The PICOT Question

• Create Keywords — The elements or components of your PICOT 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 PICOT concepts. The MeSH database (Medical Subject Headings thesaurus) provides a great tool for this.
• Do Pre-Research — When you have decided on a PICOT 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 PICOT. 
• 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 PICOT 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 PICOT question, investigating your exact intervention and comparison. However, depending on the nature of your PICOT 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 PICOT 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 PICOT. 
• 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.
• Tip #4 — Know that an acceptable answer to a PICOT question can be that more research needs to be done. Remember, you conclusion is dependent on the state of the research on a topic.

Example: In adults suffering from depression (P), how does St. John's Wort (I) effect depression symptoms (O) compared to SSRIs (C) [within six months (T)]?

When utilizing PICOT to search for literature, it is also important to discern whether what you find is the best available evidence to answer the clinical question that you develop. The strength of a study is determined by the level and quality of evidence. There are multiple tools available to assist you in assessing evidence for level and quality. 

• Johns Hopkins Nursing Evidence-Based Practice (JHNEBP)
• Joanna Brigs Institute (JBI)
• Melnyk's Levels/Hierarchy of Evidence

• Qualitative - The investigation of phenomena, typically in an in-depth fashion, through the collection of rich narrative materials using a flexible research design.
• Quantitative - The investigation of phenomena that lend themselves to precise measurement and quantification, often involving a rigorous and controlled design and statistical analysis.
• 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 synthesizes the evidence from the primary literature on a certain topic.
• Meta-Analysis - A study that merges and quantitatively integrates the findings of the relevant literature on a topic to arrive at a conclusion.
• Randomized Controlled Trials (RCT) - A full experimental test of an intervention involving random assignment of participants to different treatment groups (experimental and control groups).
• Evidence-Based Practice (EBP) - A practice that involves making clinical decisions based on clinical judgement, patient preferences, and the best available evidence.
• Research - Systematic inquiry that uses orderly, disciplined methods to answer questions or solve problems.