Assessment for Evidence-Based Practice and Applied Nursing Research

Qualitative Research Article: Pain Management in Children

Title of the Article: Valizadeh, F., Ahmadi, F., & Zarea, K. (2016). Neglect of Postoperative Pain Management in Children: A Qualitative Study Based on the Experiences of Parents. Journal of Pediatric Nursing, 31(4), 439-448. doi:10.1016/j.pedn.2016.02.012

Introduction

 The authors of this research article introduce the work well by providing an introduction to the subject which is Pain management. They go on to say that pain management is known as the ‘fifth vital sign' which calls for a holistic approach to management.  In this manner, pain management is about putting in place a holistic assessment an screening, a collaborative care plan between the hospitals and at home. Low interference of the body function, an efficacious treatment that leads to inadequate pain relief among other few adverse effects.  During pain management, the authors show the relevance of being involved and all aspect to pain management in terms of clinical guidelines as they govern their organization and the whole care system.

Among the issues that have been factored will in the introduction is the way that the author insists on the rights of patients to be involved in all aspects of pain management through the governing and organization of all the clinical guidelines related to pain management and the healthcare institutions.  In doing this, the author has been able to identify the purpose of the study which was to determine parents ‘experience on the barriers to optimal postoperative pain management in children

Review of Literature

Review of literature was also done well and looked at the developments in post-operative central management among children. The literature review was also based on background studies especially on the numerous factors that contribute to inadequate pain management among children. In particular, the researchers focussed on organizational factors in pain management that looked at the lack poor access to drugs, limited staff, lack of time to attend to patients and the tasks that came up with competing priorities. The researcher also outsourced information from different studies done in the area of pain management. The literature review was based on studies done between the 1960s to 2017. Among the evidence-based information found in the literature review included healthcare provider related factors that were more focused on the reason patients underwent pain than on the way that pain was managed.  For example, the study looked at the insufficiency in the prescription of analgesics, the fear of poisoning against children and addition and the belief that children usually exaggerate the rate of pain.  The other evidence-based study was based on the prescription of analgesics, where one study identified barriers to communication as one of the challenges caregivers undergo during pain management in children. In particular, the researcher mentioned that children who have no verbal communication skills were the most affected in effective pain management.

From the litterateur review, the authors also identified the lack of knowledge on analgesics of fear of children's addition and the assumption that children always cry like some of the barriers to pain management in children.  This was mainly related to parental care, and it was among the main factors that derailed the treatment of pain. The literature review was done very well and was based on various experiences from hospitals and home care for children undergoing treatment of pain.  Also during the literature review, empirical studies where done on parents perception on how hospitals manage children’s pain. The studies were based on different interviews done in the U.K, South American and other parts of Europe, looking at perceptions of parents in children's postoperative pain management. From the evidence gathered in this literature, the researchers revealed that parents who reported having a limited and passive role in their children management of pain, often felt that caregivers or nurses were the major obstacles in the provision of children postoperative pain management due to lack of communication.

Data Analysis

When it comes to data analysis, it looked at how the researcher went from all the data collected to remaining with only the meaningful insight to the study.  In this study, the analysis was done after completing the interview together with data collection.  The technique here was to analyze content from the interview recordings, where the interviews were transcribed verbatim in support of transcripts which brought out the understanding of the study topic. Other techniques used in data analysis included comparing different codes and grouping them in subcategories by their differences and similarities. After all the abstraction process was complete, the central theme was discovered that reflected the concept of the study area. This method of data analysis was relevant as it ensured that there was the narrowing of the information related to the management of pain among children. 

Methodology

The study was a quantitative type which was based on analysis of different contents from 16 parents that had school children who had undergone an emergency abdominal surgery in the University of Ahvaz hospitals, in Southern Iran.

The sampling method used in the study was purposive.  There are often a lot of benefits in using purpose sampling in quantitative research as it allows from critical case sampling or expert sampling for each area under study.  The researchers also made use of different techniques in collecting data which include semi-structured interviews. Since the study involved children, the researcher ensured that all the interviews were recorded, transcribed and later analyzed.  In evidence-based research, it is always essential to record the interview and data collection process as this helps in ensuring the ethical aspects of the study are taken care of. It also means that all the participants in the study consented and that what the researcher publishes can later be reviewed or clarified through the recorded items. 

2. Evidence and study outcomes

Generally, it can be concluded that evidence presented in the background, literature review, data collection and analysis supports the study outcomes and implication for future studies. This is because the researchers were able to conduct a background and current trends in post-operative pain management in children.  The study was also able to identify the causes of neglect and provided evidence from empirical studies and recorded interviews. The interviews presented views of both parents and caregivers which influenced the study outcomes. With the study outcomes, future studies can understand the difficulties related to post-operative pain management and reflect it on their patients thus find ways to counter the challenges. 

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3. Protection of Human Subjects

There was consent written to which the researcher also assured parents that they were not in any way associated with any hospital. There were letters of introduction which were shown to each hospital as part of the protection of human subjects.

4. Strength and Limitation

One strength of the study is the researchers were able to interview target groups and used the right tool to gather data.

One limitation of the study is that it was done in one location, meaning they were not able to explore other factors related to the management of pain.

5. Evidence and current practices

The evidence study informs the current nursing practices as it revealed that there is a lot of disregard in healthcare systems, lack of sensitivity from healthcare providers and delay, hesitance in hospitals will affect postoperative management in children. 

