Description
Benchmark – Capstone Change Project Objectives
Assessment Description (Remember my topic will be: Falls prevention in hospital setting)
Part A of the assignment (I don’t need references for part A of this assignment)
Review your problem or issue and the cultural assessment. Consider how the findings connect to your topic and intervention for your capstone change project. Write a list of three to five objectives for your proposed intervention. Below each objective, provide a one or two sentence rationale.
After writing your objectives, provide a rationale for how your proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations.
Part B of the assignment (I do need references for part B of this assignment)
Review your problem or issue and the study materials to formulate a PICOT (Patient, Intervention, Comparison, Outcome and Time) question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.
The PICOT question will provide a framework for your capstone project change proposal.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.
Step 1: Create PICOT question; A PICOT question is presented and provides a clear framework for the capstone project change proposal. Your PICOT question should clearly outline all of these elements: patient, intervention, comparison, outcome and time.
Step 2: PICOT Problem: Identify the PICOT problem, what clinical problems or issues may arise from clinical care? The PICOT problem as it relates to evidence-based solution, nursing intervention, patient care, health care agency, and nursing practice is thoroughly described.
Step 3: Describe nursing intervention: A nursing intervention used to address the problem. Compare the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process.
Step 4: Summarize Clinical Problem and Patient Outcome: The clinical problem and how it can result in a positive patient outcome.
Prepare this assignment according to the guidelines found in the APA Style Guide
plagiarism report (less than 10%)
Resources provided by my instructor for this week’s assignments (other resources are under attachments)
https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx
https://journals.lww.com/jncqjournal/Abstract/2020/04000/Development_and_Implementation_of_a_Model_for.2.aspx
https://scholarlycommons.baptisthealth.net/cgi/viewcontent.cgi?article=1113&context=nhsrj
https://www.currentnursing.com/nursing_theory/
Unformatted Attachment Preview
AACN Advanced Critical Care
Volume 31, Number 1, pp. 92-97
© 2020 AACN
Clinical
Inquiry
Bradi B. Granger, PhD, RN
Department Editor
Life After PICOT: Taking the Next Step
in a Clinical Inquiry Project
Bradi B. Granger, PhD, RN
T
he art of clinical inquiry begins in the patient care arena with 2 questions:
Why do we practice this way? Could we do it better? Learning to question is a critical thinking skill that can be applied to each aspect of patient care,
from asking why we do a certain practice or procedure, to how, when (the timing of care), and even where (the setting in which care is provided). Often a new
clinical question must be reshaped to be answered—transformed into a format
that is specific and able to be objectively and subjectively measured.
A common approach used to define a clinical question and make it measurable is to identify the Patient Population, Intervention, Comparator, Outcome,
and Time Frame for Evaluation (PICOT). This approach clarifies the clinical
question and establishes a point of departure for a study to answer the question. However, the next step in designing the study is not always clear from
the PICOT question alone. For example, given the question, “In patients with
cardiovascular disease, is technology-based patient education better than standard patient education for improving guideline-directed medication use after
discharge?” how would you design the study? Is it research or quality improvement? What are the next steps?
Using an evidence-based practice model (eg, the Iowa model1) can provide
a map to the next steps: determining the quantity and quality of existing evidence, leading logically to the next decision point in study design. An evidencebased–practice map is a useful step-by-step guide for navigating evidence. In
this example, however, the evidence for educational strategies in cardiovascular disease is voluminous and inconclusive, suggesting more work is needed.
In this case, as with many PICOT questions, the outcome of interest is a
high-priority Centers for Medicare and Medicaid Services and Agency for
Healthcare Research and Quality metric, measured by the hospital version of
the Consumer Assessment of Healthcare Providers Survey score on item 16:
“Did you receive information regarding your medications in a way that you
could understand?”2 Because the question is important to your patients, your
research team, and the organization, and because there are no conclusive
answers in the literature, what are the logical next steps? How would you
narrow the patient population to create a measurable cohort? How will the
groups be defined for the comparison? Many options are possible: 2 cohorts
compared sequentially, using first a standard educational approach, followed
Bradi B. Granger is Professor, Duke University School of Nursing, and Director, Duke Heart Center
Nursing Research Program, 307 Trent Drive, Durham, NC 27710 (bradi.granger@duke.edu).
