PICOT Questions and an Evidence-Based Approach

PICOT Questions and an Evidence-Based Approach


PICOT Questions and an Evidence-Based Approach

Health care professionals work hard to address patient needs as situations necessitate. Despite their commitment to delivering quality and patient-centered care, health care professionals face many challenges that hinder them from achieving the desired outcomes. Such challenges need to be analyzed in-depth and suitable interventions adopted to address and prevent them in the future. The outcomes depend on the approaches used to address a care issue. The purpose of this paper is to develop a PICOT question for a specific care issue and evaluate the evidence that could be used to answer the question.

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Practice Issue to Explore via a PICOT Approach

Nurses play an instrumental role in health care delivery as primary care providers. They are involved in most processes regarding patient care, implying that patient outcomes always depend on how effectively nurses deliver their work. As a result, they should be mentally and physically healthy to execute their roles as professionally and ethically expected. To ensure continuity of care, new graduate nurses join the practice at different times. They are expected to get maximum support from their colleagues to execute their mandate confidently. However, they are typical targets of workplace incivility, with many experiencing bullying at some point during the transition from education to practice (Anusiewicz et al., 2019). Such nurses should be prepared to cope with practice challenges to adapt comfortably.

The impacts of workplace incivility cannot be overlooked at any point of care. Shi et al. (2018) found that graduate nurses transitioning to practice are highly vulnerable to workplace incivility due to inexperience and confidence problems. If not assisted, workplace incivility further affects their ability to provide patient care. For instance, workplace incivility has been found to cause distraction and emotional upset that put patients at risk (Khan et al., 2021). Bullied or intimidated nurses feel like they do not get the support needed, losing interest in their work. Such problems increase their vulnerability to medication administration malpractices, common among new graduate nurses (Armstrong, 2018). Patients should be protected from adverse outcomes by addressing workplace incivility effectively.

PICOT Question: In graduate nurses (P), can cognitive rehearsal training (I) compared to no intervention (C) empower graduate nurses to cope with workplace incivility (O) within six months?

The PICOT approach identifies the Problem/Population, potential Interventions, Comparison, Outcomes, and Timeline. It guides evidence search since the practice issue is known and proposed interventions identified. The process that follows primarily involves searching and appraising evidence on the proposed interventions to help address the practice issue.

Sources of Evidence to Answer the PICOT Question

The internet has a lot of information on workplace incivility and how to control it in health care settings. Information on the practicality of cognitive rehearsal is also extensive in websites, blogs, books, dissertations, and journal articles, among other sources. Reliable websites from government, health, and learning institutions can provide tips on workplace incivility control and help new nurses adapt to new climates. Books are also authoritative to a significant extent. However, journal articles are the most effective in answering the PICOT question among these sources.

When answering a PICOT question, nurses use the evidence-based approach to address a practice issue. They search for the best evidence from current, authoritative, accurate, and relevant sources. Accurate sources seek information from research studies. They are also peer-reviewed by experts in the same field. As a result, journal articles will be used to answer the PICOT question since they meet these criteria.

Findings from Articles

Health care research has explored the effectiveness of cognitive rehearsal in addressing workplace incivility, and findings vary depending on the studied population, the scope of research, and the objectives of the researchers. Armstrong (2018) recommended combining educational training about the workplace and effective responses to enable nurses to deal with uncivil behaviors. Cognitive rehearsal was proposed as part of the educational training to enable nurses to identify and report uncivil behaviors. Increased knowledge on identifying incivility issues ensures that nurses are not easily distracted.

