Comparison of Current Nursing Practice To Evidence Based Practice for Post-Operative Pain Management

Task 1: qualitative study

Background

Postoperative period is one of the critical periods for patients due to uncertainty. The quality of care majorly determines patients’ health outcomes. Pain is one of the causes of discomfort that can cause additional complications and costs during recovery. An article by Suresh et al. (2015) titled the effect of audio therapy to treat postoperative pain in children undergoing major surgery: investigated the effect of music therapy as a non-drug method to control acute postoperative pain among Iranian children.

The article provides a brief overview of the background problem of the research. The background problem is presented, which in this case, is the effects of using analgesic drugs in managing postoperative pain. The background justifies why the study is crucial. It seeks to investigate the effects of music therapy as a non –drug method in managing acute postoperative pain among Iranian children.

Introduction

The article’s initial section presents a detailed introduction defining postoperative pain as one of the health concerns. The following paragraphs present the problem statement highlighting why pediatric postoperative pain management remains a problem. The major concern with pediatric postoperative pain management is the difficulties in pain assessment combined with analgesics’ side effects. The article further justifies why postoperative pain in pediatrics is a severe health concern. The introduction precisely highlights the importance of controlling postoperative pain because it improves children’s clinical outcomes and comfort and justifies why narcotics are not the best approach to control pain due to these side effects. Studies have presented different suggestions, including drug agents and non-drug methods. This study aims at proving how non-drug methods such as music therapy can be effective in managing postoperative pain. The study is crucial as it seeks to investigate the effects of music therapy as a non –drug method in managing acute postoperative pain among Iranian children.

Review of literature

The study does not justify the study’s aim by reviewing literature; instead, it presents statistics from past observations to justify the importance of finding ways to manage postoperative pain among children effectively. The need for research on music therapy is justified by the fact that 80 percent of patients who undergo surgery often experience moderate to severe pain. (Suresh et al., 2015). For pediatrics, uncontrolled acute postoperative pain activates biochemical stress responses that cause discomfort due to physiologic changes.

Research Design

The author presents a well-structured procedure that articulates how the study was conducted. The study is a quasi-experiment with both quantitative and qualitative features. For quantitative, which is a repeated measure design conducted between 2015 to 2016. The study’s location was at the research-teaching hospitals, which are affiliates of Ahvaz Jundishapur University of Medical Sciences in Iran. The sampling method is well articulated, with the inclusion and exclusion criteria being well defined. The Poukak formula was used to calculate the sample size that identified approximately 30 patients for each group. A total of 63 children were selected for the study. A total of 32 of them chosen for the music group and 31 for the control group.

Data collection

This study’s data included specific characteristics such as age, gender, area of residence, and type of surgery. The pain intensity was measured using a numeric rating scale using a 10-centimeter ruler. Surgical nurses delivered the intervention. Before the intervention commenced, the baseline data were recorded for comparison.

Method

The data collection process is presented in detail, including demographic information collected. The study used a quasi-experiment that was appropriate in assessing the relationship between the intervention and the outcomes. Participants in the music group listened to different music sounds ranging from sounds of birds, ocean, and water for over 20minutes. The effects of these sounds were measures after one hour (Suresh et al., 2015). The pain intensity was measured in intervals of 1 to 6 hours. The nurse conducted music therapy using an MP3 player and headphones to limit the sounds from the environment. The control groups’ pain intensity was also measured during the same time when measuring for the music group (Suresh et al., 2015). The data collected from the two groups were analyzed using the SPSS version. For this study, the pain intensity levels were assessed one hour after the surgery.

The observations made from the NRS scale supported the study outcomes. The study findings revealed that music sessions could be effective in assisting pediatric manage acute postoperative pain. Furthermore, the intervention can equally reduce the frequent usage of drugs in managing postoperative pain in pediatrics. Deriving support from several similar studies, the study concludes that music therapy can effectively control post-surgery pain and minimize the effect of the side effects caused by drugs. Non-drugs therapies such as music benefits include; increased patient levels of satisfaction, decreased cost, reduced fear and anxiety during post-operation, and minimal use of drugs to manage pain.

Protection of human subjects

The study did not specifically highlight how human subjects were protected during the study. However, the author mentioned that patients and their families were informed about the purpose of the study. The children and their families involved in the study were well informed, and accepting to participate in the study meant they had consented.

Study strengths and limitations

One of the study’s strengths is the selection process; the Poukak formula was used to calculate the sample size. Participants for the two groups were equally selected. A well-detailed eligibility criterion resulted in an equal number of participants for both the music group and the control group (Suresh et al., 2015). The eligibility criteria are well elaborated and include a limitation that can validate the study outcomes. For example, an individual with no prior history of major surgery and those without underlying disease were selected for the study. The main study limitation was the scope, which cannot be generalized. The sample size was limited to the urban population, limiting the possibility of relocating it in other regions. The use of a quasi-experimental design had its limitation.

