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Social Work: EBP & PICO

Research guide for social work.

What is Evidence-Based Practice?

According to the Social Work Policy Institute (SWPI)... 

"Evidence-based practice (EBP) is a process in which the practitioner combines well-researched interventions with clinical experience and ethics, and client preferences and culture to guide and inform the delivery of treatments and services.

The practitioner, researcher, and client must work together in order to identify what works, for whom, and under what conditions.

This approach ensures that the treatments and services, when used as intended, will have the most effective outcomes as demonstrated by the research. It will also ensure that programs with proven success will be more widely disseminated and will benefit a greater number of people."

Code of Ethics

EBP is a part of the National Association of Social Workers' (NASW) Code of Ethics.

The Code "serves as a guide to the everyday professional conduct of social workers."

VIDEO

Creating Your Question (PICO)

Background vs Foreground Questions

In order to locate the most useful research, social workers must ask well-defined questions:

 

Background questions - the "forest" (broad in scope)

  • seek general knowledge about a condition or thing
  • provides basic information for a greater understanding of concepts; not intended for making a clinical decision about a specific patient
  • typically found in textbooks, guidelines, point-of-care monographs, and encyclopedias
  • contain two essential components: Example: What causes migraines? or How often should women over the age of 40 have a mammogram?
    • A question root (who, what, when, etc.) with a verb
    • A disorder, test, treatment, or other aspect of healthcare

 

Foreground questions - the "trees" (focused in scope)

  • seek specific knowledge to inform clinical decisions or actions
  • require a grasp of basic concepts to fully comprehend
  • typically found in journals and conference proceedings
  • contain 3-4 essential components (see PICO)

 

Content in this guide based on the nursing research guide at Oregon Health and Science University Library, created by Loree Hyde.

Typically used in evidence-based medicine, the PICO model is a useful way of formulating client, community, or policy-related research questions.

 

P = Problem How would I describe the problem, population, or patients?
I = Intervention What main intervention, prognostic factor or exposure am I considering?
C = Comparison Is there an alternative to compare with the intervention?
O = Outcome What do I hope to accomplish, measure, improve or affect?

 

Example PICO-based research questions:

In patients with acute bronchitis, do antibiotics reduce sputum production, cough, or days off?

Among family members of patients undergoing diagnostic procedures, does standard care, listening to tranquil music, or audio-taped comedy routines make a difference in the reduction of reported anxiety?

 

Original PICO model by Richardson, W.S., et al (1995). The well-built clinical question: a key to evidence-based decisions. ACP Journal Club, 123(3), A12-A13.

 

  P = Problem I = Intervention C = Comparison O = Outcome
Treatment Disease or condition A therapeutic measure (e.g. surgery) Standard of care, another measure, or placebo E.g. mortality rate, days lost from work, pain, disability
Prevention Patient's risk factors or general health condition A preventative measure (e.g. lifestyle change) May not apply E.g. disease incidence, mortality rate, days lost from work
Diagnosis The target disease or condition A diagnostic test or procedure The current "gold standard" for the problem E.g. survival rates, mortality rates, rates of disease progression
Prognosis The main prognostic factor or clinical problem in terms of severity, duration The exposure of interest is usually *time* Usually does not apply. Identify the standard treatment if your question is about "watchful waiting." E.g. survival rates, mortality rates, rates of disease progression
Etiology or Harm Patient's risk factors, current health disorders, or general health condition The exposure of interest, including some indication of strength and duration May not apply E.g disease incidence, rates of disease progression, mortality rates

 

From Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Fill in the blanks with information from your clinical scenario:

 

THERAPY
In_______________, what is the effect of ________________on _______________ compared with _________________?

 

PREVENTION
For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?
 

DIAGNOSIS OR DIAGNOSTIC TEST
Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?
 

PROGNOSIS
Does ____________ influence ______________ in patients who have _____________?
 

ETIOLOGY
Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________ with/without______________?
 

MEANING
How do _______________ diagnosed with _______________ perceive __________________?