The author declares no conflicts of interest.
DOI: https://doi.org/10.4037/aacnacc2020986
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CLINICAL INQUIRY
Table: Criteria for Systematic Consideration of SMART Objectivesa
Objective
Definition
Specific
Objective clearly states, so anyone reading it can understand, what will be done and who
will do it.
Measurable
Objective includes how the action will be measured. Measuring your objectives helps you
determine if you are making progress. It keeps you on track and on schedule.
Achievable
Objective is realistic, given the realities faced in the community. Setting reasonable objectives helps set the project up for success.
Relevant
A relevant objective makes sense, that is, it fits the purpose of the grant, it fits the culture
and structure of the community, and it addresses the vision of the project.
Time frame
Every objective has a specific timeline for completion.
Abbreviation: SMART, specific, measurable, achievable, relevant, time frame.
a
Definition adapted from Doran.3
by a comparable time using a technology-based
approach; 2 cohorts compared in parallel, with
1 side of a clinic or patient-care unit using standard education practices and the other side using
technology; a single convenience sample, with
patients alternating assignment to a standard
approach versus technology; or a single group
with individuals randomly assigned to receive
technology-based or standard education. Alternatively, the groups and the delivery of the
intervention could be defined by advanced
practice nurse–based patient groups, registered nurse staffing patterns, clinical settings,
or calendar months, rather than patients. The
possibilities for defining each component of a
PICOT are almost endless. Which is best?
The answer lies in the details of feasibility
that are often specific to your own clinical
setting. Unless you have the luxury of conducting or participating in a large, randomized clinical trial, the best design of a local
clinical inquiry project is a matter of optimizing control and minimizing bias. This is done
using careful consideration and selection of
operational definitions for each component
of the PICOT. Although PICOT questions
are a useful first step in the clinical inquiry
process, answering them requires further
insight into the clinical context, the availability
of preexisting baseline data, time constraints,
and many other logistical questions before
one can determine the best design for the project. The purpose of this column is to describe
next steps after PICOT by highlighting critical thinking skills necessary for designing a
clinical inquiry project that not only is measurable and can answer the question at hand
but is also feasible for your research team to
answer in a reasonable time.
Making Your PICOT SMART
If PICOT is the question, SMART is how
to get there. SMART is an acronym and mnemonic device for specific, measurable, attainable, relevant, and time-bound objectives.3
SMART objectives help define the specific
steps to reach a desired goal—in this case, the
answer to the PICOT or study question. The
Table outlines the details of what might be
considered in a health care approach for using
SMART objectives with each PICOT component. Each component of the clinical inquiry
question is broken down to further examine
and operationally define the nuances and
incremental steps needed to determine who,
what, where, when, how, and why.
A systematic approach for considering each
component of PICOT is useful in real-world
study design because it provides a tool that
lends structure to the critical thinking process. However, such a tool should be used as
simply that, a tool, and should never be used
so rigidly that one’s thinking is limited to a
set of finite checkboxes. Rather, the approach
provided here might be thought of as a means
of getting the creative juices flowing and a
process to ensure that major areas of consideration are not omitted or overlooked in the
design process.
SMART Considerations for “P”
Using our example of technology-based
versus standard patient education for guidelinedirected medication therapy (GDMT) in cardiovascular disease, the population, by
definition, refers to patients with cardiovascular disease. This broad definition requires
additional narrowing to be measurable and
feasible for the study. In a large, randomized
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CLINICAL INQUIRY
Tier 1: Feasibility
• Number of patients eligible for the intervention
on your unit
• Cycle length: time to see a change or effect
intervention
• Limitations of cost or time
• Constraints of staffing, patient participation, or
other aspects of time
Tier 2: State of the Science
• State of the science (what currently is published)
• Designs that close the gap in published literature
(observational vs experimental designs)
Tier 3: External Input and Key Advisory Personnel
• Patient experts or caregivers
• Community advisory boards
• Key stakeholders affected by the design of the
groups
Figure 1: Decision tree for “C”: comparator group
design in research and quality improvement.