Two more articles provide valuable information on the importance of cognitive rehearsal training as an empowerment method for new nurses. Kim et al. (2020) advised health care administrators to be committed to identifying incivility toward junior nursing students and develop targeted programs to reduce clinical incivility. Cognitive rehearsal training is among the targeted programs that can work effectively for nurses when learning and during practice. Zhang and Xiong (2019) found cognitive rehearsal an effective method for improving environments in which care is provided. Besides empowering nurses to identify, resist, and report incivility, it improves interpersonal relationships and decreases turnover intention. Overall, these articles meet the credibility criterion and can answer the PICOT question authoritatively. They share similar characteristics for nursing research evidence, including authority, relevance, currency, and reliability. Although their study designs vary, they are extensive and conclusive on how cognitive rehearsal can help new nurses cope with workplace incivility.


Relevance of the Findings

Research relevant to a PICOT question should help health care providers address a practice issue comprehensively. Armstrong (2018) conducted a systematic review specifically on applying workplace training techniques to enable nurses to deal with incivility. It is detailed on when, how, and why the training is essential. Kim et al. (2020) explained the importance of targeted programs in improving nurses’ well-being. The study illustrates the expected outcomes when cognitive rehearsal and other methods are used for addressing incivility. However, the article focuses primarily on junior nursing students. Zhang and Xiong (2019) provide evidence on cognitive rehearsal as a coping strategy. However, the study reviews the effectiveness of the approach among many other methods. It is right to deduce that all the articles are relevant as far as addressing workplace incivility is concerned.

Cognitive rehearsal is a psychological intervention. It ensures that nurses are prepared to face a problem and can identify and respond to it confidently. Among the findings, Kim et al.’s (2020) article recommendations are the most likely to lead to positive outcomes. Kim et al. (2020) explained the outcomes achieved through cognitive rehearsal, including behavior change, adjustment, and improving the work environment. The article also explains how cognitive rehearsal can be combined with other methods for better outcomes.


A healthy workplace is crucial for nurses to deliver comprehensive patient care. Such a workplace is characterized by high collaboration, support, and protecting nurses from abuse and intimidation. As an issue hampering patient safety and health care quality, workplace incivility among new graduate nurses can be addressed via a PICOT approach. The population of concern would be the graduate nurses experiencing incivility, the proposed intervention would be cognitive rehearsal, and the outcome is improving coping ability. Research should be sourced from current, authoritative, and credible resources. The selected articles address workplace incivility from multiple dimensions, but cognitive rehearsal dominates the proposed interventions.



Anusiewicz, C. V., Shirey, M. R., & Patrician, P. A. (2019). Workplace bullying and newly licensed registered nurses: an evolutionary concept analysis. Workplace Health & Safety67(5), 250-261. https://doi.org/10.1177%2F2165079919827046

Armstrong, N. (2018). Management of nursing workplace incivility in the health care settings: A systematic review. Workplace Health & Safety66(8), 403-410. https://doi.org/10.1177%2F2165079918771106

Khan, M. S., Elahi, N. S., & Abid, G. (2021). Workplace incivility and job satisfaction: Mediation of subjective well-being and moderation of forgiveness climate in health care sector. European Journal Of Investigation in Health, Psychology and Education11(4), 1107–1119. https://doi.org/10.3390/ejihpe11040082

Kim, S. A., Hong, E., Kang, G. Y., Brandt, C., & Kim, Y. (2020). Effect of Korean nursing students’ experience of incivility in clinical settings on critical thinking. Heliyon6(7), e04367. https://doi.org/10.1016/j.heliyon.2020.e04367

Shi, Y., Guo, H., Zhang, S., Xie, F., Wang, J., Sun, Z., … & Fan, L. (2018). Impact of workplace incivility against new nurses on job burn-out: A cross-sectional study in China. BMJ Open8(4), e020461. http://dx.doi.org/10.1136/bmjopen-2017-020461

Zhang, X., & Xiong, L. (2019). Impact of nurse horizontal violence and coping strategies: A review. Yangtze Medicine3(4), 289-300. https://doi.org/10.4236/ym.2019.34028


Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question. Scenario
For this assessment, please use a health care issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question.research, document (accessible from the “Create If you need some structure to organize your initial thoughts and the PICOT Question and Research Template PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style.
Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

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