PICO Paper Reflection



PICO Paper ReflectionSheila MahaneyFerris State UniversityAbstractThis paper includes reflection on dissection of articles related to the clinical use of Ofirmev in the perioperative setting regarding effective pain management and post op nausea and vomiting using databases and incorporation of the knowledge into clinical nursing practice. Also included in this paper is how to develop a PICO statement and knowledge of levels of evidence using a pyramid based scale developed by Bernadette Melnyk based on the strength of articles. Identification of American Nurses Associations standards and the correlation of evidence-based research are also identified throughout the paper.Keywords: Cinahl, PubMed, AHRQ, Cochrane Reviews, Ofirmev, Evidence Based Research, PICOT development, QSEN, ANA standards PICO Paper Reflection Introduction“Nurses interpret research findings and use evidence based research to support nursing decisions. The purpose of this is assignment is to reflect how nursing knowledge is disseminated for use in personal and professional practice”(Urusy, P. 2014, Ferris State University). This paper will explore the use of Ofirmev or Intravenous (IV) acetaminophen in the postoperative setting and the effectiveness in the pain management and decreased nausea and vomiting that patients experience.Clinical QuestionWithin the last year the surgical department in the hospital that I work at has begun to use Intravenous Tylenol or Ofirmev for pain management. Effective pain management is needed for patients in the postoperative settings. Over the last couple years Ofirmev has been the “buzz” in decreasing pain and PONV (Post-op nausea and vomiting). I began asking clinical questions about the research that our unit started by using the PICOT acronym. “The PICOT format provides an efficient framework for searching electronic databases, one designed to retrieve only those articles relevant to the clinical question” (Mazurek Melnyk, Fineout- Overholt, Stillwell, & Williamson, 2010, p. 52). Formulating a good PICO question enhances the likelihood of finding evidence-based research that is applicable to the topic of interest and therefore increased knowledge of the research that is done.In using the PICO acronym, my statement is ‘Is Ofirmev effective in pain management and reducing PONV in the postoperative patient compared to patients that do not receive Ofirmev?’ P (population)- post op patientsI (intervention)- administration of OfirmevC (comparison)- patients not receiving OfirmevO (outcome)- decreased pain and PONVT (time)- pain-management postoperativelyMethodologyIn researching my PICO question I searched several databases in answering this question. I used the following keywords for my searches: Ofirmev, IV Tylenol (acetaminophen), decreased pain and PONV. The databases that were used were Cinahl, Pub-Med and Cochrane Reviews. I also used The Agency for Healthcare and Research Quality (AHRQ). The databases where I found articles of interest to my subject were Cinahl, Pub-Med and Cochrane Reviews. AHRQ provided no relevant information to include in my findings. I used the advance searches and narrowed my search to include research from 2008 to current. Using the databases I explored the articles that were relevant to my PICO statement. I reviewed the articles by reading the abstracts and then gathered those articles to start conducting my research on Ofirmev. I critically appraised four articles and dissected each of those articles in the design method that was used, determined quantitate or qualitative research, what kind of sample size and measurements that were used, and the findings from each article. I also reviewed each article for a level of evidence (Melnyk & Fineout-Overholt, 2011).Levels of evidence are used for articles based on the strength and quality of the research that is provided. There are many different hierarchies of level of evidence that are used in research. I used the hierarchy that Melnyk provides. There are seven levels in her pyramid that is used to rate the level for each article. The strongest level is one that uses systematic reviews and analysis of several random clinical trials. The levels of evidence range from studies that use controlled groups where internal validity is used, cohort studies to articles that are author reviews and opinions on subjects, which according to Melnyk is the weakest or a seven on the level of evidence pyramid. Understanding how to rate levels of evidence is important for nursing and the medical community because it allows for optimal care and educated decisions that can be passed on to patients in clinical areas. (Melnyk, 2004, p. 323)Discussion of LiteratureArticle OneOne article that was retrieved from Cinahl, explored how Ofirmev reduces post op nausea and vomiting (PONV) and pain in the postoperative population. The authors were credible and experts in the field of anesthesia and pharmacology. The article stated that IV Tylenol or Ofirmev is a relatively new concept to the United States. Systematic reviews and analysis from several sources were conducted and revealed that Ofirmev is safe and effective for pain management. When Ofirmev is given prophylactic, ponv and pain is substantially decreased from those patients that have not received the medication prophylactically (Apfel, Turan, Souza, Pergolizzi, & Hornuss, 2013, p. 683) This substantiates that the timing of Ofirmev is vital in the treatment of pain and nausea and vomiting.This article used random studies and analysis for the data that was collected. Descriptive statistics were used to validate the information that was procured. The level of evidence of this article is a one because it incorporates several studies and trials that were conducted and used a systematic method to display the materials that were presented. The authors concluded that IV Tylenol is safe and effective in the postoperative patient to decreases nausea and vomiting.Article TwoThis article was retrieved from PubMed database from the Journal of Pain Management Nursing and identifies the role that Ofirmev has in pain management. Ofirmev has been “recognized worldwide as a safe and effective agent for relieving pain….”