clinical trial, results from a single study may
be generalizable to the larger population,
but for most studies, the design will be limited to a local setting, so the generalizability
of findings will be more limited. It is important to note that large trials rarely achieve
much granularity in the data with regard to
patient preferences for education, such as
local educational venues, regional resources,
family-support demographics, health literacy,
first-language preferences, and other important
regional differences, which are best assessed
and captured in local study designs. Smaller,
single-site studies are useful to inform current
practice in a local setting and must then be
conducted again in other patient groups and
settings to be applied more broadly.
A systematic approach for considering the
population might begin with identifying specific objectives for defining the population for
your PICOT using the SMART acronym. Figure 1 gives an example of how SMART may
apply in our current example of patient education. By considering specific, measurable,
attainable, relevant, and timely criteria for the
population where you work, your operational
definition for the study will include important details such as patient preferences, literacy levels, age range, and how the patients of
interest characterize the problem themselves
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W W W .AACN ACCON LIN E .ORG
in your own clinical setting. Using SMART to
define “P” may not definitively solve or answer
problems for the population proper, but it
will get you to the next step of a successfully
designed unit- or hospital-based project.
SMART Considerations for “I”
The “I” in PICOT, for intervention, is
typically less abstruse in an initial PICOT as
compared with the population, comparator,
outcome, and timing. Because the research
team arrived at the clinical question themselves, the intervention and the outcome of
interest are generally clear, even if the ways
in which the intervention will be applied
(eg, with regard to timing or sequencing) or
the outcome that will be measured remain a
bit blurry. The team typically recognizes the
“thing” in which they are interested and that
they wish to test or improve.
Take the example of patient education for
GDMT. The question is: Can we do it better?
The educational intervention needs simply to
be specified in a way that is measurable and
feasible. Whether the approach being tested
is novel versus usual care, new content, a new
visual display, or a different level of health
literacy, the intervention itself must be simply
and clearly defined, and measurable.
SMART Considerations for “C”
Defining the comparator (“C,” in PICOT)
group(s) is perhaps the most challenging, but
also the most fun, creative, and exciting aspect
of life after PICOT. The ways in which groups
are defined and compared will also define, in
large measure, the nature of the study and the
challenges yet to come in the weeks, months,
and sometimes years after project approval
and initiation.
First, basic considerations from the literature
review must be assessed. For example, what is
the current state of the science in terms of study
design? In your literature review, were most
studies descriptive or observational, or were
they randomized, controlled studies? The
answer to this baseline question defines the
state of the science and should serve as a
launch pad for subsequent studies of the same
intervention. If randomized assignment of
individuals to the same or similar intervention
has already been carried out and published,
a new study describing group differences or
patient characteristics likely will be difficult
to publish, because it represents a less rigorous
VO L U M E 3 1 • N U MB E R 1 • S PRING 2020
approach and is unlikely to move the science
forward or improve on existing evidence.
Alternatively, if several descriptive or observational studies have been published but few
or no randomized studies can be found in the
literature, then the next logical step is to build
on the evidence by designing a more controlled
or rigorous test of the intervention, which may
include randomization.
A second consideration for where to begin
when designing the comparison group is in
the limitations section of published studies
of the same or a similar intervention. Do previous authors indicate specific limitations to
their studies that might inform the way you
choose to group participants and compare
groups? Can you identify ways to limit bias
in your own study that are based on group
design or grouping strategy?
After taking these preliminary considerations
into account, your team is ready to identify
groups and define a comparison strategy. Many
options are available for designing how the
groups and the comparison will be defined.
