Select a nursing practice problem of interest to use as the focus of your research
Select a nursing practice problem of interest to use as the focus of your research
The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.
For this assignment you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem. To support your PICOT question, identify six supporting peer-revised research articles, as indicated below. The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.
Use the “Literature Evaluation Table” to complete this assignment.
- Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200–250 words, provide a summary of the clinical issue.
- Following the PICOT format, write a PICOT question in your selected nursing practice problem area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
- The PICOT question will provide a framework for your capstone project.
- Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.
Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article.
The author will provide a description of data collection using qualitative or quantitative methods. Systematic Reviews, Literature Reviews, and Metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Expert Answer and Explanation
Literature Evaluation Table
Summary of Clinical Issue (200-250 words):
Postoperative comfort is important for good surgical outcomes for patients. The control of nausea, vomiting and pain in the postoperative period is important and has a great role in influencing the perception of patients on surgical procedures. Post-operative nausea, vomiting and pain is a significant problem for adult patients receiving general anesthesia. It is influenced by multiple factors related to the patient, surgery, and medications administered preoperative i.e. versed or medications administered intraoperatively. Postoperative pain, nausea and vomiting delays patient recovery, and can lead to unexpected delay in discharges.
The long delays in discharge can also have tremendous psychological burden on the patient that further exacerbates the health issues faced by the patient. Using pre-emptive multimodality medications such as Tylenol, Gabapentin, Celebrex, and Dexamethasone reduces the risk of postoperative pain, nausea and vomiting and increase patient satisfaction. It is for this reason that the PICOT question selected aimed at evaluating the effectiveness of some of the identified interventions in dealing with postoperative symptoms. Therefore, the PICOT question is noted as follows;
PICOT Question: In adult patients undergoing general anesthesia does giving preoperative analgesic and antiemetics decrease pain, nausea and vomiting postoperatively and provide better patient outcomes as compared to not receiving pre-operative meds?
| Criteria | Article 1 |
| APA-Formatted Article Citation with Permalink | Fecher-Jones, I., & Taylor, C. (2015). Lived experience, enhanced recovery and laparoscopic colonic resection. British Journal of Nursing, 24(4), 223–228. https://doi-org.lopes.idm.oclc.org/10.12968/bjon.2015.24.4.223 |
| How Does the Article Relate to the PICOT Question? | The study aimed at explaining the lived experience for patients who have undergone laparoscopic surgery on an enhanced program. The links with the PICOT question from the aspect of identifying the outcomes of patients’ post-surgery which the PICOT also aims to also achieve |
| Quantitative, Qualitative (How do you know?) | The study is a qualitative study as it used interviews to collect data, which is common tool for collecting qualitative data. The data analysis approach which was hermeneutical-phenomenological method also indicated the research as qualitative. |
| Purpose Statement | The purpose of this study was to explore patients’ lived experience of undergoing laparoscopic colonic resection on an enhanced recovery (ER) program |
| Research Question | The research question for the study was “what is the lived experience for patients who have undergone laparoscopic procedures on an ER program?” |
| Outcome | The study was able to identify the lived experience of patients who have undergone laparoscopic procedures on an ER program |
| Setting
(Where did the study take place?) |
The study took place in the participants own homes post-surgery |
| Sample | 11 patients were selected to participate in the study |
| Method | Purposive sampling was used to select the study’s participants in a target population of 46 participants. |
| Key Findings of the Study | The study identified that participants of the ER program were keen to achieve their goals and return to full health as soon as possible after surgery which was against the longer than expected duration of recovery. The long hospital stays resulted to negative psychological outcomes with additional accompanying symptoms worsening the patient outcomes. The findings also indicated that patients had different expectations from surgical procedures, in this case the laparoscopic surgery. |
| Recommendations of the Researcher | The researcher recommended that nurses need to not only consider the physical but also to the emotional needs of patients on an ER program until they are discharged. It was also recommended that nurses should do more to prepare patients for what to expect post- discharge. |
| Article 2 |
| Herbert, G., Sutton, E., Burden, S., Lewis, S., Thomas, S., Ness, A., & Atkinson, C. (n.d.). Healthcare professionals’ views of the enhanced recovery after surgery programme: a qualitative investigation. BMC HEALTH SERVICES RESEARCH, 17. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-017-2547-y
|
| This article focuses on the how to improve patient outcomes and recovery after surgery using the enhanced recovery after surgery (ERAS). The implications are the same as identified in the PICOT question, which is to reduce the pain and improve recovery for postoperative patients. |
| The study used semi-structured interviews to collect opinions of the study’s participants making it a qualitative study |
| The main aim of the research was to understand some of the factors that facilitate or act as barriers in the implementation of the ERAS program, with a specific focus on nutritional elements. |
| The research question for the study was “What are the challenges and facilitating factors to ERAS program implementation from the perspective of healthcare professionals? “ |
| The research identified various challenges and facilitating factors in implementation of the ERAS program as cited by the healthcare professionals |
| The study took place in UK teaching hospitals |
| The sample for the study was 26 participants |
| Purposive sampling was used in the study where invitational emails were sent to the study’s participants. This method is ideal when opting to select participants with specific characteristics. |
| The findings from the research identified various facilitating factors like patient involvement and education and challenges like resistance to change which had an impact on the ERAS program.
