Forming Focused Questions with PICO: Choose a specialty

Patients on coronary artery bypass graft (CABG) waiting lists often experience anxiety and depression and your nurse manager wants to know if it would be a good idea to reach out to these patients with presurgical home visits and follow-up calls from a specialist cardiac nurse.

Open to check your PICO analysis of the scenario.

P: patients on CABG waiting lists
I: program consisting of presurgical home visit and follow-up calls form a specialist cardiac nurse
C: no intervention
O: decreased patient anxiety and depression


For patients on CABG waiting lists, does an intervention program consisting of presurgical home visits and follow-up calls from a specialist cardiac nurse lead to decreased patient anxiety and depression [when compared with no intervention]?

In the past few years, your hospital has installed antibacterial foam dispensers on all the nursing units. You’ve had nurses asking you if the foam is just as effective as washing their hands with water and soap.

Open to check your PICO analysis of the scenario.

P: hospital nurses
I: using antibacterial foam
C: hand washing with soap and water
O: decreased bacteria count

In hospital nurses, does antibacterial foam decrease bacteria count on hands as much as hand washing with soap and water?

Shift change on your busy med-surg unit can be frustrating for you and your coworkers. Report at the nursing station takes up to 30 minutes, by the end of which you’re anxious to see your patients. You read something in a recent ANA newsletter about other hospitals switching to a bedside shift report, and you want to find out if staff liked that style of shift change better.

Open to check your PICO analysis of the scenario.

P: Staff med-surg nurses
I: implementation of bedside shift reports
C: shift change reports at the nurses station/standard practice
O: greater satisfaction with care

Among staff nurses on a medical-surgical unit, do implementing bedside shift reports lead to greater satisfaction with care when compared to traditional shift change reports at the nurses station?

It’s the last semester of your BSN students’ time in school and they’re excited.. and anxious! They’ve been asking you if they should take the NCLEX right after they graduate or wait for a while after graduation so they can relax and study.

Open to check your PICO analysis of the scenario.

P: BSN students
I: Sitting for the NCLEX within 2 months of graduation
C: Sitting for the NCLEX after 2 months from graduation
O: Higher pass rates

Among BSN students, does taking the NCLEX within 2 months of graduating result in a higher pass rates when compared to sitting for the exam later?

You work with patients with advanced cancer and have been taught to suggest pain diaries for your patients as a form of pain management. You’ve been wondering for a while now if these diaries actually improve pain control or make pain worse by making patients more aware of their pain.

Open to check your PICO analysis of the scenario.

P: patients with advanced cancer
I: keeping a pain journal
C: no intervention
O: lower reported pain scores

In patients with advanced cancer, does keeping a pain journal result in lower reported pain scores when compared to no intervention?

You work in a pediatrician’s office and give patients their routine vaccinations. The younger children are often fearful of needles, and some of the RNs use toys to distract the patients. You want to know if this technique actually has an effect on the children's pain response.

Open to check your PICO analysis of the scenario.

P: young children
I: distraction techniques during immunization
C: no intervention
O: lower pain scores rated by the Faces pain scale

In young children, do distraction techniques during immunization administration using toys result in lower pain scores when compared to no intervention?

You coordinate health education programs and have been holding seminars for low-income teenagers about STI prevention. You’ve been found that they’re hesitant to open up to you during classes to ask you questions. You’re wondering if recruiting peer educators closer to their age will encourage them to actively participate and get more satisfaction out of the classes.

Open to check your PICO analysis of the scenario.

P: low-income adolescents
I: a peer-led STI prevention class
C: a nurse-led STI prevention class
O: greater client participation and satisfaction

In low-income adolescents, will a peer-led STI prevention class result in greater participation and client satisfaction when compared to a nurse led class?

You’re a school nurse at a school in a low-income area. One aspect of your job is counseling pregnant teens with the aim of enabling them to complete high school. You’ve even been conducting home visits on top of your normal in-school meetings as part of their preparation-for-motherhood counseling. You want sources to backup the effectiveness of these home visits.

Open to check your PICO analysis of the scenario.

P: pregnant high-school adolescents
I: nurse home visits adjunct to in school interventions
C: in school interventions alone
O: decreased drop out rate

In pregnant high-school adolescents, do nurse home visits adjunct to in-school interventions decrease drop out rate when compared with in-school interventions alone?

You work in the Big City Hospital ICU. Your mechanically ventilated patients sometimes contract nosocomial pneumonia, which leads to costly complications. You want to know if raising the head of the bed lowers the chance of the patient contracting pneumonia compared to letting the patient lie flat on their back.

