Nursing

Population (P) – What individual or group are we interested in studying?

Intervention (I) – What is the action (intervention, treatment) we are considering taking?

Comparison (C) – To what other action (intervention, treatment) are we comparing the considered action?

Outcome (O) – What do we anticipate as an outcome?

“In patients undergoing abdominal surgery, is there evidence to suggest that chewing gum post-operatively compared with not chewing gum post-operatively affects post-operative ileus?”

Plan a search strategy by:

• Determining which database(s) to search

• Identifying the major elements of your question

• Translating natural language terms to subject descriptors, EBSCO Headings, or synonyms

Synonyms, words or phrases that mean exactly or nearly the same as another word or phrase, can help expand your search appropriately. For example: when searching the keyword ‘surgery’, you might miss articles that instead describe a patient as ‘postoperative’ or in ‘recovery’. Adding synonyms will help to expand your results to those articles that are still relevant but might not include the words ‘abdominal surgery’. These are shown as ‘Search Strategies’ in the table below.

Advanced Search Mode set to Boolean/Phrase

The reason this is important is because this option allows for “exact phrase” searching. For example, if you searched for the phrase, Heart Disease, the system will search for records where the two words heart and disease appear together, as a phrase, and not simply records where the two words appear separately.

To begin your search, first refer to Fig. 2 above. Each PICO Element (P, I, C, O) will be searched individually using the correlating Search Strategy. After each search, you will clear the screen and start a new search before beginning your next search.

• P (Patient or Population): Begin your search with the Patient or Population, which are those patients undergoing abdominal surgery. As mentioned above, to increase your search results, try adding less descriptive terms that have the same meaning, such as Surgery, Postoperative or Recovery. *Note: Be sure to use the Boolean operator, “Or”, so that each result contains at least one of these search terms. Fig. 3 is an example of this search strategy shown on EBSCOhost.

• I (Intervention): Start a new search for the Intervention, which is Chewing Gum or Gum. Be sure to use the Boolean operator, “Or”. Note the number of results.

• O (Outcome): You can now conduct a search for the Outcome, which is post-operative ileus. Add the synonyms paralytic ileus or ileus. Your goal is to determine whether chewing gum postoperatively affects postoperative ileus, positively or negatively. Click search and note the number of results.

• Combine searches: To complete your search, you will combine the Population (those patients undergoing abdominal surgery); the Intervention (Chewing gum) and the Outcome (Post-operative ileus/paralytic ileus). By using your database’s Search History, you should be able to combine these searches into one search showing results from all three of your previous searches.

You can now refine you results by adding limiters. Applying limiters to your search will allow you to focus your results to the most pertinent and relevant content ensuring that you aren’t wasting time wading through content that may not be useful.

For example, you may wish to limit your results by Date and Type:

Published Date – Use this option to search for articles within a specified date range.

Evidence-Based Practice – You may wish to limit your articles to only those which are evidence-based. When searching an EBSCOhost database for example, the Evidence-Based Practice limiter searches the Special Interest field for the value “Evidence-Based Practice.” Applying this limiter allows you to limit results to:

• Articles from evidence-based practice journals

• Articles about evidence-based practice

• Research articles (including systematic reviews, clinical trials, meta analyses, etc.)

• Commentaries on research studies (applying practice to research)

Should you find that you are left with too few articles by limiting your results to Evidence-Based Practice, you can instead choose any or all of the following publication types:

1. Case Study

2. Clinical Trial - an experiment performed on human beings in order to evaluate the comparative efficacy of two or more therapies. 

3. Meta-Analysis - When results of individual studies are combined to produce an overall statistic.

4. Randomized Controlled Trial - An experimental design used for testing the effectiveness of a new medication or a new therapeutic procedure. Individuals are assigned randomly to a treatment group or a control group, and the outcomes are compared. RCT is the most accepted scientific method of determining the benefit of a drug or a therapeutic procedure. It represents the best evidence available, which is integrated into the final decision about the management of a condition by healthcare practitioners in what is called evidence-based healthcare.

5. Research

6. Systematic Review - Address a focused clinical question where review authors systematically search for, identify, select, summarize and critically apraise all of the medical research literature available on a specific topic.  Statistical techniques may be used to combine the results of these studies.  The authors clearly state the search methods used to locate these studies.  It is important to examine the search methods used and decide for yourself if it was broad enough to include all of the relevant studies, and if the studies found were relevant to the clinical question.

The final step to the perfect PICO search is to determine the level of evidence within each relevant article. In searching for the best available evidence, a hierarchy exists regarding the level and strength of evidence (see Fig. 4). As you review the journal articles, select those that are based on highest level of evidence, such as a Meta-Analyses or a Systematic Review