The findings noted from the study provided useful information from different surgical specialties that can assist in informing healthcare providers during the implementation of the ERAS program. |
| The author recommended that addressing the challenges and focusing on the facilitating factors such as visible leadership can help in the implementation of the ERAS program. |
| Article 3 |
| Phillips, E., Archer, S., Montague, J., & Bali, A. (2019). Experiences of enhanced recovery after surgery in general gynaecology patients: An interpretative phenomenological analysis. Health psychology open, 6(2), 2055102919860635.
https://doi-org.lopes.idm.oclc.org/10.1177/2055102919860635 Permalink |
| The study focused on establishing the ERAS experiences of patients who have undergone general gynecological surgery. This links which the PICOT which also focused on the patients postoperative experiences. |
| The study was a Qualitative since it employed phenomenological analysis which is a method used to analyze qualitative data. |
| The objective of the study was to explore the experiences of women after undergoing general gynecological surgery, with the main focus being on their experiences of the ERAS program |
| What are the experiences of women who are on ERAS pathway after undergoing gynecological surgery? |
| The study was able to identify the postoperative experiences of women on the ERAS pathway. |
| The study took place in Britain where the participants were interviewed via phone calls. |
| The study sample consisted of 7 patients who had undergone hysterectomy according to the ERAS pathway |
| Purposive sampling was used to select the study’s sample where only those patients scheduled for hysterectomy were selected |
| The research results identified that most patients were satisfied with their experience on the ERAS pathway, with some factors influencing their experience being described for example personal relationship with the staff in charge.
The findings highlight the importance of qualitative studies especially in identification of the main satisfaction factors of the ERAS program which will be useful in enhancing the program going forward. |
| The researcher recommended that more experiential information is required and the impact of informal support of the protocols used in ERAS be studied and communicated to the healthcare personnel. |
| Article 4 |
| Gomez-Hernandez, J., Orozco-Alatorre, A. L., Dominguez-Contreras, M., Oceguera-Villanueva, A., Gomez-Romo, S., Alvarez Villasenor, A. S., Fuentes-Orozco, C., & Gonzalez-Ojeda, A. (2010). Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer. BMC Cancer. |
| The research focused on using dexamethasone as the preferred method of reducing postoperative nausea and vomiting (PONV), which corresponds to what the PICOT question wants to identify. |
| The study is a quantitative study given that it used randomized control trials as the research design and descriptive statistics to analyze data collected. These are methods used in quantitative studies |
| The main purpose of the study as quoted was “to evaluate the efficacy of dexamethasone treatment for reducing pain and PONV as well as analgesic and antiemetic requirements in women undergoing general anesthesia for mastectomy with axillary lymph node dissection.” |
| How effective is dexamethasone treatment in reducing PONV as well as analgesic and antiemetic requirements in women undergoing general anesthesia for mastectomy with axillary lymph node dissection? |
| The outcome of the research identified a positive effect of dexamethasone in reduction of pain in women who have undergone mastectomy |
| The study was conducted in surgical wards located in Mexican hospitals |
| The study sample was 70 patients scheduled for mastectomy. |
| The study’s sample were purposefully selected given that the study required patients with specific characteristics (patients undergoing mastectomy) |
| It was noted from the study that preoperative intravenous dexamethasone plays a role in reducing the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.
