List of Nursing PICO Question

L I S T O F
N U R S I N G P I C O
Q U E S T I O N

PICO QUESTIONS FOR EMERGENCY
NURSING
Electronic medical record (EMR) system is an organized
method of collecting, encoding, and storing patient and
hospital information digitally. Evidence shows that EMR can
improve patient outcomes by increased staff productivity,
improved communication, improved quality of care, and
reduced medical errors.
P: Staff nurses in the emergency department (ED) of a tertiary
academic hospital in District A
I: electronic medical record system
C: Staff nurses in the ED of a tertiary academic hospital in
District B
O: Patient admission time
Question: Does the use of an electronic medical record system
in a tertiary academic hospital have an effect on patient waiting
time?
Intussusception is a medical emergency among pediatric
patients where the intestines telescope into a distal portion
causing bowel obstructions. If left undiagnosed and
untreated, this condition can be fatal within five days.
Surgical intervention is a conservative way of treating
intussusception, however, improved patient recovery is
observed among pediatric patients who are treated with
surgery and water enema.
P: Pediatric patients who were admitted in the ED because of
intussusception
I: Surgical intervention alone

C: Pediatric patients who were admitted in the ED because of
intussusception and who received both ultrasound-guided
water enema reduction and surgical intervention
O: Recovery time
Question: In pediatric patients who were admitted in the ED
because of intussusception, how effective is surgical
intervention alone compared to ultrasound-guided water
enema reduction and surgical intervention in the patient’s
recovery (time)?
Triage process is very important in emergency practice
particularly in hospitals posed with patient overcrowding
challenges such as the increasing number of emergency
patient visits and decreasing number of in-patient beds.
Strong scientific evidence shows that effective patient triage
process can lead to better patient outcomes and improved
patient satisfaction.
P: Staff nurses in the emergency department (ED) of one
medium-sized municipal hospital
I: Use of Emergency Severity Index (ESI) as a triage system
C: Staff nurses in the ED of another one medium-sized
municipal hospital
O: Better patient recovery outcomes and improved patient
satisfaction
Question: Does the adoption of the ESI triage system in one
medium-sized municipal hospital lead to better patient recovery
outcomes and improved patient satisfaction?
Mild traumatic brain injury is one of the leading causes of
emergency visits. One of the emerging approaches in
emergency care is the use of a checklist/ questionnaire in

identifying the concussion subtypes. The early identification
of concussion subtype can help deliver treated in a timely
manner.
P: Concussed athletes aged 18 years and older who visited the
emergency department (ED) in one multi-sports health facility
I: Use of the Rivermead Post-concussion Symptoms
Questionnaire (RPQ)
C: Concussed athletes aged 18 years and older who visited the
ED in one multi-sports health facility who were not assessed
using the RPQ checklist
O: Lower incidence of memory or thinking problems
Question: Among patients who complained of mild head
concussion during their ED visits, does the use of the Rivermead
Post-concussion Symptoms Questionnaire (RPQ) prevent the
incidence of memory or thinking problems when they are
discharged?
The use of Glasgow Coma Scale (GCS) scoring has been used
as a critical tool for nurses in assessing the level of patients’
consciousness and detecting early deterioration in patients’
neurological function. The elderly patients respond
differently to head trauma and may benefit from a modified
GCS scoring and prevent mortality.
P: Elderly patients aged 65 years and older who were admitted
in the ED of an academic tertiary hospital because of a mild
head trauma
I: Modified GCS scoring triage cutoff from GCS 13 to 14
C: Elderly patients aged 65 years and older who were admitted
in the ED of the same academic tertiary hospital because of
mild head trauma who were assessed by the traditional GCS
scoring

O: Hospitalization time
Question: Is changing the GCS scoring triage cutoff from 13 to 14
can reduce the hospitalization time among elderly patients
aged 65 years and older who were admitted in the ED of one
academic tertiary hospital?
Patient satisfaction is considered as one of the most sensitive
indicators of healthcare. In emergency nursing, patient
satisfaction has been linked to nursing care and effective
patient triage. Evidence shows that nursing communication is
associated with patient satisfaction.
P: Patients who presented in the emergency department of a
district hospital
I: Communicating with patients their waiting time and informing
them about situations that might cause a delay
C: (none)
O: Patient satisfaction as measured by the Consumer
Emergency Care Satisfaction Scale (CECSS)
Question: Does nurses’ communication to patients in regards to
their waiting time and emerging situations that might cause
delay to improve patient satisfaction as measured by the
Consumer Emergency Care Satisfaction Scale (CECSS)?
Quality emergency care is dependent on an appropriatelytrained
team of medical practitioners. Providing regular and
up-to-date training on emerging nursing practice guidelines
are often a neglected priority. When emergency front-line
nurses are adequately trained, there is a lower incidence of
job dissatisfaction and burnout.
P: Emergency department (ED) staff nurses in rural state facility
A

