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The PICOT Framework in Healthcare


The PICOT framework provides a convenient method of developing researchable questions in nursing. It is important because to research and address a problematic issue, it is needed to set up boundaries, i.e. to identify exactly the types of cases that are to be studied and examined and to define involved parties, variables, expected outcomes, and time. One of the types of PICOT questions is meaning questions. They explore the way certain individuals and groups within a population perceive certain experiences or phenomena in healthcare. The selected topic is understaffing in nursing. This issue can be addressed from the perspective of human resources management, internal and external communications, nursing education and practices, and several other perspectives. However, the PICOT perspective should not be neglected in approaching the issue of understaffing, as this perspective can provide valuable data and possible solutions for the problem.

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Developing a PICOT meaning question

First of all, PICOT questions on meaning are constructed based on four elements: population (also, “patient”), intervention, outcome, and time. The “C” part of the abbreviation (comparison) is often excluded from meaning questions. The key element of such questions is perception, as they explore the meaning of certain risks, circumstances, and occurrences (outcome) for certain patients (population/patient) in a certain medical or clinical condition (intervention; e.g. diagnosed with a particular disease) within particular periods (time). Correctly formulated, such questions are aimed at understanding patient perception, which contributes to reducing adverse patient outcomes and increasing patient satisfaction. As a factor of providing nursing care, understaffing can affect patients significantly, which justifies the necessity to study the perception of understaffing. The meaning question for the selected topic is: How do inpatients of Palmetto Hospital with the need for acute care perceive the effects of understaffing in nursing while being provided with acute care from nurses?

Research Design

The question suggests conducting a qualitative study among acute care patients to reveal their feelings and attitudes from analyzing their experiences. The most appropriate form of such a study is interviewing. However, surveys and questionnaires can be employed, too. Questions should address aspects of nursing practice in general as well as particular nursing interventions experienced by participating patients. The hypothesis is that understaffing negatively affects the quality of patient care. However, the research should not be limited to merely assessing the patients’ perception of understaffing as positive, negative, or neutral. Interviewing and surveying should be arranged in a manner that would allow patients to describe their impressions related to particular aspects or consequences of understaffing. Patients’ answers may reveal something that has not been initially identified as important aspects of addressing the problem of understaffing. Therefore, analyzing patients’ perceptions can change the direction of further research and make the problem-solving efforts more effective.

Literature Review

A review of relevant academic literature shows that understaffing is likely to cause adverse patient outcomes. A study conducted by Hinno, Partanen, and Vehviläinen-Julkunen (2012) showed that reductions, as well as major changes, in nursing staff of hospitals often lead to decreases in patient care quality and patient satisfaction. However, it does not mean that this connection is acknowledged by patients or perceived by them the say way it is perceived by managers or researchers. Medina-Mirapeix, Del Baño-Aledo, Oliveira-Sousa, Escolar-Reina, and Collins (2013) point out that patient perception often lacks insight into the way medical facilities operate, but it is still important and should be used in strategic planning to ensure the development of a facility and improve patient-centered care. It can be beneficial for Palmetto Hospital to have patients share their ideas on possible solutions for the understaffing problem.


Hinno, S., Partanen, P., & Vehviläinen-Julkunen, K. (2012). Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal of Clinical Nursing, 21(11), 1584-1593.

Medina-Mirapeix, F., Del Baño-Aledo, M. E., Oliveira-Sousa, S. L., Escolar-Reina, P., & Collins, S. M. (2013). How the rehabilitation environment influences patient perception of service quality: A qualitative study. Archives of Physical Medicine and Rehabilitation, 94(6), 1112-1117.

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