The results realized by the study contributes to nursing practice by providing an alternative means of reducing PONV in patients who have undergone surgery and alleviating postoperative symptoms. |
| No recommendations were given by the researcher. |
| Article 5 |
| Elgohary, H., Baiuomy, M., Abdelkader, A., Hamed, M., & Mosaad, A. (2017). Comparative study between enhanced recovery after surgery and conventional perioperative care in elective colorectal surgery. Egyptian Journal of Surgery, 36(2), 137–144. https://doi-org.lopes.idm.oclc.org/10.4103/1110-1121.204527 |
| This study was focused in identifying the safety and feasibility of ERAS program elective colorectal surgery. The results obtained from the research had a correlation with the PICOT question in identification of ways of reducing postoperative pain nausea and vomiting. |
| The study was a quantitative study indicated by the study design which was RCT and the data analysis technique which was descriptive statistics. |
| The main purpose of the study was to examine the feasibility and safety of (ERAS) program in elective colorectal surgery |
| How feasible and safe is the ERAS program in handling patients who have undergone elective colorectal surgery? |
| The outcome of the research identified the feasibility and safety of the ERAS program in patients who have undergone elective colorectal surgery |
| The study was conducted in various teaching and general hospitals in Saudi Arabia |
| The study used 80 patients as the research sample |
| Random sampling techniques was used to select and categorize the study’s participants |
| The results collected from the research identified that the ERAS pathway was feasible for use in colorectal surgery, as it shortened the postoperative hospital duration and displayed no risk to patients in terms of morbidity or mortality.
This indicated that the ERAS program can be effective in reducing postoperative symptoms for patients who have undergone colorectal surgery |
| The researcher recommended that more needs to be done to improve the ERAS pathway procedure and facilitate its distribution. |
| Article 6 |
| Chetna A. Jadeja, Rashida Jadaliwala, & Manoj Kathiria. (2014). Pre-emptive use of Gabapentin for post-operative pain relief in upper abdominal surgeries. Indian Journal of Pain, 2, 99. https://doi-org.lopes.idm.oclc.org/10.4103/0970-5333.132848 |
| The research considers gabapentin as a drug that can alleviate postoperative pain in patients who have undergone abdominal surgery. The drug is one of the identified drugs for evaluation by the PICOT question. |
| The study was a quantitative study having used RCT as the study design and data analysis using descriptive statistics, which is usually used for quantitative data. |
| The main aim of the study was to find out how effective gabapentin is in reducing post-operative pain in upper abdominal surgeries. |
| The research question was “How effective is gabapentin in reducing post-operative pain in upper abdominal surgeries?” |
| The research was able to identify the effectiveness of gabapentin in reducing post-operative pain in abdominal surgery |
| The research setting was conducted in Indian learning and general hospitals |
| 50 identified patients of American Society of Anesthesiologists (ASA) grade I and II of either sex, aged between 20 to 60 years were selected to participate in the study as the sample. |
| Random purposive sampling was used where patients who match to the ASA grade I and II were selected to participate in the study. |
| The research findings indicated that It that patients in gabapentin group had statistically significant lower pain score at all time interval as compared to the placebo group
The implications of the results identify the option of gabapentin as a suitable drug in reducing post-operative pain for patients who have undergone abdominal surgery. |
| No recommendations were given by the researcher |
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Picot Question and Literature Search: A Comprehensive Guide
In the field of research, the Picot question and literature search are essential components for designing and conducting successful studies. The Picot question is a framework that helps researchers formulate focused research questions, while a literature search is a process of identifying relevant studies related to the research question. In this article, we will discuss what the Picot question and literature search are, how to develop a Picot question, and conduct a literature search to gather relevant evidence.
What is a Picot Question?