I: Regular quarterly clinical professional training updates for
nurses
C: ED staff nurses in rural state facility B
O: Job dissatisfaction and burnout
Question: Are regular quarterly clinical professional training
updates for ED nurses in rural state facility A help lower job
dissatisfaction and burnout?
Indwelling urinary catheters (IUC) are often required in older
patients aged 65 years and older in the emergency
department (ED). Care of elderly patients with IUC including
proper placement, reassessment, and removal is required to
prevent catheter-associated urinary tract infections.
P: Elderly patients aged 65 years and older admitted in the ED
of a tertiary referral hospital with an IUC
I: Catheter irrigation with antimicrobials
C: Elderly patients aged 65 years and older admitted in the ED
of a tertiary referral hospital with an IUC who do not receive
catheter irrigation with antimicrobials
O: Catheter-associated urinary tract infections
Question: In elderly patients aged 65 years and older admitted
in the ED of a tertiary hospital with an IUC, does catheter
irrigation with antimicrobials prevent catheter-associated
urinary tract infections?
Emergency tracheostomy is a surgical treatment given to
patients with acute respiratory distress syndrome.
Tracheostomy may prolong patient survival, however, studies
show that ICU and hospital stay is found longer among
patients who underwent a tracheostomy.

P: Adult patients, aged 18 years and above, diagnosed with
acute respiratory distress syndrome in one private hospital
I: Emergency tracheostomy
C: Adult patients, aged 18 years and above, diagnosed with
acute respiratory distress syndrome in one private hospital who
had endotracheal intubation
O: Hospital stay (in days)
Question: Does emergency tracheostomy among adult patients
aged 18 years and above, who were diagnosed with acute
respiratory distress syndrome in one private hospital reduce the
hospital stay (in days) compared to adult patients from the same
hospital who had endotracheal intubation?
The use of ultrasonography in the acute care setting is not a
common practice. However, scientific evidence demonstrates
that the use of an airway ultrasound as a treatment adjunct to
determine treatment can lead to better patient outcomes.
P: Patients with complaints of stridor and breathing difficulties in
the emergency department of one medium-sized hospital
I: Use of airway ultrasonography
C: (none)
O: Detection of cause and treatment of respiratory difficulties
Question: In patients with complaints of stridor and breathing
difficulties in the emergency department of one medium-sized
hospital, does the use of airway ultrasonography detect the
cause of stridor on a timely basis and eventually treat the
respiratory difficulties?

LIST OF PEDIATRIC PICO QUESTIONS
Croup treatment among pediatric patients usually includes
the use of dexamethasone combined with nebulized
epinephrine for the relief of airway constriction relief. The
conventional dose of nebulized epinephrine is 0.5mg/kg of
1:1000 in patients to treat moderate to severe croup.
However, research shows that the use of 0.1 mg/kg
nebulized epinephrine also relieves airway constriction.
P: Pediatric patients aged 6 months to 5 years old diagnosed
with severe croup admitted in three pediatric emergency
departments
I: Use of 0.1 mg/kg dose of nebulized epinephrine as an adjunct
to dexamethasone
C: Pediatric patients aged 6 months to 5 years old admitted in
three pediatric emergency departments who were nebulized
with 0.5 mg/kg conventional epinephrine dose
O: Relief of severe airway constriction
Question: In pediatric patients aged 6 months to 5 years old
diagnosed with severe croup admitted in three pediatric
emergency departments, how does the use of 0.1 mg/kg dose
of nebulized epinephrine in combination with dexamethasone
relieve severe airway constriction compared to the 0.5 mg/kg
conventional epinephrine dose?
Stress ulcer prophylaxis is considered standard care among
critically ill patients in the intensive care unit. Scientific
evidence demonstrates that the use of proton pump
inhibitors as prophylaxis help prevent the development of
stress ulcers among ICU pediatric patients.

P: Pediatric patients admitted in the critical care unit of one
medium-sized public hospital
I: Use of proton pump inhibitors as prophylaxis to stress ulcers
C: Pediatric patients admitted in the critical care unit of one
medium-sized public hospital receiving histamine-2-receptor
antagonists as prophylaxis to stress ulcers
O: Shorter ICU stay
Question: Does the use of proton pump inhibitors as prophylaxis
to stress ulcers compared to those who are receiving histamine-
2-receptor antagonists shorten the ICU stay of pediatric patients
admitted in the critical care unit of one medium-sized public
hospital?
Delaying the first bathing time of newborn infants to 48 hours
after birth is effective in preserving the body temperature of
the infant. It can also improve skin moisture and skin integrity.
P: Newborns born within 24 hours and admitted in a medical
hospital
I: Delaying the first bathing time to 48 hours after birth
C: Newborns born within 24 hours and admitted in a medical
hospital who were bathed immediately after birth
O: Higher body temperature at the 10th minute of life
Question: In newborn infants who were born within 24 hours and
admitted in a medical hospital, how does delaying the first
bathing time to 48 hours after birth increase the body
temperature at the 10th minute of life?
Early screening of type 2 diabetes in adolescents is important
as it helps prevent the development of metabolic and
cardiovascular complications. The use of glycosylated
hemoglobin A1c as a screening method is a standard practice
among adults.

