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After you identify a triggering issue or opportunity (see Chapter 1), the next step in the evidence-based practice (EBP) process is to clearly define the problem and develop a purpose statement or question. Use a systematic approach and structured format as a guide to set parameters around the scope of the work. Focus on outcomes to achieve and set boundaries that keep the work measurable, manageable, and achievable.

Several frameworks or formats exist to structure the clinical question such as PICO, SPIDER, and SPICE. PICO is widely used (Eriksen & Frandsen, 2018; Kloda et al., 2020), although experts question its value in EBP and classroom work (Schiavenato & Chu, 2021). PICO was proposed decades ago as a four-part “anatomy” model to facilitate searching for a precise answer that was intended to guide research (Richardson et al., 1995). The four parts are: P = patient/problem/population; I = intervention, practice change, or exposure; C = comparison; and O = outcome. Adaptations to PICO customize the acronym. The term PICOT employs the same elements as PICO with the addition of T = time, which can be useful to narrow the time commitment for piloting an EBP change.

In the first edition of this book, we identified some of the limitations associated with the use of PICO and suggested using the “P” to mean patient population, problem, and pilot area. In this revised edition, we suggest using a new acronym, PURPOSE, to guide developing the purpose statement and scope of an EBP project. The rationale for introducing this new acronym is fourfold. First, PICO was created to guide literature searches, and there is limited evidence to support the effectiveness of PICO as a guide for evidence searches (Eriksen & Frandsen, 2018; Schiavenato & Chu, 2021). Second, bibliographic databases have evolved and function more efficiently than when PICO was developed in the 1990s. Indeed, other formats or frameworks may be more appropriate depending on the context of the project being initiated, depth of key concepts needed to guide the search, and flexibility in selecting keywords and databases (Bramer et al., 2018; Ho et al., 2016; Kloda et al., 2020). Moreover, other frameworks may be more likely to ensure all types of evidence are included, such as local quality improvement data, rather than only research evidence (Jones, 2015). Thus, to some extent, PICO with its widespread use has become an outdated tradition or “sacred cow.” Third, through extensive experiences teaching EBP, we have observed that the use of PICO can prematurely drive selection of an intervention before knowing what the evidence indicates. The purpose of the project should stand alone as a goal-directed statement, followed next by use in a systematic search for the best evidence. Fourth, using the “I” and “C” elements in the PICO statement tend to lead nurses down the path of developing questions best ...

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