Quantitative Research Article: Infections in Hospitals

Title: Esfandiari, A., Salari, H., Rashidian, A., Masoumi Asl, H., Rahimi Foroushani, A., & Akbari Sari, A. (2017). Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders’ Views. International Journal of Health Policy and Management, 7(1), 27-34. doi:10.15171/ijhpm.2017.34

Background/ Introduction

 The research article focussed on the issue of Healthcare-Associated Infections, which continues to pose a huge threat in terms of health and economic development of countries around the world. The paper is based on studies that indicated various causes of healthcare-associated infections, though the authors reveal that there is still very little literature related to Health Associated Infections and measures used in addressing the problem. Through the background, the researchers have tried to provide a background on the problem by looking at data from 1986 -2017. As part of the background, the authors reveal that recent data on Healthcare-associated infections indicate that the United States has 722,000 related cases in acute care hospitals, especially in 2011 which lead to almost 75000 death among hospitalized patients. 

The evidence-based study also reveals that more than half of all Health Associated Infection will occur outside the intensive care unit. From the background of the study, it was found that healthcare-associated infections affect the country's budget where about US$ 33 billion is spent annually. The study also looked at evidence-based from EU which revealed that over 4.5 million people would befall victims t Healthcare Associated Infections which eventually results to about 37,000 deaths in addition to 16 million extra days spent by patients in hospitals. According to the background study evidence it shows that globally, Healthcare-associated infection is a global burden in terms of economic development of countries which is common in five Health associated infections areas like; Ventilator-associated pneumonia ( VAP), Surgical Site Infection ( SSI), Central line-associated bloodstream infection ( CLABSI), catheter-associated urinary tract infection ( CAUTI and Clostridium difficile Infection (CDI). All these representations cost the world about 9.8billion annually, according to the evidence presented by the background study. 

Review of Literature

Concerning the literature review, the researcher used both current and old data related to healthcare infections. The review of the literature was based on published research, news story, and economic related information in healthcare-associated infection. To come up with reliable, evidence-based literature review, the study compared literature from three nations; United States, European Union, and Iran or the number of affected people and its effects in the country's economy. For instance, the researcher's evidence-based literature revealed that Health Associated Infections in Iran account to about 18% resulting in an economic burden in the country of around $150,000 in costs.  Also, the overall death from Health Associated Infections was at 14.8%. This evidence-based literature looks at an empirical study done between 2007-2010).  The literature also revealed reported cases of Health associated infections at 28.9% with the most common being the urinary tract infections. Most infections way is shown to be in intensive care units standing at 12.8% in Iran.

The literature review was also appropriate as it revealed the increasing threat posed by associated health infections which inspired the purpose of this study. The researcher also posted information from a reliable source for evidence like the World Health Organisation, and some of the practices implemented to ensure that there is a reduction in healthcare infections. The studies also revealed some of the causes of infection; however, there is still very little literature on the development of prevention mechanisms making the research topic appropriate for the study.

Data Analysis

As this was an evidence-based qualitative study, the researchers used the MAXQDA10 data coding software. To ensure that everything was captured, the thematic framework approach was relevant which identified five steps; Familiarization, thematic framework identification, index, charting and mapping and interpretation. The evidence-based study was also indicated by recording of information of which two researchers listened to them and gained a holistic view in prevention and control of Health associated infections.

Methodology

The research type used in this study was qualitative. In any case, qualitative research is more exploratory than quantitative research, which made it more applicable to the research topic. This is because the research looked toward gaining an understanding of the reason, causes, and opinions related to health associated infections in hospitals. By using the qualitative study, the researchers were able to provide an insight into the problem thus help in coming up with mechanisms for solutions to the existing problem. It was also appropriate for the researchers to use qualitative research to be able to uncover trends in opinions and thoughts and come up with a deeper understanding of the existing problem or phenomenon.

The techniques used were both structured and unstructured, for example during sampling, the purposive sampling technique was used as it would be appropriate to identify the study participants to the moment of saturation of. To ensure that there was enough evidence based information, samples were classified where 10 experts from the ministry of health participated in the study; others included 7 staff from hospitals, 7 participants from universities in a Macro, Micro and Meso levels as these are groups of people involved in the prevention and control of Healthcare-associated infections in the country. The tools used for collecting data were semi-structured interviews where the interviewees targeted were key informants and representatives to the country's national committee of Hospital Infection.  On being said that the data analysis and research method used by the researcher was appropriate since the study was not looking at the number of infections or the population but in the causes, implications and what can be done to prevent future occurrences of health associated infections. Another important group that participated in the study to affirm the evidence-based practice aspect included; healthcare professionals, and health technical officers.

2. Support for the study

The evidence-based approach practiced by the researchers supports the research topic due to the study methodology. There were samples collected with the purpose of finding out the cause and effects of the existing problem, and all the stakeholders were represented.

3. Protection of Human Subjects

There is no indication of human subjects used in the study, meaning that this was considered. However, cultural consideration was discussed, where the researcher selected only stakeholders from different departments as a way of showing balance and impartiality in the study.

4. Strength and limitations

One strength of the study is that the researcher was able to compare the collected data, which were indexed under themes and sub-themes. Credibility, transferability, and dependability were also ensured. Because the whole study took 11 months, for purposes of engagement, the reliability of the findings was guaranteed. 

One limitation of the study is that it did not include human experience information from patients who have undergone Health associated infections.

5. Current nursing practice

The evidence from the study informs the current nursing practice in a manner that it will improve nursing care especially for health professionals working with patients from the intensive care units.

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