Formulating a clinical question using the PICO format

Formulating a clinical question using the PICO format provides a focus that will guide an efficient

electronic literature search.

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• Remember, the findings of one study on a topic do not provide sufficient evidence to support a change in practice.

• The ability to critically appraise and synthesize the literature is essential to acquiring skills for

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making successful presentations, as well as participating in EBP/QI projects.

Searching for evidence Students often state, “I know how to do research; why I need to go see the librarian?” Perhaps you have thought the same thing because you too have “researched” a topic for many of your course requirements. However, it would be more accurate for you to say that you have “searched” the literature to uncover research studies and conceptual information to prepare an academic paper on a topic. During this process, you search for primary sources and secondary sources. It is best to use a primary source when available. Table 3.1 provides definitions and examples of primary and secondary sources, and Table 3.2 identifies the steps and strategies for conducting an efficient literature search. Table 3.3 indicates recommended databases. The top two, CINAHL Plus with full text and PubMed (MEDLINE), are always a must. There are multiple databases that health science libraries offer, and most offer online tutorials for how to use each database. Using the CINAHL Plus and PubMed databases and at least one additional resource database is recommended. Example: ➤ If your topic is about changing a patient’s behavior, such as promoting smoking cessation or increasing weight-bearing exercises, you would use the top two as well as PsycINFO. Another recommendation if your clinical question focuses on interventions is to use the Cochrane Library (http://www.cochranelibrary.com), which has full text systematic reviews as well as an extensive list of randomized control trials (RCTs) and other sources of studies.

TABLE 3.2 Steps and Strategies for Conducting a Literature Search: An EBP Perspective

Steps of Literature Review Strategy Step I: Determine clinical question or research topic.

Focus on the types of patients (population) of interest.

If the goal is to develop an EBP project, start with a PICO question. If the goal is to develop a research study, a researcher starts with a broad review of the literature to refine the research question or hypothesis (see Chapter 2).

Step II: Identify key variables/terms.

Review your library’s online Help and Tutorial modules related to conducting a search, including the use of each databases’ vocabulary, prior to meeting with your librarian for help. Make sure you have your PICO format completed so the librarian can help you limit the research articles that fit the parameters of your PICO question. If, after reviewing tutorials on Boolean connectors “AND, OR, and NOT” that connect your search terms when using a specific database, you don’t understand the use of these connectors, clarify with a librarian.

Step III: Conduct electronic search using at least two, preferably three if needed for your topic, recognized electronic databases.

Conduct the search, and make a decision regarding which databases, in addition to CINAHL PLUS with Full Text via EBSCO and MEDLINE via Ovid, you should search; use key mesh terms and Boolean logic (AND, OR, NOT) to address your clinical question.

Step IV: Review abstracts online and weed out irrelevant articles.

Scan through your retrieved articles, read the abstracts, mark only those that fit the topic and are research; select “references” as well as “search history” and “full-text articles” if available, before printing and saving or e-mailing your search.

Step V: Retrieve relevant sources.

Organize by type or study design and year and reread the abstracts to determine if the articles chosen are relevant research to your topic and worth retrieving.

Step VI: Store or print relevant articles; if unable to print directly from the database, order through interlibrary loan.

Download the search to a web-based bibliography and database manager/writing and collaboration tool (e.g., RefWorks, EndNote); most academic institutions have “free” management tools, such as Zotero. Using a system will ensure that you have the information for each citation (e.g., journal name, year, volume number, pages), and it will format the reference list. Download PDF versions of articles as needed.

Step VII: Conduct preliminary reading; eliminate irrelevant sources.

First read each abstract to assess if the article is relevant.

Step VIII: Critically read each source (summarize and critique each source).

Use critical appraisal strategies (e.g., use an evidence table [see Chapter 20] or a standardized critiquing tool) to summarize and critique each articles; include references in APA format.

Step IX: Synthesize critical summaries of each article.

Decide how you will present the synthesis of overall strengths and weaknesses of the reviewed research articles (e.g., present chronologically or according to the designs); thus, the reader can review the evidence. Compare and contrast the studies in terms of the research process steps, so you conclude with the overall similarities and differences between and among studies. In the end, summarize the findings of the review—that is, determine if the strengths of the group of studies outweigh the limitations in order to determine confidence in the findings and draw a conclusion about the state of the science. Include the reference list.

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