1. Construct a "searchable question" from a clinical scenario.
2. Plan and carry out a search of the literature for the best evidence.
3. Critically appraise the literature for validity and applicability.
4. Apply the evidence to your clinical practice.
5. Evaluate your performance.

The content and images on this page have been adapted (with approval) from Liz Bayley's "Evidence-Based Nursing" subject guide available at the McMaster Health Sciences Library website: http://hsl.mcmaster.ca/resources/topic/eb/nurse.html

PICO is a tool used to assist in the construction of a "searchable question" from the clinical scenario.

Further information on PICO:

Asking Focused Clinical Questions (CEBM)
Evidence-Based Practice - PICO (Duke University Medical Centre Library)

Develop a plan for searching the literature. If you are not sure where to start use the "Hierarchy or pre-processed evidence" that illustrates the hierarchy of literature. Begin at the top and work your way down.

Examples:

Systems:
Computerized decision support

Summaries:
Evidence-Based Guidelines
Clinical Practice Guidelines and Protocols in BC
CNA Standards & Best Practices
Clinical Practice Guidelines for Nurses in Primary Care (First Nations & Inuit Health)
CMA Infobase
National Guideline Clearinghouse
TRIP Database
Evidence-Based Texts

Synopses of Syntheses:
Database of Abstracts of Reviews of Effects (DARE) (Cochrane Reviews)
NHS Centre for Reviews and Dissemination Databases includes NHS Economic Evaluation Database (NHS EED) and Health Technology Assessment (HTA) Database Evidence-Based Abstract Journals (See Synopses of single Studies)

Syntheses (Systematic Reviews):
Cochrane Database of Systematic Reviews
Joanna Briggs Institute Database of Systematic Reviews
TRIP Database

Synopses of Single Studies:
Evidence-Based Abstract Journals:
Evidence-Based Nursing
ACP Journal Club
Evidence-Based Obstetrics & Gynecology
Evidence-Based Oncology

Single Studies:
CINAHL
Search tips:
"Refine Search":
- Select "Evidence-Based Practice".
- Select relevant publication types, such as: Systematic Reviews, Practice Guidelines, etc.
- Think about the type of measurement used: questionnaire/survey, interview, etc. Look for these in publication types or
incorporate subject headings.

Medline (OVID)
Search tips:
Clinical Queries:
- Select "More Limits". Apply one of the 9 categories (therapy, diagnosis, prognosis, qualitative studies, and so on) to
limit to clinical sound evidence.

Medline (Ebsco)
Search tips:
"Refine Search":
- Select "Evidence-Based Reviews".
- Select relevant publication types, such as: Clinical Trials, Practice Guidelines, etc.
- Think about the type of measurement used: questionnaire/survey, interview, etc. Incorporate appropriate
subject headings accordingly.