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Nursing - Evidence-Based Practice

Step 1: Asking a Question

Asking the Clinical Question - Video

Credit: Molly Montgomery, MLS, MS - ISU Library

Background vs. Foreground Questions

Background Questions

  • Asks for general knowledge about a disease or disease process
  • Have two essential components:
    • A question root (who, what, when, etc.) with a verb
    • A disorder, test, treatment, or other aspect of healthcare
    • Example: What causes migraines? or How often should women over the age of 40 have a mammogram
  • The background question is usually asked because of the need for basic information. It is not normally asked because of a need to make a clinical decision about a specific patient.

Foreground questions

  • Ask for specific knowledge about managing patients with a disease
  • Have 3 or 4 essential components (see PICO below)

Types of Questions

Different types of questions are answered by different types of research/studies. Common types of questions include:

  • Therapy/Treatment - how to select treatments that do more good than harm and that are worth the efforts and costs of using them
  • Diagnostic Test - how to select and interpret diagnostic tests
  • Prognosis - how to estimate the patient’s likely clinical course over time (based on factors other than the intervention) and anticipate likely complications of disease
  • Harm/Etiology - how to identify causes for disease (including iatrogenic forms)
  • Duke University Medical Center Library (2015). Introduction to Evidence-Based Practice.

    Focusing Clinical Questions - PICO

    The first step in the EBP process is to ask a clinical question that can be answered with evidence-based research. To help us take our clinical problem and turn it into a focused and answerable question, we can use the PICO formula.

    PICO, or PICO(T), stands for:

    • P - Population/Patient/Problem
    • I - Intervention or prognostic factor
    • C - Comparison
    • O - Outcome
    • T - Time (added when there is a time component to the question)

    Once you've identified each aspect of your PICOT, here is a formula that you can use to turn it into a question:


    In __________________(P), what is the effect of __________________(I) compared to _____________ (C) on ________________(O within _____________(T)?


    In ____________________(P), how does ____________________ (I) compared to ____________________(C) affect _____________________(O) within ___________(T)?


    In ______________ (P), how does ___________________ (I) compared to _____________(C) influence __________________ (O) over _______________ (T)?


    In ___________________(P) are/is ____________________(I) compared with _______________________(C) more accurate in diagnosing _________________(O)?


    Are____________________ (P), who have ____________________ (I) compared with those without ____________________(C) at ____________ risk for/of ____________________(O) over ________________(T)?


    How do _______________________ (P) with _______________________ (I) perceive _______________________ (O) during ________________(T)?

    PICO Templates & Worksheets