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[ANSWERED 2022] 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 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.

  1. 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.
  2. 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).
  3. The PICOT question will provide a framework for your capstone project.
  4. 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

Permalink https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=101196786&site=eds-live&scope=site

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

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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 open6(2), 2055102919860635.

https://doi-org.lopes.idm.oclc.org/10.1177/2055102919860635

Permalink

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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.

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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

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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

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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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