The decision tree in Figure 1 depicts a process for evaluating which grouping strategy
is best for you. Three tiers of decision-making
are important to arrive at the best possible
grouping strategy. In tier 1, feasibility issues
are listed for consideration, including the
number of patients eligible for the intervention on your unit; the cycle length, or the
length of time, it would logically take to see
a change or effect from the intervention; and
last, limitations of cost or time. Consideration
of time refers to time constraints of staffing,
patient participation, or other aspects of time
that are associated with the research team
actually delivering, documenting, and entering data for the intervention, as well as the
time required on the part of patients to participate in the study. These feasibility issues
are critical to the success of the study and
must be carefully considered in the design
phase. Any additional feasibility constraints
that arise in the planning and design phase
should be added and accounted for prior to
beginning the project.
Tier 2 describes issues related to the state of
the science and ensures your study will build
on or add to existing science in a meaningful
way. Although replication studies are a good
learning experience for the novice research
team and can make valuable contributions to
existing science, if many replication studies
CLINICAL INQUIRY
already exist, then another is not likely of
added value and will be difficult to justify
to an editor for eventual publication.
Tier 3 addresses other important considerations to take into account when designing
groups, such as input from patient experts or
caregivers, community advisory boards, or
other key stakeholders who may be affected
by the design of the groups and/or the approach
taken for group comparison. Patient or caregiver input into study design can often inform
the way groups are configured or compared,
leading to a more effective study design and
potentially more relevant, realistic, and adoptable results. Patient input into the design strategy is now required for some federal grant
funding. In addition, the perspective of patients
is considered critically important for the eventual
uptake or adoption of results that are relevant to patients. As might be true for our current example of GDMT, patient experts could
contribute valuable input about the relative
utility of a given intervention approach and
whether they would be able to effectively carry
out the expectation of a given group assignment.
SMART Considerations for “O”
The outcome (the “O” in PICOT) measure
and operational definition of that measure
typically include a primary and at least 1 or
2 prespecified secondary outcomes of interest
to the team. The outcome of interest may seem
simple at first, but how it is defined and measured requires more thought and work than
initially meets the eye. For example, what are
we improving and how will we know if that
gets better? If we consider the outcome for our
project on educational interventions for GDMT
in cardiovascular disease, would we be most
interested in improving patient knowledge,
optimizing the content delivered in the 60minute time allocation required by the Centers for Medicare and Medicaid Services, or
ensuring that all classes of medications for a
given cardiovascular indication were actually prescribed according to the guideline?
Or is the team primarily concerned that a
patient goal for taking medication was established and documented, that the skills for
self-managing prescribed medications were
demonstrated, or that a designated caregiver
was present for the education and could also
demonstrate the management of prescribed
medications using a teach-back approach?
Will understanding be measured using a
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CLINICAL INQUIRY
Population
Who?
• Adults
W W W .AACN ACCON LIN E .ORG
Intervention
What and where?
Comparison
How and when?
• Content
Outcome
Why?
• Group design
Time Frame
For how long?
• Process?
S • CVD? All?
S • Type
S • Prospective
S • Cognitive?
Specify!
• Volume?
M • Turnover?
• Inclusion?
• Health lit
• Mode
M • Learning
style
• Before and
after
M • Repeated
measures
• Confidence
M • Knowledge
• Adherence
• 1 week
• 3 or 6
M months?
• 12 months
• Inpatients
• No. needed
• No. eligible
A • No. consented
• Priority?
• Media
• Time to do?
A • Who will
deliver it?
• Health lit
R • For staff
R • Mode
T N/A
T • Frequency?
• For patient
• Learning style
• Reinforce?
• Teach-back
• Retrospective
• Baseline?
• Behavioral?
• Feasible
A • Accessible
A
• Learner
limitation?
• Educ level
A • Attainable
• What does
lit say?
• None?
R
• Organization
priority
• Staff interest
R • Maybe not
• Documented
R
• Concomitant
T • Sequential
• Cross-over
• Hot topic?
T • Journal
interest?
• Achievable
• Relevant?
• Not needed
T • Too short?
• Too long?
