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Evidence-Based Practice Toolkit for Nursing

Created in collaboration with the OHSU Clinical Inquiry Council

Using PICO to Formulate your Question

It is helpful to begin by identifying the type of information you seek. For example, EBP questions are typically classified as background or foreground questions. Knowing your question type will help you determine where and how to search for answers.

Background questions help you identify and understand what is known about an area of interest when it is unfamiliar. These questions address general knowledge of disease processes or clinical contexts and are often broad in scope. Secondary sources such as textbooks, nursing reference sources, and review articles can often provide relevant and reliable answers. Knowledge gained from the answers to background questions informs foreground questions.

Background question example: How does the drug acetaminophen work to affect fever?

Foreground questions ask for specific knowledge to inform decisions or actions and generally compare one or more options (interventions). Therefore, foreground questions require primary sources that synthesize a wide range of knowledge, requiring a comprehensive literature search. The best way do ask a foreground question is often by using PICO. See the other tabs to learn how.

Foreground question example: In children, how does acetaminophen affect fever within 30 minutes of administration compared to ibuprofen?

Developing an effective and well-structured EBP question is very important because it directs the strategies you and your team will use to search for evidence.  The PICO format is used to create questions that are as specific as possible, making your search more productive and efficient.

PICO defines and describes the elements of an answerable EPB question:

P = Patient/Population/Problem: Describes the patient, population, or problem succinctly. Include the type of patient or population and the setting, considering attributes such as age, gender, symptoms, and diagnosis.

I = Intervention: The intervention can be a clinical treatment, an educational or administrative intervention, or a structure or process.

C = Comparison:  Foreground questions compare one intervention to another. Background questions do not include a comparison.

O = Outcome: This component describes the desired change or improvement.

Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central,

PICO Example of a Foreground Question

P = Patient, Population or Problem Children with a fever
I = Intervention Acetaminophen
C= Comparision Ibuprofen
O = Outcome

Reduced fever within 30 minutes

 Fill in the blanks with information from your clinical scenario:

In_______________, what is the effect of ________________on _______________ compared with _________________?

For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

Does ____________ influence ______________ in patients who have _____________?

Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________

How do _______________ diagnosed with _______________ perceive __________________?

Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.