Evidence Based Practice

The first stage of any evidence-based practice process is formulating an answerable question. This forms the foundation for quality searching. A well-formulated question will facilitate the search for evidence and will assist you in determining whether the evidence is relevant to your question.

The most commonly used framework for formatting questions is PICO. The acronym translates to:

Other variables that can be added to this PICO framework are:

The PICo variation is useful for for qualitative studies

Example of the scenario that the question comes from:

A nurse in aged care home has a lot of patients who get bed sores because they are in bed all, or most of the day. Is there any way to stop them getting bedsores as often? And how can they be treated so that they don't keep getting worse?

The example question laid out using the PICO framework:

NOTE: You don't have to fill in all of the fields. In this case you can't fill in the intervention, because that is what you are trying to discover. And because there is no intervention, you can't add a comparison intervention either.

Example question reworded as a clinical question for research:

Which interventions reduce the incidence and severity of bed sores in residents of aged care facilities?

Keywords from the example question and possible alternatives:

The database search string from the example question

("aged care residents" OR "aged care" OR "nursing home" OR aged OR elderly OR geriatric) AND ("bed sores" OR bedsores OR "pressure sores" OR "pressure ulcers" OR "decubitus ulcers") AND (reduc* OR lessen OR decrease OR minimi?e OR prevent OR improve)

Notes:

• reduc* will tell the database to search for reduce, reduces, reduced, reducing, reduction, and reductions.
• minimi?e will tell it to search for both minimise (English spelling) and minimize (American spelling).
• Go to the Searching databases page for information on how to structure your search like this one.

Other limits you can apply in a database for this search

• Age range, e.g. Aged 80 and over.
• Subject headings, e.g. wound care. (You can use the database subject headings to narrow the focus of your search.)
• Publication date range, e.g. in the last 10 years.
• Publication type, e.g. case study. (Sometimes this is a filter. Sometimes you need to use it as a search term.)
• Geography, e.g. Australia. (Sometimes this is a filter. Sometimes you need to use it as a search term.)

This worksheet was adapted from Syrene A. Miller, PICO Worksheet and Search Strategy, National Center for Dental Hygiene Research.

The PICO Framework may not fit the type of issue or topic you may want to research, therefore, here are some other frameworks that may assist in building a research question.

ECLIPSE – can facilitate the building of a review question looking at health policy and management. The aim of ECLIPSE is to focus on terms that differ to those used in the medical profession.

SPIDER – has been designed to enable researchers to develop a research question and search strategy that is focused on qualitative and mixed methods primary research.

SPICE – was formulated to assist in the development of research questions and search strategies looking to evaluate the outcomes of a specific intervention.