NursingResearch paperCritical appraisal

Healthcare problem, PICO and evidence matrix guide

Summarise a healthcare problem and its significance, complete a PICO table and question, document your search strategy and evidence levels, fill an evidence matrix with five level I-III sources under five years old, then recommend and plan a practice change.

Aug 13, 2026

Editorial process

Last reviewed · August 13, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

A chain from problem to implementation

Parts A to F form a chain, and a break anywhere shows up in every later section. The problem statement in part A fixes the population that part B's PICO must use, which fixes the keywords in part C, which determines what part D can find. So sequencing matters more than the page counts. Do not commit to part A until you have checked that literature on it exists at levels I to III within the last five years, because discovering otherwise at part D means rewriting everything above it. Part A also asks something easy to miss — how the problem impacts the organisation and the patient's cultural background, meaning values, health behaviour and preferences. That is a distinct requirement, not a sentence about diversity, and it should name the specific values, behaviours or preferences that make this problem play out differently in the population you have chosen.

Part C requires you to distinguish research from non-research evidence and to discuss two of each across levels I to V, which means you need to know the level hierarchy your programme uses before you search. Part D is stricter still: five research sources at levels I to III only, from major medical databases, by four different authors, none older than five years. Levels I to III mean systematic reviews, meta-analyses and trials, so a search returning mostly descriptive studies has not found what the matrix needs. Part E must sit inside the evidence you actually collected, and part F asks for three named stakeholders and how you would involve them in the decision — involve, not inform, which implies a role in the choice rather than an announcement after it. The note about uploading full texts of the articles is easy to overlook and just as easy to fail on, so collect the PDFs as you find them.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
State a healthcare problem precisely enough to search the literature for it.
02
Build a PICO question whose elements match the stated problem.
03
Distinguish research from non-research evidence across levels I to V.
04
Appraise and tabulate level I-III evidence within a recency constraint.
05
Plan an implementation that gives named stakeholders a role in the decision.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

A. Write a brief summary (suggested length of 2–3 pages) of the significance and background of a healthcare problem by doing the following: 1. Describe a healthcare problem Note: A healthcare problem can be broad in nature or focused. 2. Explain the significance of the problem. 3. Describe the current practice related to the problem. 4. Discuss how the problem impacts the organization and/or patient’s cultural background (i.e., values, health behavior, and preferences). B. Complete the attached “PICO Table Template” by identifying all the elements of the PICO. 1. Develop the PICO question. C. Describe the search strategy (suggested length of 1–2 pages) you used to conduct the literature review by doing the following: 1. Identify the keywords used for the search. 2. Describe the number and types of articles that were available for consideration. a. Discuss two research evidence and two non-research evidence sources that were considered (levels I–V). Note: Be sure to upload a copy of the full text of the aritcles with your submission D. Complete the attached “Evidence Matrix” to list five research evidence sources (levels I–III) from scholarly journal sources you locate in major medical databases. Note: Four different authors should be used for research evidence. Research evidence must not be more than five years old. E. Explain a recommended practice change (suggested length of 1–3 pages) that addresses the PICO question within the framework of the evidence collected and used in the attached “Evidence Matrix.” F. Describe a process for implementing the recommendation from part E (suggested length of 2–3 pages) in which you do the following: 1. Explain how you would involve three key stakeholders in the decision to implement the recommendation. 2. Describe the specific barriers you may encounter in applying evidence to practice changes in the nursing practice setting. 3. Identify two strategies that could be used to overcome the barriers discussed in F2. 4. Identify one indicator to measure the outcome related to the recommendation. G. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized. Articles have already been chosen, if can be helpful. If you would like to choose an easier healthcare related problem or different articles, that is fine as well.

Course-wide instructions that accompany this question

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

Turn the brief into deliverables

01
A 2-3 page summary of the problem's significance, background, current practice and cultural impact.
02
A completed PICO table with all elements and a developed PICO question.
03
A 1-2 page search strategy with keywords, article counts and types, and two research and two non-research sources.
04
A completed evidence matrix with five level I-III sources by four different authors, none over five years old.
05
A 1-3 page recommended practice change grounded in the matrix.
06
A 2-3 page implementation process involving three key stakeholders, with barriers addressed.

Problem, PICO, search, matrix, recommendation, plan

The problem and its significance

What the problem is, why it matters, and what current practice does about it.

Organisational and cultural impact

How the problem affects the organisation and interacts with patient values and behaviour.

PICO table and question

Every element identified, then assembled into a searchable question.

Search strategy

Keywords, databases, counts and types of article, with two research and two non-research sources.

Evidence matrix

Five level I-III sources, four authors, all within five years.

Recommended practice change

A change the matrix evidence supports, answering the PICO question.

Implementation process

Three stakeholders involved in the decision, with barriers and how they are addressed.

Levels of evidence and the databases that hold them

Recommended databases

PubMed
CINAHL
Cochrane Library
AHRQ
Your programme's evidence level table

Search sequence

1.
Draft the PICO question and run a trial search before committing to the problem.
2.
Confirm which level hierarchy your programme uses and what counts as levels I to III.
3.
Search PubMed and CINAHL with filters for systematic reviews, meta-analyses and trials from the last five years.
4.
Record counts and article types as you search, because part C asks for them.
5.
Check author names across your five matrix sources to confirm four distinct authors.

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Quality Improvement
Agency for Healthcare Research and Quality · 2025
Implementation frameworks and stakeholder engagement approaches for part F.
02
Patient Safety and Quality Improvement
Agency for Healthcare Research and Quality · 2025
Non-research evidence sources and measurement definitions for the problem summary.
03
PubMed
National Library of Medicine · 2025
The major medical database the matrix sources must come from, with the filters that isolate levels I-III.
04
Nursing Scope and Standards of Practice
American Nurses Association · 2021
The professional standard the recommended practice change must remain consistent with.

Review before submission

Common mistakes

Choosing a problem before checking that level I-III evidence exists for it.
Writing a PICO question whose population differs from the one in part A.
Treating the cultural impact requirement as a general statement about diversity.
Filling the evidence matrix with descriptive studies that are not levels I to III.
Using fewer than four different authors across the five research sources.
Recommending a change the collected evidence does not actually support.

Submission checklist

The problem, the PICO population and the search keywords all match.
Cultural impact names specific values, behaviours or preferences.
Two research and two non-research sources are discussed with their levels.
The matrix holds five level I-III sources, four different authors, all within five years.
The recommendation cites only evidence that appears in the matrix.
Three stakeholders are named with a role in the decision, and full texts are uploaded.

Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.