Figure 2: Inquiry algorithm for making a PICOT SMART. CVD indicates cardiovascular disease; educ, education; lit, literature; N/A, not applicable; PICOT, Patient Population, Intervention, Comparator, Outcome, and
Time Frame for Evaluation; SMART, specific, measurable, attainable, relevant, and time-frame objectives.
validated knowledge scale, a return demonstration, a health-literacy assessment, or a picturebased medication-selection game? Any of
these would be valid outcomes for measuring improving guideline-directed medication
use after discharge.
The fact is, the outcome of almost every
PICOT question can be defined and measured
in a number of ways, and the onus is on the
team to think carefully and systematically
about outcome selection and definition.
SMART considerations for outcome are
shown in Figure 2.
SMART Considerations for “T”
Timing in a PICOT question refers to the
timing of the intervention comparison and
the time frame for the overall duration of the
project. To some extent, the definition of timing depends on the decisions made regarding
groups and comparison approaches. However, an important consideration is the existing literature. If studies have been done and
evaluated for 3 months, does the gap in evidence lie in the months beyond that, when
perhaps the intervention has not been applied,
or has been applied but not evaluated for
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long enough to determine a sustained effect?
Often in science, early studies test an intervention or novel approach for a very short
time to ascertain early efficacy but do not to
continue the intervention long enough to
assess important sustainability factors, such
as dropout rates and regression to the mean.
A SMART, systematic approach for next
steps in defining “T” in PICOT is shown in
the last column of Figure 2. These key questions about time frames for measurement and
timing of the interval and final evaluations
should be taken into account to answer the
questions about “when” and “for how long.”
A checklist can also be created and used by
the team to ensure that each of the obvious
areas for the implications of timing have been
considered and integrated into the study protocol and the evaluation plan.
Research or Quality
Improvement?
Now that the PICOT is parsed, and specific, measurable, attainable, relevant, and
time-based operational definitions have been
identified for each component of the clinical
question, the study design itself is complete.
VO L U M E 3 1 • N U MB E R 1 • S PRING 2020
One remaining question may be whether the
study represents research or improvement
science (ie, quality improvement). The details
for distinguishing research from quality
improvement can be accessed at the Health
and Human Services website4 or by using the
previously published checklist in this column.5
Conclusion
In summary, the PICOT approach is invaluable in clarifying the basic topic and direction
for clinical inquiry; however, the next steps
after PICOT may be even more important for
the ultimate success of your project. To ensure
that operational definitions are thoughtfully
constructed for each component of PICOT
and options for study design are carefully
CLINICAL INQUIRY
weighed, your team may find SMART objectives a useful addition to PICOT in your clinical inquiry toolkit.
REFERENCES
1. Titler MG, Kleiber C, Steelman VJ, et al. The Iowa model
of evidence-based practice to promote quality care. Crit
Care Nurs Clin North Am. 2001;13(4):497-509.
2. Wolosin R, Ayala L, Fulton BR. Nursing care, inpatient
satisfaction, and value-based purchasing: vital connections. J Nurs Adm. 2012;42(6):321-325.
3. Doran GT. There’s a S.M.A.R.T. way to write management’s
goals and objectives. Manag Rev. 1981;70(11):35-36.
4. Office for Human Research Protections. Quality improvement
activities FAQs. https://www.hhs.gov/ohrp/regulations
-and-policy/guidance/faq/quality-improvement
-activities/index.html. Accessed November 9, 2019.
5. Engel J, McGugan L, Ellis M. Creating clinical research
protocols in advanced practice: part III, building blocks
of study design. AACN Adv Crit Care. 2017;28(1):
74-83.
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Editorial
The Underappreciated and Misunderstood
PICOT Question: A Critical Step in the EBP
Process
Regardless of what model of evidence-based decision-making and practice is selected, Step #1 in the EBP process is to
ask the burning clinical question in PICOT format.
As an early and critical step in the EBP process, it is remarkable to discover how often PICOT questions are incorrectly written. Whether it is the fact that the value of
the PICOT question is underappreciated, the purpose of the
PICOT question is misunderstood, or the approach to formulating and using a PICOT question is taught incorrectly,
the outcome is the same: People are writing incorrect
PICOT questions, which leads to a problematic EBP process
(Table 1).