(Pasero & Stannard, 2012, p. 107). This article further explains that IV Acetaminophen has a quick onset compared to the oral and rectal counterparts. Therefore using IV Acetaminophen in the perioperative or intraoperative areas is beneficial to the patient for effective pain management. Treatment of the pain before progression of intense pain is a goal for the surgical nurse. (Pasero & Stannard, 2012)The article also elaborates on the importance for effective pain management by using a multimodal approach with Tylenol and a non-steroidal anti-inflammatory drug around the clock for optimal pain control. The data that was collected for this article were derived from those that had general surgeries including gallbladder removal and gynological procedures. The information was quantitative in methodology and descriptive statistics were used to validate the findings in the study. The level of this article is a one (Melnyk & Fineout-Overholt, 2011). It includes systematic review and analysis of random trials. The authors concluded that IV acetaminophen is effective in pain management postoperatively.Article ThreeThis article was retrieved from PubMed; its authors are graduate nurses from Wayne State University in Detroit, MI. This article is an informative article about Ofirmev and the clinical and nursing implications it delivers. The level of evidence is a seven because it involves an expert’s opinion Ofirmev and does not include systematic reviews or analysis of data. (Melnyk & Fineout-Overholt, 2011). The data comes from Cadence Pharmaceuticals, which have established that Ofirmev is a leader of injectable analgesics. The article suggests that Ofirmev can be used alone or in conjunction with other analgesics to decrease pain and nausea. Data is presented that state that using Ofirmev has reduced the amount of opioids in surgeries. (Pickens & Meinke, 2011) Treating postoperative pain in patients is vital to the care that is provided for adults and pediatric patients. “Research suggest that as a multimodal approach to perioperative pain, the use of IV acetaminophen can reduce opiate consumption, minimize adverse events, improve pain relief and patient satisfaction, facilitate earlier recovery and reduce cost of hospitalizations” (Pickens & Meinke, 2011, p. 495).Significance to NursingThe American Nursing Association (ANA) have developed standards that make nursing the stronghold it is today. One of the ANA standards is Evidence Based Research. This includes evaluating and incorporating data and evidence that is conducted in the clinical setting and applying it directly to a field of practice. (White & O’Sullivan, 2012). Robert Wood formed the Quality and Safety Education of Nursing (QSEN) in 2005, he identified the importance of safety of culture and identified six competencies that nurses use in our profession every day. The six competences are patient centered care, team- work and collaboration, evidence based research, quality improvement, safety and informatics (Cronenwett et al., 2007) QSEN is instrumental for the nurse as well as for the patient. The articles on the use of Ofirmev and pain management identified ways that benefit patients by alleviating their pain and therefore benefit from quicker recovery. The competencies that I identified with are patient centered care and safety. In providing care for my patients, I aspire them to have a positive outcome; this can be achieved by administering Ofirmev prior to surgery to have effective pain management postoperatively. Along with effective pain management, I can educate those patients on the risk of overdosing on Tylenol and the effects it has on the liver. Education is also a core competency that the ANA has developed (as cited in White & O’Sullivan, 2012).ConclusionIn answering my clinical question, I sought inquiry and explored to gain more knowledge and awareness on the benefits of Ofirmev. I retrieved relative nursing research articles in several databases using evidence based research and gathered credible evidences and scrutinized them to find information that would further my knowledge and care in the postoperative setting. After analyzing several articles, I have gained knowledge and new information that I can share and collaborate with my colleagues regarding Ofirmev and its nursing implications. ReferencesApfel, C. C., Turan, A., Souza, K., Pergolizzi, J., & Hornuss, C. (2013). Intravenous acetaminophen reduces postoperative nausea and vomiting: A systematic review and meta analysis. PAIN, 677-689. , L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., ... Warren, J. (2007, May). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131.Mazurek Melnyk, B., Fineout- Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010, January). The Seven Steps of Evidence-Based Practice. American Journal of Nursing, 110, 51-53.Melnyk, B. M. (2004, July-August). Integrating levels of evidence into clinical decision-making. Pediatric Nursing, 30(4) 323-5. from , B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott: Williams & Wilikins.Pasero, C., & Stannard, D. (2012, June). The Role of Intervenous Acetaminophen in Acute Pain Management: A Case- illustrated Review. Pain Management Nursing, 13, 107-124. , L. A., & Meinke, S. M. (2011). Ofirmev: A Recently Introduced Drug. Journal of Pediatric Nursing, 26, 494-497. , P. (2014). NURS 350 Class Syllabus. Big Rapids, MI: Ferris State University. White, K. M., & O’Sullivan, A. (2012). The essential guide to nursing practice: Applying ANA’s scope and standards in practice and education. Washington D.C.: American Nurses Association [ANA]. ................
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