Open to check your PICO analysis of the scenario.

P: mechanically ventilated ICU patients
I: semi-fowlers position
C: supine position
O: lower incidence of nosocomial pneumonia

In mechanically ventilated ICU patients, does positioning the patient in semi-fowlers result in a lower incidence of nosocomial pneumonia when compared to the supine position?

You’re a new nurse on a labor and delivery unit. You’ve noticed that most women give birth in the lithotomy position at the encouragement of their doctors. However, you’re sure you heard in nursing school that other positions are less likely to lead to deliveries with forceps or a vacuum.. or did you? You want to find some literature to back up your claim.

Open to check your PICO analysis of the scenario.

P: laboring women delivering in a hospital
I: positions other than the lithotomy position
C: lithotomy position
O: decreased incidence of assisted deliveries

In laboring women delivering in the hospital, do positions other than lithotomy position lead to a decreased incidence of assisted deliveries?

You’re the nurse manager of a NICU unit. One concern of parents of infants receiving tube feedings is being able to successfully breastfeed their child upon discharge. One of your staff nurses asks if it would be helpful to give the infants cup feedings instead of tube feedings during their NICU stay.

Open to check your PICO analysis of the scenario.

P: Infants in the NICU
I: cup feeding throughout the hospital stay
C: tube feedings throughout the hospital stay
O: greater reported success with breastfeeding post-discharge

In infants in the NICU, will cup feeding throughout the hospital stay lead to greater success with breastfeeding post-discharge when compared to tube feedings?

It’s winter at your family practice, and you have a lot of patients coming in with runny noses and general malaise. Brenda, a 35 year old working mother in for a checkup states, "I’m so busy between work and home that I definitely don’t have time to get sick! Can those vitamin C or zinc pills prevent colds?"

Open to check your PICO analysis of the scenario.

P: adult females
I: taking daily vitamin C or zinc supplements
C: no intervention
O: incidence of the common cold

In adult females, will daily vitamin C or zinc supplements reduce the incidence of the common cold when compared with no intervention?

The main concern for most of your patients coming out of anesthesia in your PACU is pain. You want to explore nursing interventions you can use on top of medication administration to decrease pain. One coworker mentions trying to make the PACU feel less clinical by playing soft music to relax patients.

Open to check your PICO analysis of the scenario.

P: PACU patients
I: soft music as an adjunct to standard care
C: standard care alone
O: lower reported pain scores

In PACU patients, will playing soft music in the PACU as an adjunct to standard care result in lower reported pain scores when compared to standard care alone?

You work on an inpatient psychiatric unit. One of your patients with chronic schizophrenia, Joe, normally mumbles to himself, but will occasionally speak to others when residents play games together. Noticing this, you say to a coworker that maybe social skills group training sessions would bring out Joe’s conversational skills. Your coworker shakes her head and says "I don’t think so. Joe is in and out of this hospital, he’s a lost cause."

Open to check your PICO analysis of the scenario.

P: Inpatient chronic schizophrenia patients
I: social skills group training sessions
C: standard care
O: increased conversational skills as evidenced by greater number of interactions with peers

In inpatient chronic schizophrenia patients, do social skills group training sessions increase conversational skills when compared to standard care?

On your pulmonary unit, many of your COPD patients receive injections of heparin to prevent pulmonary emboli, and patients find the bruises associated with heparin injections unsightly. You’ve had nursing students shadowing you lately, so you’ve been particularly concerned with injection technique. You want to find out if the duration of injection has any effect on the extent of bruising.

Open to check your PICO analysis of the scenario.

P: COPD patients receiving prophylactic heparin
I: heparin injection duration of thirty seconds
C: heparin injection duration of ten seconds
O: decreased circumference of bruising

In COPD patients receiving prophylactic heparin, will a heparin injection duration of thirty seconds lead to a decreased circumference of bruising when compared to an injection duration ten seconds?

A diabetic patient from a nursing home has recently been admitted with a stage III pressure ulcers on his heels. The unit nurses have called you in for a wound consult. You have to choose between standard moist wound therapy and using a wound vac.

Open to check your PICO analysis of the scenario.

P: elderly diabetic with stage III foot ulcers
I: negative pressure wound therapy
C: standard moist wound therapy
O: improved wound healing as measured by pressure ulcer grading system guidelines

In elderly diabetic patients with stage III foot ulcers, does negative pressure wound therapy lead to improved wound healing when compared to standard moist wound therapy?