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Nursing Resources

A research guide on Nursing resources for ESU students and faculty.

Researching a PICO Question

What is a PICO Question?

PICO is an acronym used for exploring clinical questions. It serves as a framework for evidence-based practice.


P (Problem and Population)

  • What health problem is your selected intervention intended to solve?
  • Identify what population of people will benefit the most from your chosen intervention. 
  • Think about age, sex, geographic location, or specific characteristics that would be important to your question.

I (Intervention)

  • What particular aspect of health care is the focus of your question? Is it therapeutic, preventive, diagnostic or an organizational intervention?

C (Comparison Intervention)

  • Standard care or no known intervention for comparison.

O (Outcome)

  • What are the patient relevant consequences/benefits of the intervention? 
  • What goals are the interventions aimed to achieve?

PICO Topic Examples

 

P

(Problem/Population)

I

(Intervention)

C

(Comparison)

O

(Outcome)

Example 1 Infants in the NICU cup feeding tube feedings greater reported success with breastfeeding post-discharge
Example 2 men over age 65 daily 30 minute exercise regimen no exercise regimen reduce the future risk of cardiac arrest
Example 3 women ages 25-40 who take oral contraceptives  who use IUDs for contraception greater risk for developing blood clots
Example 4 adults 65 years and older influenza vaccine no vaccine influence the risk of developing pneumonia

 

Search CINAHL for articles: 

Search keywords using the Advanced Search.

STEP 1) Brainstorm Keywords: Pull keywords from your PICO questions. Think about synonyms.  Use “or” in between synonyms in the search boxes.

Example: P = Accidental falls in hospitals, adults aged 65+ years

                 I = Walking aids, assistive devices

                C = Non-skid footwear

                O = Reduce fall risk

Now it's your turn to brainstorm keywords for your search. 

NURS 310 - Activity 1: Brainstorm your keywords Write your PICO question:                      ___________________________________________________________________________    ___________________________________________________________________________ 

Write down potential keywords and synonyms for your intervention:

1st ______________________ or _______________________ or ____________________

2nd ______________________ or _______________________ or ____________________

3rd ______________________ or _______________________ or ____________________

If you have a comparison intervention, brainstorm keywords for it here:

______________________ or _______________________ or ____________________

 

STEP 2) Perform an Advanced Search using keywords. You may need to perform at least two searches: one search for the intervention and another search for the comparison intervention.

  • Click on Advanced Search under the CINAHL search box.
  • Type in your keywords.  Use “or” in between synonyms in each search boxes.  
  • Click Search or hit enter.
  • Before reviewing results, you must use the Refine Results column on the left.
    • Narrow by Publication Date: 2016-2021
    • Narrow by Source Types: select Academic Journals
    • Language: Select languages you can read fluently.
    • Age or Gender (if applicable to your topic)
  • Begin reviewing the search results.
  • If your results contain systematic reviews or meta-analysis, you need to eliminate them from your results. Add an extra search box if needed (click on the + icon), change the AND box to NOT, and type in systematic reviews or meta-analysis.

 

NURS 310 - Activity 2: Advanced Search in CINAHL

Perform an Advanced Search using your keywords.

How many results (yields, hits) did you initially get? ________________________

Now narrow on the left side using the Refine Results column. What did you select to refine results for your topic?

______________________________________________________________________________________________ 

______________________________________________________________________________________________

How many results (yields, hits) do you have now? _______________________

Email yourself potential articles you can use. Remember to select APA citation.

CINAHL Subject Headings

Search CINAHL Subject Headings to find controlled vocabulary used in the database. Then perform a subject heading search using your Search History.

STEP 1)  Start a CINAHL Subject Heading search

Click on "New Search" to clear any previous search history.

Click on "CINAHL Subject Headings" located on the top blue navigation bar:

Click on CINAHL Subject Headings on the top blue navigation bar

Type in one keyword. Make sure you're using Relevancy Ranked.  Then click Browse

Type keyword in CINAHL Subject Heading search bar and click on Browse.

Click on the keyword link to see an expanded list. 

Click on the keyword link.

Review related terms and check off the words that best describe your keyword. I selected "Ambulation Aids" below. Click on the Scope icon for a definition of the term. 

Review and select terms you want. Click on the Scope icon for a definition of the term.

You'll see the blue Subheadings column on the right side of the page.  For now, you can leave the default box for "Include All Subheadings" checked off. 

Subheadings column in CINAHL Subject Headings

You can also choose to select "Explode" (to expand) or "Major Concept" (only where the word is a major concept subject heading in an article) on the right side.

Then click the green Search Database button.

Explode, Major Concept, Search buttons in CINAHL Subject Headings

 

STEP 2) Repeat STEP 1 with another keyword. 

Go back up to the top blue navigation bar, click on CINAHL Subject Headings and perform another CINAHL Subject Heading search. If you initially searched for an intervention (like I did above), then search for a keyword about your PICO  problem or outcome.  For example, I searched for accidental falls next. 

STEP 3) Repeat STEP 1 with a third keyword (if necessary). 

For example, I searched for hospital since my PICO population focused on patients in hospitals. 

STEP 4) Combine Subject Headings in your Search History

Under the Advanced Search boxes at the top of the page, click on the Search History link. 

Now clear any words from the top three Advanced Search boxes. It may interfere with your search results.

You'll see all the searches you performed so far during your current CINAHL session. 

Check off the CINAHL Subject Headings searches you created (STEPS 1, 2 and 3). 

Then click on Search with AND button. This will combine all of your Subject Heading search results to get articles using the controlled vocabulary you selected in the database. 

Check off the CINAHL Subject Headings you searched and click on "Search with AND" 

Click on View Results

Then narrow on the left side by using the Refine Results column (by publication date, Academic Journals, etc.). 

If you received no results, go back to the Search History page.  Select a different search variation (select 2 instead of 3 terms) or perform another CINAHL Subject Heading search. 

 

NURS 310 - Activity 3: CINAHL Subject Headings

Perform two-four CINAHL Subject Heading searches. Start with the keywords you brainstormed. 

What CINAHL Subject Headings did you come up with?  ___________________________________________________

_________________________________________________________________________________________________

__________________________________________________________________________________________________

Combine CINAHL Subject Heading in your Search History.  

How many results (yields, hits) did you initially get?  ________________________

Email yourself potential articles you can use. Remember to select APA format for your citation.

Level of Evidence (for the NURS 412 Evidence Table)

For the level of evidence, you want to determine the type of study design for each article. 

See the Types of Study Design definitions on the right side of this Level of Evidence LibGuide (from Ascension Library Services).

How can you determine the type of study?  Read the Methods/Methodology section of the article and compare it to the type of study design definitions. 

Some article records in CINAHL will list the type of study. Look for the Publication Type line.  Example:

Publication Type line in CINAHL record

For NURS 310 and NURS 412 PICO Papers, you CAN NOT use the article type Systematic Review or Meta-Analysis.