A Picot question is a structured framework that helps researchers develop a focused and answerable research question. The acronym stands for Population, Intervention, Comparison, Outcome, and Timeframe. These elements are the building blocks of a research question that guides the research design and analysis. The Picot question format is widely used in healthcare research, but it can also be applied in other research domains. The following are the elements of a Picot question:
Population
The population refers to the group of individuals or subjects who are the focus of the research. The population can be defined by demographic characteristics such as age, gender, race, or specific clinical conditions.
Intervention
The intervention is the treatment or exposure that the research is investigating. It can be a medication, surgery, behavioral intervention, or any other intervention that affects the outcome of interest.
Comparison
The comparison is the alternative intervention or placebo that the research is comparing to the intervention. The comparison is essential to determine whether the intervention is more effective than the alternative or placebo.
Outcome
The outcome is the desired result or effect of the intervention. It can be a clinical outcome such as reduced morbidity or mortality, or a patient-reported outcome such as quality of life.
Timeframe
The timeframe is the period during which the intervention is administered and the outcome is measured. The timeframe can be short-term, intermediate-term, or long-term, depending on the research question.
How to Develop a Picot Question
Developing a Picot question involves identifying the key elements and formulating a focused research question. The following steps can guide the process of developing a Picot question:
- Identify the problem or research topic: Start by identifying the problem or research topic that you want to investigate. The research topic should be specific and relevant to the field of study.
- Formulate the research question: Use the Picot framework to formulate a focused research question that addresses the problem or research topic. The research question should be specific, measurable, and answerable.
- Identify the population: Identify the population of interest that is relevant to the research question. The population can be defined by demographic characteristics, clinical conditions, or other criteria.
- Specify the intervention: Specify the intervention or exposure that is the focus of the research question. The intervention can be a medication, surgery, behavioral intervention, or any other intervention that affects the outcome of interest.
- Identify the comparison: Identify the alternative intervention or placebo that the research is comparing to the intervention. The comparison is essential to determine whether the intervention is more effective than the alternative or placebo.
- Specify the outcome: Specify the desired result or effect of the intervention. The outcome can be a clinical outcome such as reduced morbidity or mortality, or a patient-reported outcome such as quality of life.
- Determine the timeframe: Determine the period during which the intervention is administered and the outcome is measured. The timeframe can be short-term, intermediate-term, or long-term, depending on the research question.
What are the problems faced by beginner nurse researchers while identifying a research problem?
Introduction
Becoming a nurse researcher is a rewarding journey filled with opportunities to make a significant impact on the healthcare field. However, for beginners, the path is laden with challenges, especially when it comes to identifying a research problem. In this article, we’ll explore the common issues faced by novice nurse researchers and offer solutions to help them overcome these hurdles.
The Importance of Research Problem Identification
Before delving into the challenges, it’s crucial to understand the significance of identifying the right research problem. The research problem serves as the foundation for any study, guiding the research process, data collection, and analysis. It must be relevant, meaningful, and feasible. Here’s where beginners often face their first challenge.
Lack of Research Experience
Beginner nurse researchers often lack hands-on experience in the research domain. They may have theoretical knowledge from their education, but practical application is an entirely different realm. As a result, they might struggle to identify research problems that are both significant and feasible.
Information Overload
In the age of the internet, aspiring researchers can access a vast amount of information. While this is a boon, it can also be overwhelming. Novices might find themselves drowning in data, making it difficult to narrow down a research problem.
Identifying a Niche Topic
Nursing research is a diverse field, and identifying a niche topic can be challenging. Novice researchers might have a broad understanding of nursing, but honing in on a specific area for research can be perplexing.
Ethical Considerations
Nursing research often involves working with human subjects, raising ethical concerns. Beginners may struggle with ethical considerations and regulations that need to be adhered to during the research process.
Limited Resources
Securing resources for research can be a major roadblock for beginners. Access to funds, equipment, and even participants can be limited, affecting the scope and scale of their research.
Time Constraints
Balancing the demands of nursing practice, education, and research can be time-consuming. Novice nurse researchers might find it challenging to allocate enough time for their research projects.
Supervision and Guidance
Mentorship and guidance are invaluable for beginners. The lack of an experienced mentor can leave novice nurse researchers feeling adrift, unsure of their research direction.
