The PICO Research Question

• Create Keywords — The elements or components of your PICO question are what will assist you in your research. Your P, I, C, and O, (especially those nouns and adjectives) can all serve as search terms to help you find relevant literature. Use various combinations of your terms and connecting words (AND for different concepts, OR for similar ones) to search for articles. Use quotation marks around phrases when searching. Develop synonyms or related terms to your PICO concepts. The MeSH database (Medical Subject Headings thesaurus) provides a great tool for this.
• Do Pre-Research — When you have decided on a PICO question, do some initial or pre-research in databases and online. This allows you to see if there is enough research out there for you to answer your question before moving forward with the actual research. If not, you may need to go back to the drawing board and tweak some elements of your PICO. 
• Utilize Databases — The library subscribes to and offers a plethora of databases. These databases are where you will find a majority of your sources. Take advantage of database tools like limiters and filters. Many databases include study type, publication date, geography, gender, and age filters, among others.
• Evaluate Sources — When evaluating articles, begin with the title, the abstract (summary of an article), the introduction, and the conclusion. Skimming these can save you time and also clue you in on whether an article is relevant to your research. If you discover it is not, you can stop at any point in the process. If an article does seem relevant, then read the entirety of it. If you locate a high-quality article, check their references page. There you can potentially find more useful articles. It is also helpful to determine a source’s level and quality of evidence so you can find the best articles possible. 
• Organize & Save Sources — If you find an article you like, do something with it! Article metadata pages often include various ways for your to keep track of your sources, like pdf versions you can save directly to your computer, email options, permalinks, exporting to citation managers, etc. The library also offers citation manager tools like RefWorks & Zotero where you can compile your sources and references.

• Tip #1 — Go where the research leads you. You may think you have an answer to your PICO question before you even start. Don’t let your assumptions or personal bias interfere with the research process. 
• Tip #2 — The best sources address the entirety of your PICO question, investigating your exact intervention and comparison. However, depending on the nature of your PICO question and the extent of the research on it, you may find more articles dealing with solely your intervention or comparison. These articles can still provide useful information and can contribute to the answer to your PICO question. When encountering these articles, you will eventually see patterns in the research, allowing you to conduct the comparison yourself and come to a conclusion regarding your PICO. 
• Tip #3 — It is recommended for medical research to limit your sources to no more than the last 10 years. Medical research is constantly changing, and something written even as recently as three years ago could be considered out of date, depending on your topic.

Example: In adults suffering from depression (P), how does St. John's Wort (I) effect depression symptoms (O) compared to SSRIs (C)?

It is important to consider the types of evidence you are looking at when researching for a PICO question. If you are conducting a thorough literature review, you want to draw from as many levels and types of evidence as possible, including both quantitative and qualitative studies, unless otherwise indicated. The Hierarchy of Evidence Pyramid is a good visual tool indicating the different types of research and their intrinsic value. Another tool that is helpful in determining level or quality of evidence is the Johns Hopkins Evidence Based Practice for Nurses and Healthcare Professionals Model.

• Qualitative - Textual data
• Quantitative - Numerical data
• Peer-Reviewed - Essentially an article screening process. If a nurse wants to submit an article to a particular journal, it is reviewed by experts within the nursing field, primarily for content. An article can be rejected, accepted, or revised before publication.
• Systematic Reviews - A study that critically appraises and summarizes the evidence from the primary literature on a certain topic.
• Meta-Analysis - A study that merges the findings of the relevant literature on a topic to arrive at a conclusion.
• Randomized Controlled Trials (RCT) - Subjects are randomly assigned to one of two groups: the experimental group or the control/placebo group.