The purpose of a PICOT question is simple: It is the
mechanism to identify the terms to be used to search for
the best evidence to answer a burning clinical question. In
other words, the PICOT question is the search strategy. The
search strategy leads to an unbiased and effective search.
The unbiased and effective search leads to the evidence.
The evidence answers the question and underpins the evidence-based recommendation, decision, or practice. Instead
of uncovering hundreds of studies, most of which do not
answer the clinical question because of a poorly designed
PICOT question, use of a correctly formed PICOT question
when conducting a search allows for a small number of
relevant studies to be discovered to answer the question.
The fact that this first step in the EBP process is often
undervalued, misunderstood, and miscommunicated is not
a benign problem. It is, instead, a major error that leads to
a number of critical problems that carry through the rest of
the EBP process and can lead to very biased recommendations and those not based on best evidence, the exact opposite of the intent of EBP.
The best way to conduct a great search for evidence is
to write an excellent PICOT question and take that question to a skilled librarian. Many of the dangers caused
by an incorrectly formed PICOT question can be averted
with the expertise of a librarian, and they are surely the
evidence-based practitioners’ most important “searching”
partner. However, not every curious clinician has access to
a librarian. Therefore, PICOT skills have to be developed,
refined, honed, and mastered to avoid faulty results.
The following are some basic tips for writing well-designed PICOT questions.
PICOT questions should not be wordy. Instead of a “P”
of “hospitalized geriatric patients with dementia,” a “P”
422
that would lead to a better search is “geriatric patients with
dementia” OR “geriatric dementia patients” because you
want to search for and find all the literature about the “P”
(population) of interest. Your intent may be to implement
the evidence found on this population when they are in the
hospital, but that is your project not your question. PICOT
questions should not include unnecessary words. Instead,
PICOT questions should include only the key term(s) you
are interested in. Instead of an “I” of “applying a sterile
dressing,” an “I” of “sterile dressing” will lead to a better
search. Extra words such as “provide,” “implement,” “use,”
“deliver,” or “apply” add more words for the search engine
to look for that are not important. Only include the key
words that matter.
PICOT questions should not be used to find evidence to
support the solutions that clinicians have already decided is
the right answer. Instead, PICOT questions should be used
to find out what is the best practice. Instead of an “I” of
“providing distraction activities,” an “I” that would lead to
a better search is “interventions” OR “strategies” because
the best practice is often something that you (and your
committee or task force or council) did not know about
or consider. For instance, what if the best intervention for
addressing agitation in dementia patients is music therapy?
You would never discover the right answer if you only
searched for something that you had already decided on.
This critical error leads people to search for evidence to
support their idea, and it may not be—and often is not—
the best idea. This mistake can be made inadvertently or
with true intention. In the first scenario, you do not realize
that you are making the mistake. In the second scenario,
you intentionally look for evidence to support your idea
and intentionally do not look for anything else. Either way,
this problem needs to be avoided.
PICOT questions are always written in the past tense. You
are searching for things that have already occurred. Research
questions, on the other hand, are written in the present tense.
PICOT questions never include a directional term such
as “increased” or “improved.” Once a directional term is
included, the search is biased; if you only look for studies
where a particular intervention “increased” an outcome of
interest, you will miss all the articles where the intervention “decreased” that outcome. This is a dangerous mistake.
PICOT questions cannot be changed once you have
started searching. More PICOT questions can be written
Worldviews on Evidence-Based Nursing, 2019; 16:6, 422–423.
© 2019 Sigma Theta Tau International
Editorial
Table 1. An Example of a Poorly Written PICOT
Question and the Corrected Version
This is an example of a PICOT question that is wrong in
all facets. A dissection of the question will help
identify the poorly written components.
In hospitalized geriatric patients more than 65 years of
age with dementia (P), how does providing distraction
activities (I) compared with providing traditional
hospital care (C) decrease agitation (O)?
P: hospitalized geriatric patients more than 65 years of
age with dementia
I: providing distraction activities
C: providing traditional hospital care
O: decrease agitation
1. The terms in this PICO question are too wordy.
The words placed into the search database are
the exact words the computer is going to scan in
the literature, so the more words, the less you will
find.