Evidence from the article that informs current nursing practices

The study highlights that non-drug methods such as music therapy are a cheaper and more convenient method of managing pain. This method can help manage postoperative pain among children, reducing the cost of treatment and anxiety levels among pediatrics (Economidou et al., 2012). The outcome of the research is informative and can help hospital management, especially nurses. Music therapy approach can be adopted as one of the procedures for minimizing postoperative complications. Current research activities by health professionals who believe in music’s advantages have gained momentum, and the idea of using music as a therapeutic tool is widely adopted in current health care settings. The research findings prove that non-drug therapies, such as music, have several benefits. These include increased patient levels of satisfaction, decreased cost, reduced fear and anxiety during post-operation, and minimal use of drugs to manage pain.

Task 2: a quantitative study

Background

Hospital-based quality measures are widely utilized as the best strategy for measuring the levels of mortality among patients with cardiovascular diseases. The article by Lim et al., 2015 titled: Risk‐Adjusted In‐Hospital Mortality Models for Congestive Heart Failure and Acute Myocardial Infarction: Value of Clinical Laboratory Data and Race/Ethnicity, presents the debate on the importance of using medical records to estimate the levels of severity of the certain chronic condition, more so among ethnic minority population living in the U.S.

The background information reveals the existing debate on how medical records can estimate the levels of severity of certain chronic illnesses. Additional information regarding hospital-based quality measures are presented as the best option for predicting mortality rate for cardiovascular diseases. A 30-day risk-standardized mortality rate (RSMR) that advocates for the usage of administrative data to assess the levels of severity of diseases is introduced as justification. This quantitative study is key in assessing the impact of using an ethnic background combined with the latest laboratory findings and other clinical findings from other departments, which can help determine the severity of two chronic diseases, congestive heart failure and myocardial infarction.

Introduction

The introductory section of the article presents the problem statement concerning the lack of understanding by health experts about the causes of health disparities among minority groups. The article further justifies the importance of obtaining comprehensive information regarding patients’ race and ethnic background to improve in-hospital prediction of mortality and other chronic illnesses such as congestive heart failure. The aim of the research is articulated in the introduction, which is to understand the value of clinical laboratory data combined with patient’s ethnic background or race in assessing the severity levels of acute myocardial infarction and congestive heart failure. Thus, the article asserts that using information from the database can limit false impressions about certain diseases. The research question is presented in initial paragraphs to state how the study results can improve hospital performance if adopted as a measurement for assessing mortality rates.

Review of literature

The article presents several kinds of literature to justify how researchers failed to find ways of understanding the current health disparities, more so among the minority population using demographic data. The literature review highlights specific attempts by researchers to utilize electronic health data and linking data to improve the rates of prediction of mortality rates among patients suffering from chronic illness.

Research design

The study design is well presented. The research used a cross-sectional design with data collected from a Hawaii hospital database between 2009 and 2011 that were majorly linked to the database from the laboratory. A total of 25 laboratory tests across Hawaii was assessed according to the logical observation identifier and code standards results (Lim et al., 2015). The sample size was drawn from major six ethnic groups, including Chinese, Native Hawaiian, Filipino, and Japanese. A total of 5,718 were selected for the study. Patient’s characteristics were reviewed using descriptive statistics, which in this case was the mean standard deviation from the two diseases (Lim et al., 2015). The bivariate association used to examine the research variables.

Protection of human subjects

The study did not indicate how patient’s health information were protected during the research process. Instead, the study followed the National Quality Forum guidelines when conducting the research. The guidelines were important in understanding the features used when differentiating different races.

Strength and limitation

The study’s strength is the variety of patients selected from the six largest ethnic groups, namely, Chinese, Native Hawaiian, Filipino, and Japanese (Lim et al., 2015). The wider representation provides an accurate representation of the ethnic composition of the entire population. The article acknowledges the study limitations. One of the notable limitation is the replication of data and performance ranking across Hawaiian and other regions based on the previous data.

The authors acknowledge the study’s limitations, highlighting that the assumption made regarding missing laboratory results. Tin situation when laboratory data was missing, the assumption was that medical personnel only ordered laboratory tests relevant to patient conditions. Such an assumption cannot accurately assess patients’ mortality rates without missing laboratory test and other normal laboratory results (Lim et al., 2015). The assumption is likely to affect the accuracy of the prediction of the mortality rate. Another limitation noted is the laboratory score that was predicted based on the abnormal laboratory results. Such an assumption cannot reflect the value of using lab results.

The study emphasizes the need to utilize laboratory results. However, irregular tests are not examined, hence, the results might not present the true nature of the severity levels. Furthermore, the calculation of irregular laboratory tests and the normal lab test cannot guarantee an accurate measure of the disease’s severity.

Evidence from the article that informs current nursing practices

The study results assert that health personnel often overlook important patient characteristics that can help predict the levels of severity of chronic illnesses among ethnic minority groups. The study justifies that laboratory results combined with patient ethnic background are important predictors of disease progression among ethnic minority groups. Even though the data analysis used information from specific states, the study can provide important insights to policymakers and health care providers to advocate for the use of such data to minimize health disparities among minority groups.

Cardiovascular disease is a major health concern, thus there is need to make accurate prediction in assess the levels of severity to minimize the mortality rates among patients. Hence, the use of other measures to assess mortality rates such quality of patient care cannot accurately present the actual outcomes. The study advocates for the usage of administrative data as the best alternative to assess the levels of severity of diseases. This study is a useful guide in formulating a predictive framework applied to a specific population across different states with high health disparities.

References