Skip to Main Content
It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

Nursing and Allied Health: Asking the PICO Question

Online Learning


Four A's: Ask, Acquire, Appraise and Apply


The first step of the nursing research process or evidence-based  process involves formulating the clinical question into a searchable, answerable question.  The model which is frequently used for this part of the process is termed “PICO.”





Background Search: Before we begin our online search, let's learn how to create a search strategy for finding relevant information using the PICO method.  This is preliminary to using Medical Subject Headings.


  • Begin a good online search  with a general background investigation.  Medical encyclopedias such as GALE GVRL (online), WebMD, Dorland's Medical Encyclopedia (Shreveport reference), Tabor's Medical Encyclopedia - Shreveport reference, Mayo Clinic website or other nursing textbooks on your subject in the library stacks are considered authoritative medical information about your subject.
  • Collect general background information from an authoritative source (also called legitimate source) as opposed to Google
  • Fill in a PICO chart with possible keyword terms. 

This is what a P-I-C-O chart looks like.  Ask your librarian or instructor if you need help getting started.



Key Questions: Complete the Answers: A good online database begins with...


  • planning what information you need
  • organizing your information into a query
  • deciding how you will use connectors to combine your query and search statement
A good online database search begins with planning and organizing your information.





View the example PICO worksheet below which is used to formulate a question relating to children with a temperature presenting to Emergency Centers. A blank PICO worksheet is available for you to practice how to formulate your question. ( Purdue University)


PICO Tools


(Adapted from Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins.) 2nd edition - 2011

Power Point Example:


Frame your reference question:


Construct your PICO chart:


Enter key terms:


Consider other alternate terms:


Go to MESH ON DEMAND and enter a term.:


Look for other terms:


What other terms could be used for stress:




  • CINAHL has a built in Thesaurus
  • If you enter the term bed sore, the Thesaurus tells you to use the term "pressure ulcer"



The asterisk * symbol is a WILDCARD representing unlimited truncation. The WILDCARD is found on the keyboard by pressing  SHIFT 8.   When we add the * (asterisk) to a key word, the search retrieves all words containing the root word:


  • stress*   retrieves stress, distress, distressed
  • anxiet*   retrieves anxiety, anxieties



Let's talk about combining thee terms in your PICO diagram.  Generally, you will combine terms with OR, before using AND. 


  • The OR operator finds results from wither term
  • The AND operator finds results that are common to all three terms.
  • The NOT operator removes terms you wish to exclude.

The OR operator finds results with both Texas AND Travel


If you were asked to combine these terms, how would you use AND...OR...NOT?


Perhaps Venny can help us...


"Venny" has a simple rule:  OR before AND and AND before NOT.


The OR connector should always be used to combine items before using the AND connector.

  • (Pizza OR BBQ) AND restaurant*
  • (Handwashing OR Scrubbing) AND "Cross-Infection"


  • It is wise to keep a search statement in separate units. 
  • However some people keep OR'd search strings together in one statement.

Now it is your turn.  (1) Go to the MESH BROWSER and see if you can find other related terms to use in this search.     (2) Consult a THESAURUS in the Shreveport, Natchitoches or Leesville NSU Libraries.



P.I.C.O.(T.) Tips


Visit Our Libraries

Northwestern State University of Louisiana Libraries    |   Watson Memorial Library   |  913 University Pkwy    | Natchitoches LA 71457

  |    Shreveport Education Center Library   |Eugene P. Watson Memorial Library    |    NSU Leesville Library 

   |  Prince Music Media Library