. |
PICOT Questions Exploration
View the activity below to formulate PICOT questions.
PICOT Activity (Links to an external site.)
In this activity, you will use the PICOT mnemonic to describe the elements of a focused, answerable practice question including:(a) patient, population, or problem; (b) intervention; (c) comparison with other interventions; (d) measurable outcomes; and (e) timeframe for the intervention to a achieve an outcome.
Fineout-Overholt (2006) developed PICOT templates to assist in the formulation of a focused, answerable question. These templates align with the primary clinical domains, which include intervention/therapy, etiology, diagnosis, prognosis/prediction, and meaning.
Let’s use these PICOT templates to formulate a focused, answerable question to address each clinical domain.
Clinical Domain: Intervention/Therapy
Questions in this domain address the treatment of an illness or disability.
Use the Intervention template to formulate a focused, answerable question addressing an intervention.
Intervention
In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?
Now compare your answer to a sample question addressing an intervention.
In African-American female adolescents newly diagnosed with Type 2 Diabetes (P), does medical nutrition therapy (I) as compared to a low-carbohydrate diet (C) help achieve and maintain blood glucose levels in the normal range (O) over 8-12 weeks (T)?
Use the therapy template to formulate a focused, answerable question addressing a therapy.
THERAPY
In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?
Now compare your answer to a sample question addressing therapy.In obese adolescents (P), does a personal movement tracker device (I) as compared to not using a movement tracker device (C) influence BMI and quality of life (O) over 8-12 weeks?
Reflect on how these templates addressing intervention and therapy are similar? How are they different?
Clinical Domain: Etiology
Questions in this domain address the causes or origins of disease (i.e., factors that produce or predispose toward a certain disease or disorder).
Use the Etiology template to formulate a focused, answerable question addressing etiology.
ETIOLOGY
Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O)over ________________(T)?
Now compare your answer to a sample question addressing etiology.
Etiology:
Are 30-50 year old women (P), who complete mindfulness based stress reduction (MBSR) training (I) compared with those who do not complete MBSR (C) have blood pressure levels within the normal range (O) over 8-10 weeks (T)?
Clinical Domain: Diagnosis
Questions in this domain address the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.
Use the Diagnosis template to formulate a focused, answerable question addressing a diagnosis.In ____________________(P), are/is ____________________ (I) compared with those without ____________________(C) more accurate in diagnosing _____________________(O) within ___________(T)?
Now compare your answer to a sample question addressing a diagnosis.
Diagnosis
In women under age 50 (P) is a yearly mammogram (I) compared with a mammogram every 3 years (C) more effective in detecting breast cancer (O)?
Clinical Domain: Prognosis/Prediction
Questions in this domain address the prediction of the course of a disease.
Use the Prognosis template to formulate a focused, answerable question addressing a diagnosis.In ____________________(P), how does ____________________ (I) compared to ____________________(C) influence _____________________(O) over ___________(T)?
Now compare your answer to sample questions addressing prognosis and prediction.
Prognosis/Prediction
For individual 65 years and older (P), how does the use of an influenza vaccine (I) compared to not receiving the vaccine (C) influence the risk of developing pneumonia (O) during the flu season (T)?
Clinical Domain: Meaning
Questions in this domain address how one experiences a phenomenon.
Use the Meaning template to formulate a focused, answerable question addressing meaning.How do ____________________(P), with ____________________ (I) compared to ______________(C) perceive _____________________(O) during ___________(T)?
Now compare your answer to a sample question addressing prognosis.
Meaning
Do women completing a 28-day treatment program for opioid addiction( P), with regular participation in a 12-step problem (I) compared to those with no participation (C) perceive self-efficacy (O) during the first 8-10 weeks of sobriety (T)?
Although writing clear and concise questions may be the most fundamental step of evidence-based practice, it is not always easy to put practice problems into the format of a focused, searchable question. Using these PICOT templates focuses the question and helps to identify and narrow search terms, making the search for relevant evidence less time-consuming and more productive.
Searching for Evidence
After you have a one-sentence practice question (PICOT format), the search for evidence begins with the following steps.
- Identify the searchable keywords contained in your practice question and list them on the Questionnaire Development Tool (located in Appendix B of Johns Hopkins Nursing Evidence-Based Practice).
- Identify the types of information needed to best answer the question and list the sources where such information can be found. What scientific search engines will you utilize to begin your search?
- Develop the search strategy.
- Evaluate search results relevant to the practice question.
- Revise the search strategy as needed. Keep in mind that this is an iterative process. You will continue this search for evidence throughout the design phase of your practice change project.
- Record your search strategy specifics, including search terms used, limits placed on the search, and years searched on the Question Development Tool and save the results.
References
References
American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Author.
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Author.
Dang, D., & Dearholt, S. (2018). Johns Hopkins nursing evidence-based practice model and guidelines (3rd ed.). Sigma Theta Tau International.
Magda, M. M., Safaan, N. A., & Okby, O. (2016). Overcoming barriers facing barriers facing nurses for research utilization in clinical settings. American Journal of Nursing Research, 4(1), 13–24.
Rhiner, M. (2013). Using implementation science as the core of the doctor of nursing practice inquiry project. Journal of Professional Nursing, 31(3), 200–207. https://doi.org/10.1016/j.profnurs.2014.11.002
(Links to an external site.)
Tacia, L., Pheley, A., & Lehto, R. H. (2015). Identifying barriers to evidence-based practice adoption: A focus group study. Clinical Nursing Studies, 3(2), 90–96.
Tucker, S. (2017). People, practices, and places: Realities that influence evidence‐based practice uptake. Worldviews on Evidence‐Based Nursing, 14(2), 87–89.
White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.
