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Yacca Library NWHHS: Step 1: Ask

Yacca Library is the Medical Library for the North West Hospital and Health Service (NWHHS).

Your information need

 

 

In your day-to-day work you will come across many information needs, like a patient dilemma or discrepancy in a policy, whereby you need to gain other evidence to support a change or intervention. Being able to turn an information need into a question is a powerful way forward to solving these problems.

Turning an information need into an answerable clinical question

So how do you actually turn your information need into a question?

There are two main types of questions that may arise from an information need:

  • Background questions address general queries about a particular disease, condition, test or treatment and can often be answered sufficiently using medical textbooks or point-of-care tools (e.g. UpToDate).
  • Foreground questions address aspects of care, therapy options or possible outcomes in relation to a specific patient or situation and require a more in-depth literature search to find the answer.

Answering foreground questions involves developing well-formed, focused clinical questions. The PICO(T) framework is commonly used to translate and structure information needs into focused questions. Using PICO helps to identify the important concepts for your search strategy and makes searching for evidence easier and more time effective.

P

What is the population and/or problem of interest?

 

I

What is the main Intervention – what do you want to treat, diagnose or observe?  

C

What are you comparing your intervention with? You may also have no comparison  

O

 

What are you hypothesizing that the intervention will cause?

 
T This is optional but it may or may not be important to include a timeframe for your question  

Let’s look at a silly example to understand how you can use this formula.

Information need: You want to know if yoga or chocolate is better for reducing work related stress in new nurses.

P - What is the population and/or problem of interest? Among nurses with work related stress

I - What is the main Intervention – what do you want to treat, diagnose or observe? Does yoga

C - What are you comparing your intervention with? You may also have no comparison. Versus chocolate

O - What are you hypothesizing that the intervention will cause? Reduce work related stress

T – Is there a timeframe for your question? First 2 years of practice

Your question: Among nurses, is yoga or chocolate more effective in reducing work related stress for those who are in their first two years of practice?

This first example is good if you have a clinical question but what if you want to investigate meaning or gain an understanding of a phenomena, your approach using this framework will be slightly different.

 

P

What is the population and/or problem of interest?
I What is the defined event, activity, experience or process you want to investigate?
Co What is the setting or distinct characteristics of the situation?

Information need: You want to know about new nurses experiences with work related stress

 


P - What is the population and/or problem of interest? Nurses and work related stress

I -  What is the defined event, activity, experience or process you want to investigate? Experiences

Co – What is the setting or distinct characteristics of the situation? In first 2 years of practice

Your question: What are the experiences of nurses who are in their first two years of practice with work related stress?

Activity: Identifying PICO elements

Let's now consider a truer clinical scenario.

Read through the scenario below and try to determine how this could be turned into a PICO question.

A 47 year old woman comes to see you. She is overweight, concerned about her overall health, and would like to lose weight quickly. She has heard a report on the radio suggesting that resistant starch (corn or potato) can reduce obesity more than eating non resistant starch (beans and whole grains).

Key words bank

Highlighting the key terms from the parts of your PICO question by identifying each component will assist when identifying the terms to search for.

Among middle aged women, does resistant starch verses ordinary starch affect weight loss and reduce obesity?

The next step is to place your terms in a table like this one below.

The major concepts from the PICO question have been identified. Brainstorming other terms that could be used to describe these concepts will enable you to search these alternative words when you find that those from your question aren't bringing back relevant evidence.

(P)   Middle aged women (P)   overweight (I)   resistant starch (C)   ordinary starch (O)   weight loss
women obese R.S starch thinness
female body size dietary fibre
middle age dietary carbohydrates

Hover over the title/tab 'Tackling Evidence Based Practice' at the top of the screen and click on 'Step 2: Acquire' to continue.