P: Obese adolescents who are seen in a school clinic in the past
six months
I: Use of glycosylated hemoglobin A1c as a screening method
C: Obese adolescents who are seen in a school clinic in the past
six months and was screened using fasting plasma glucose test
O: Early diagnosis of diabetes (in days)
Question: In obese adolescents who are seen in a school
clinic in the past six months, what are the differences of the
use of glycosylated hemoglobin A1c and fasting plasma
glucose test in the diagnosis time (in days)?
Children suffering from pediatric asthma are noted to have low
self-efficacy or self-confidence. A study by Kocaaslan and
Kostak (2019) has observed that the use of a disease
management education help in improving the quality of life and
self-efficacy levels of the asthmatic children after two months.
P: Children with asthma aged 10-18 years old
I: Individual asthma education intervention
C: (none)
O: Higher self-efficacy scores using the standardized tool, “Self-
Efficacy Scale for Children and Adolescents with Asthma”
Question: In children with asthma aged 10-18 years old, what are
the effects of individual asthma education intervention on their
self-efficacy scores?
The conventional antimicrobial therapy for children with
cellulitis, bone, and joint infections, and infective endocarditis
is the continuation of intravenous antibiotics at home or after
hospital discharge. This intervention is called outpatient
parenteral antimicrobial therapy or OPAT and usually has a
negative impact on the caregivers’ work or the child’s school
attendance.

P: Children diagnosed with bone infections
I: Outpatient oral antibiotic therapy
C: Children diagnosed with bone infections who are in oral
antibiotic therapy upon discharge
O: Missed school (in days)
Question: In children diagnosed with bone infections, how does
OPAT affect the school attendance compared to those who are
in oral antibiotic therapy upon discharge?
Massage interventions are found to aid in the growth of
preterm infants in the ICU, particularly on the improvement of
weight, prevention of nosocomial infections, and reduction of
incidence of respiratory illness.
P: Preterm infants born at a gestational age between 32 and 34
weeks who are admitted in the ICU
I: 15-minute massage intervention given by their parents or
caregivers
C: Preterm infants born at a gestational age between 32 and 34
weeks who are in the NICU and do not receive massage
intervention
O: Weight gain (in kilograms)
Question: Does a 15-minute massage intervention given by
parents or caregivers have an effect on the weight gain of
preterm infants born at a gestational age between 32 and 34
weeks who are admitted in the NICU?
Evidence shows that the use of skin-to-skin care for infants
help improve physiologic development, pain perception,
brain development, and parental bonding. This low-cost and
effective intervention is also being used for infants who
underwent a surgical procedure.

P: Infants admitted in the ICU who underwent a surgical
procedure
I: Skin-to-skin care intervention with their parents or caregivers
C: (none)
O: Wound healing time (in days)
Question: Does the skin-to-skin care intervention with parents or
caregivers shorten the surgical wound healing time of infants
admitted in the ICU who underwent the surgical procedure?
Measuring the temperature of pediatric patients requires
accurate measurement. Thermometry in pediatric care can
help identify and diagnose serious illnesses that might be
caused by infections. Similarly, accurate temperature
measurement also helps prevent febrile seizures which are
quite common among children less than 5 years old. The
rectal thermometer is still the gold standard in measuring the
temperature of children compared to measuring through the
axilla, oral, or tympanic membrane.
P: Pediatric patients aged 3 years to 5 years old and admitted in
one private pediatric ward
I: Use of rectal thermometer to detect fever
C: Pediatric patients aged 3 years to 5 years old and admitted in
one private pediatric ward who are measured with an axillary
thermometer
O: Prevention of fever >38 C or 100 F.
Question: In pediatric patients aged 3 years to 5 years old and
admitted in one private pediatric ward, does the use of rectal
thermometer help prevent the occurrence of fever >38 C or 100
F compared to the use of axillary thermometer?

Chlorhexidine solution is among the many effective solutions
being used in cleaning the umbilical cord which aid in the
falling of the stump and drying of the umbilical area.
Similarly, the use of chlorhexidine also helps in preventing
bacterial colonization in the umbilical area.
P: Newborns who were delivered in one maternity clinic
I: Use of 4% chlorhexidine solution
C: Newborns who were delivered in one maternity clinic and
cleansed with saline solution
O: Falling off of umbilical cord stump (in days)
Question: Does the use of 4% chlorhexidine solution in newborns
who were delivered in one maternity clinic help in the faster
falling off of umbilical cord stump?
Find more nursing PICOT questions
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