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Nursing Resources: A Self-Paced Tutorial and Refresher: 2.3 Develop the Question: Foreground Questions, PICO (T)

An online instructional tool to orient users to the NYU virtual environment: books, databases, articles, more.

Search Strategies--Foreground Questions

Foreground questions seek evidence to answer a need for clinical information related to a specific patient, an intervention or therapy. Identifying the PICO (T)* elements helps to focus your question:


  • P = problem/patient/population
  • I  = intervention
  • C = comparison intervention
  • O = outcome
  • (T) = time factor, type of study (optional)

Example question: Does handwashing among healthcare workers reduce hospital acquired infection?



P (problem/patient/population) hospital acquired infection
I (intervention/indicator) handwashing
C (comparison) no handwashing; other solution; masks
O (outcome of interest) reduced infection



To begin a database search your initial strategy should begin with the P and the I only:




Viewing the initial article results, you may decide to narrow your search with terms for the Comparison and Outcome.

(Some models of EBP add in T  (PICOT) for time factor or type of  study. Other models add C for Context (PICOC).  You can add limits for time, type of study, or other contextual limits, later. Keep the initial search broad.

As you browse results, abstracts, and the full text of articles you will locate the narrower Comparative terms, Outcome measures and type of study elements, but keep the initial search broad.

The box on the right links to more sample PICO questions and search strategies.


The tutorial continues with FILTERING your results to capture the best evidence.


Click on the Forward button to go to Module 2.4


*Heneghan, C., & Badenoch, D. (2002). Evidence-based medicine toolkit. London: BMJ Books.

EBP Steps

Models of EBP describe the evidence-based process in 5 steps:

  1. Develop an answerable question.
  2. Locate the best evidence.
  3. Critically appraise the evidence.
  4. Integrate the evidence into practice using clinical expertise with attention to patient's values and perspectives.
  5. Evaluate outcome(s).

    (Flemming, 1998; McKibbon, Wilczynski, Eady, & Marks, 2009; Melnyk & Fineout-Overholt, 2010)