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Nursing 730

This guide is for Prof. Danna Curcio's Nursing 730 class: Evidence Based Practice for Advanced Practice Nursing

PICO Search in CINAHL: An Example

A PICO Question
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?
(Ileus: Inability of the intestine (bowel) to contract normally and move waste out of the body. Intestinal obstruction)

1. IDENTIFY KEYWORDS FOR EACH PICO ELEMENT 
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?

2. Plan YOUR SEARCH STRATEGY: Identify the major elements of your question; translate natural language terms to subject descriptors, CINAHL Headings, or synonyms. Synonyms can help expand your search. 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.

3. SEARCH IN CINAHL (CINAHL Complete)
Search each PICO element individually. After each search, you will clear the screen and start a new search.
P: Abdominal surgery or surgery or postoperative or recovery (see example below for P).
I: Chewing gum or gum
O: Postoperative ileus or paralytic ileus or ileus

Combine searches: to complete your search, click Search History, combine your individual searches (P.I.O) into one search showing results from all three of your previous searches.

4. REFINE YOUR RESULTS
You can now refine you results by adding limiters. Applying limiters to your search will allow you to focus your results to the most relevant content.  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. The Evidence-Based Practice limiter searches the Special Interest field.  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)

If 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     3. Meta-Analysis  4. Randomized Controlled Trial    5. Research   6. Systematic Review

5. REVIEW THE LITERATURE
Once you have added limiters to your combined search and run the results again, choose and review articles that are most relevant to your PICO question.

6. DETERMINE THE LEVEL OF EVIDENCE
In searching for the best available evidence, a hierarchy exists regarding the level and strength of evidence (see Pyramid of Evidence). As you review the articles, select those that are based on highest level of evidence, such as a Systematic Review or a Meta-Analyses.

Systematic reviews and meta-analysis are at the top of the “Evidence Pyramid”. As you move up the pyramid the amount of available evidence on a given topic decreases, but the relevancy and quality of that evidence increases. Systematic reviews and meta-analysis are considered to be the highest quality evidence on a clinical topic. However, you may not always be able to find the highest level of evidence to answer your question. You then need to consider moving down the pyramid. See definition for the research study types above

***The above tutorial is based on an EBSCO guide: 7 Steps to the Perfect PICO Search. Click the pdf file link to learn more.