Using PICO Searching to Support Evidence-Based Nursing Practice

            Obtaining high quality clinical research evidence can be a daunting task to many, yet it is an integral part of the clinical practice. Therefore, it requires a search strategy, a plan used to obtain information from different databases. Creating a search strategy entails mapping out the key components of the research topic in a systematic manner. A search strategy is important when using electronic databases because it keeps the researcher focused on the topic and within the boundaries of what is being searched. Searching databases in a consistent and structured manner will also save time. Also, as the search progresses and searches refined, the search strategy becomes extremely useful by improving the relevancy of the obtained results, as the keywords and synonyms are reflected based on how they influence the search strategies. In the case at hand, I will apply a basic search process with six steps. PICO to Support Evidence-Based Practice

Define and Discuss Cloud ComputingSearch Strategy

            The first step will entail defining and writing down my research question, or simply what I will be researching. In my case scenario, two questions can be defined and written down. (1) What are the best practices for suctioning? And (2) is the instillation of saline while suctioning an acceptable technique? Based on the two questions, I will proceed to step two, which will entail identification and keeping a record of the keywords, terms and phrases. I will achieve this by brainstorming the main discussion points to create a concept or mind map that will help me tease out themes and keywords. In my case, the keywords will include suctioning, instillation and saline while the phrases will include best practices for suctioning, instillation of saline, instillation of saline while suctioning and acceptable techniques of suctioning (Hastings & Fisher, 2014). PICO to Support Evidence-Based Practice

Step three will entail replacing the keywords with synonyms to diversify the search. To get the synonyms of the keywords, database Thesauri or Subject Headings will be used. Based on the case scenario, some of the synonyms for the keywords will include drawing, siphon and drain for suctioning; infiltration and fill for instillation. Step four will entail filtering the sources to remain with the recent sources. For databases such as Google Scholar, there is a filter button to set the age of the sources. In my case scenario, I will need to obtain the most recent sources, utmost 5 years old. Therefore, I will set the age filter button between 2015 and 2020. The fifth step will entail considering the type of material I will include (Hastings & Fisher, 2014). In my case scenario, I will use academic journals because of various reasons: credibility; clarity, evidence for claims, and have a wealth of knowledge. The last step will entail identifying where to search for information. Since the topic is healthcare oriented, I will utilize medical databases such as PubMed, EMBASE, Cochrane Library, Medline, CINAHL and Google Scholar.

Summary of Evidence

            The sources reviewed on best practices for suctioning have indicated that:  the ventilator settings should be adjusted to pre-suctioning baseline and if possible the procedure should involve two clinicians. The suction catheter size should be determined and the suction pressure recorded. While protecting the key parts, the clinicians should then attach the appropriate sized suction catheter to suction tubing while ensuring that the catheter does not touch anything that can contaminate it (Jansson et al., 2013). When the clinicians are ready, the Endotracheal Tube (ETT) should be disconnected from the ventilator tubing and the suction catheter passed to a predetermined length to ensure that the catheter passes the length of the ETT only (Leddy et al., 2015). While applying negative pressure, the clinician in charge should rotate the suction catheter gently when withdrawing it from the ETT. Repetitive catheters should not be used unless the secretion volume indicates another pass. To prevent extubation by accident, the patient’s head should be held in a steady position while the ventilator tubing to ETT is being reconnected. A small amount of sterile water should be used to clear secretions from the suction tubing. Lastly, the vacuum pressure should be turned off and the patient left in a comfortable position (Mwakanyanga et al., 2018).

Search results

            The literature search from different databases identified 1269 sources. I assessed 22 full-text articles for eligibility which led to exclusion of 19 of them due to design issues (those which did not examine best practices for suctioning and whether instillation of saline while suctioning is an acceptable technique).

PICO question

            For coronary artery bypass graft surgery patients (P), does the instillation of saline into the endotracheal tube when suctioning (I) cause more harm (O) to them than helping them (C)?

Application of PICO to Clinical Problems

            In clinical practice, clinical questions keep on coming up. These questions must be relevant to patients and problems. They must be phrased in a manner that facilitates search for answers. PICO framework makes the process easy by identifying the main concepts that must be incorporated to answer the questions. There are several ways through which PICO can be applied to solve clinical problems in the workplace and influence things in clinical practice (Rice, 2013). For instance, PICO plays an important role when selecting the treatments that do more harm to patients than good. PICO plays an important role when selecting and interpreting diagnostic tests to exclude certain diagnoses based on precision, acceptability, safety and accuracy. It is also very important when estimating the clinical course of patients over time due to different factors


Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing management45(8), 9-12.

Jansson, M., Ala-Kokko, T., Ylipalosaari, P., & Kyngäs, H. (2013). Evaluation of endotracheal-   suctioning practices of critical-care nurses-An observational correlation study. Journal of Nursing      Education and Practice3(7), 99.

Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory            therapists: how well do they align with clinical practice guidelines?. Canadian journal of     respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR51(3), 60.

Mwakanyanga, E. T., Masika, G. M., & Tarimo, E. A. (2018). Intensive care nurses’ knowledge and        practice on endotracheal suctioning of the intubated patient: A quantitative cross-sectional    observational study. PloS one13(8), e0201743.

Rice, M. J. (2013). Evidence-based practice: a model for clinical application. Journal of the American      Psychiatric Nurses Association19(4), 217-221.