Milner Kerry A, Hays Deana, Farus-Brown Susan, Zonsius Mary C, Saska Elizabeth, Fineout-Overholt Ellen
Sacred Heart University Davis and Henley College of Nursing, Fairfield, Connecticut, USA.
Oakland University, Rochester, Michigan, USA.
Worldviews Evid Based Nurs. 2024 Apr;21(2):216-222. doi: 10.1111/wvn.12709. Epub 2024 Mar 1.
The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood.
This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects.
Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus.
Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0-5).
Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.
PICOT（即人群、干预措施、对照、结局、时间）方法的目的是制定有针对性的临床问题，以便通过系统检索来发现相关证据，问题的各个组成部分是检索的基础。护理实践博士（DNP）毕业生运用循证实践来推动其所在组织的系统和政策变革，从而对患者和系统结局产生积极影响。鉴于临床问题是循证实践过程的基础，需要更好地了解DNP毕业生在PICOT方法方面的能力。
本分析旨在描述DNP学生如何在其DNP项目中运用PICOT方法提出临床问题。
从大学护理教育委员会认可的学校（n = 213）在2010年至2021年期间公开的DNP项目现有全国随机样本的一个子集（n = 129，60.56%）中检索项目问题。使用PICOT方法的项目问题进一步通过一个评分系统进行评估，对于缺失元素、格式、结局方向性和项目目的，0表示否，1表示是。可能的分数范围为0至8，分数越高表明错误越多。五名研究人员进行讨论，直至达成一致，得出共识。
尽管在66个（31.0%）项目中项目作者认定使用了PICOT方法，但只有4个（6%）遵循了PICOT方法。所有这66个（100%）都是干预性问题。平均错误数为2.74（标准差1.55），范围从0至6。没有问题缺失P或O。具体错误包括缺失I的有3个（4.5%），缺失C的有37个（56%），格式不佳的有34个（51.5%），结局方向性问题有44个（66.7%），项目目的问题有38个（57.6%）。33个（50%）问题缺失T；然而，T不用于检索，因此研究人员在不考虑T的情况下重新计算了平均错误数（M = 2.24，SD = 1.28，范围0至5）。
在准确运用PICOT方法构建临床问题方面存在的差距可能导致有偏差的检索、不准确的临床问题识别，并且当用作项目目的时，会导致直接采用非循证解决方案。学术教员和临床教育工作者可以通过帮助具备DNP资质的护士强化这一基础技能来减轻这些偏差结果，并增强其对质量结局的影响。