2. By including the word “providing” in the I and C
search, you would miss any study where the title
included words such as “implementing” or
“utilizing” because the computer would be looking
specifically for “providing.”
3. This PICOT is not written in past tense; as such, it
is a research question.
4. PICOT questions should not include any directional
words. They will cause a biased search.
The correctly written PICOT question to yield the most
efficient search would be:
In geriatric patients with dementia (P), how do distraction activities (I) compared with traditional care (C)
affect agitation (O)?
Your PICOT question does not always match the change
project or initiative you originally imagined or planned.
That is because a well-written PICOT question leads you
to the best practice to answer your inquiry, not the answer
you were thinking about or for which you had hoped.
It is critical to invest time in writing a great PICOT question, as it is the gateway to an efficient, effective search and,
ultimately, to making robust, evidence-based recommendations with confidence to assure the best decision-making
possible and to improve care and outcomes.
Lynn Gallagher Ford, PhD, RN, NE-BC, DPFNAP, FAAN,
Senior Director, Helene Fuld Health Trust National
Institute for EBP in Nursing & Healthcare, College of
Nursing, The Ohio State University, Columbus, OH, USA;
Director, Clinical Core, Helene Fuld Health Trust National
Institute for EBP in Nursing & Healthcare, College of
Nursing, The Ohio State University, Columbus, OH, USA
Bernadette Mazurek Melnyk, PhD, APRN-CNP, FAANP,
FNAP, FAAN,
Vice President for Health Promotion, University Chief
Wellness Officer, Dean and Professor, College of
Nursing, The Ohio State University, Columbus, OH, USA;
Professor of Pediatrics & Psychiatry, College of
Medicine, The Ohio State University, Columbus, OH, USA;
Executive Director, Helene Fuld Health Trust National
Institute for EBP in Nursing & Healthcare, The Ohio State
University, Columbus, OH, USA;
Editor, Worldviews on Evidence-Based Nursing, The Ohio
State University, Columbus, OH, USA
for the same inquiry, but you cannot change a question
that you have already used. That question is already part
of your EBP adventure and needs to be included in your
story.
Worldviews on Evidence-Based Nursing, 2019; 16:6, 422–423.
© 2019 Sigma Theta Tau International
423
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———- [ EVIDENCE IN PRACTICE ] ———STEVEN J. KAMPER, P h D 12
Types of Research Questions:
Descriptive, Predictive, or Causal
J Orthop Sports Phys Ther 2020;50(8):468-469. doi:10.2519/jospt.2020.0703
previous Evidence in Practice art icle explained why a specific
and answerable research question is important for clinicians
and researchers . 3 As a reader, if you cannot specify the question
and summarize it simply in your own words, you might as well
not read the study. The type of research question has critical implications
for the study methods. Good-quality, clinically useful research begins
A
with the research question and requires
that the study design match the type of
question.
Descriptive questions can be answered
with cross-sectional or longitudinal de
signs, but predictive and causal questions
usually need longitudinal designs.
Q uestion Types
Research questions fall into 1 of 3 m utu
ally exclusive types: descriptive, predic
tive, or causal. Imagine you are seeking
information about whiplash injuries. You
might find studies that address the fol
lowing questions.
1. Descriptive questions: W hat is the
num ber of whiplash injuries per head
of population? W hat proportion of
people who attend the emergency
departm ent with a whiplash injury
completely recover within 3 months?
W hat impact do whiplash symptoms
have on individuals?
2. Predictive question: How well does a set
of simple clinical measures predict the
likelihood of recovery within 3 months?
3. Causal questions: Are people who re
ceive education and reassurance more
likely to recover in 3 m onths than
people who receive a neck brace and
advice to rest? Do posttraumatic stress
symptoms immediately after whiplash
injury cause slower recovery?
There is a critical distinction between
question type and study design (T A B L E ).
D escriptive Questions
Descriptive questions seek to describe the
“landscape,” to provide an overview of the