Overcoming Beginner Challenges
While these challenges might seem daunting, there are practical steps that beginner nurse researchers can take to overcome them. Seeking mentorship, joining research communities, and participating in workshops can provide valuable guidance and support.
The Role of Mentorship
Having an experienced mentor can be a game-changer for novice nurse researchers. A mentor can provide guidance, help in identifying research problems, and offer insights based on their experience.
Utilizing Online Resources
The internet offers a plethora of resources for nurse researchers. From online forums to academic databases, beginners can access information and network with other researchers to gain knowledge and insights.
Conclusion
In conclusion, beginner nurse researchers do face various challenges when identifying a research problem. However, with determination, mentorship, and the effective use of resources, these challenges can be overcome. Identifying a meaningful research problem is the first step in a rewarding career as a nurse researcher.
Frequently Asked Questions
How can a beginner nurse researcher find a mentor?
Finding a mentor can be done through professional networks, academic institutions, and even online platforms dedicated to nursing research. Joining organizations like the American Nurses Association can also help connect with experienced professionals willing to mentor.
What is the significance of choosing the right research problem?
Choosing the right research problem is crucial because it sets the direction for your study. A well-defined problem ensures that your research is focused, relevant, and likely to contribute to the field of nursing.
How to narrow down a research problem to make it manageable?
To narrow down a research problem, start by conducting a literature review to identify gaps in existing research. Then, consider the available resources and your expertise to determine a research problem that is both significant and manageable.
Can you suggest some online platforms for nurse researchers to connect and learn?
Certainly! Online platforms like ResearchGate, LinkedIn, and specialty nursing forums provide a space for nurse researchers to connect, share knowledge, and learn from experienced professionals.
What are some common ethical challenges in nursing research?
Common ethical challenges in nursing research include obtaining informed consent, ensuring patient privacy, and handling sensitive data. Beginners should familiarize themselves with ethical guidelines and seek guidance from institutional review boards.
How do you identify a nursing research problem?
Identifying a nursing research problem is a crucial step in the research process, as it sets the direction for your study and determines its significance. Here’s a step-by-step guide on how to identify a nursing research problem:
- Choose Your Area of Interest: Begin by selecting a specific area of nursing that interests you the most. It could be related to patient care, healthcare policies, nursing education, or any other nursing-related field. Your passion for the subject will motivate you throughout the research process.
- Conduct a Literature Review: Before finalizing your research problem, conduct a thorough literature review. This involves researching existing studies, articles, and publications related to your chosen area. This will help you identify gaps in the current knowledge and research areas that need further exploration.
- Identify Gaps or Issues: While reviewing the literature, pay attention to gaps, inconsistencies, or unanswered questions. These gaps are potential areas for research. Ask yourself what hasn’t been addressed in previous studies or what issues remain unresolved.
- Consider Relevance: Your research problem should be relevant not only to the nursing field but also to the broader healthcare community. Think about how your research could contribute to improving patient care, nursing practice, or healthcare outcomes.
- Formulate Research Questions: Based on the identified gaps and issues, formulate clear and concise research questions. Your research questions should be specific, focused, and researchable. Avoid overly broad or vague questions that can be challenging to address.
- Review Ethical Considerations: It’s essential to consider ethical aspects when formulating your research problem, especially in nursing. Think about how your research might impact patients, their privacy, and their well-being. Ensure that your research is conducted ethically and complies with all relevant regulations and guidelines.
- Assess Feasibility: Assess the feasibility of your research problem. Consider the available resources, including time, budget, data sources, and access to participants. Make sure that your research problem is manageable within your limitations.
- Seek Feedback: Discuss your research problem with peers, mentors, or advisors. Their input can help you refine your research problem and make it more robust. They may also provide insights or suggest modifications based on their experience.
- Narrow Down Your Focus: It’s often beneficial to narrow down your research problem to a specific aspect or angle. This can make your research more manageable and allow for in-depth exploration.
- Define Your Research Problem: Once you’ve considered all these factors, clearly define your research problem. Your problem statement should be concise, specific, and actionable. It should state what you aim to investigate or explore in your research.
