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Research to Improve Pain Control for Cesarean Section PatientsChristian MerzFerris State UniversityAbstractThis paper will use the format of a PICOT to address cesarean section post surgical pain levels and identify interventions that are currently being used. The author will reflect on the written articles and conclude if they are a credible source of research that supports a nursing evidenced based practice. This paper will also include the importance of communication within the profession and identify the availability of resources to nurses. PICO ResearchThe purpose of this assignment is to “interpret research findings and use evidence-based research to support nursing decisions” (Ferris State University, 2013, p 11). Nursing is not a collection of skills. Nursing is a profession that is forever advancing as evidence based practice transforms in the fast changing health care system. The profession has developed over time through theories, research and not solely based on traditions passed down from generation to generation. All nurses should have accesses to new research knowledge to make informed, sound, decisions related to patient care. PICO Question As a Registered Nurse (RN) working in the hospital setting of the Obstetrics Department it is my responsibility to improve patient experiences and provide safe care. Having a baby is a wonderful experience a woman can endure. There are a number of ways a woman can give birth that include spontaneous vaginal delivers, induced vaginal deliveries, augmentation, and cesarean sections. Depending on how the delivery goes some women feel a lot of pain or discomfort after a deliver. Cesarean sections are either scheduled or occur when it is not safe for the newborn to be delivered vaginally. Cesarean sections are considered a major surgical procedure that includes making an incision through the abdomen wall and commonly followed by post surgical pain. If the mother is experiencing uncontrolled postsurgical pain, her experience can be crushed and she may not be able to bond with her newborn. The PICO question developed states “ Will a patient using a controlled analgesia pump (PCA) provide better pain control versus oral pain medication to cesarean section post surgical patients” (Merz, 2014).Research also provides a way for nursing to formulate questions and problems related to an area of specialty that can provide competent, safe care. Nurses use a structured outline to formulate problem statements. Developed by Fineout-Overhoult and Johnson (2005), a five letter acronym PICOT is used and stands for patient or population, intervention or interest area, comparison intervention or current practice, outcome desired, and time to achieve outcome (Nieswiadomy, 2012, p 282). The PICOT format is a systematic, consistent way to identify problems with nursing skills and patient care. When researching the clinical data related to the PICOT question, it was identified that the question needed to be reconstructed to include a specific patient population that was being addressed. This included post surgical cesarean section patients and not a generalized group of post surgical patients. It is important that a patient has good pain control after surgery. Persistent uncontrolled postoperative pain can end in negative outcomes that include physical symptoms of tachycardia, hypertension, and decreased ventilation. Uncontrolled postoperative pain can also affect mental status that can include depression, anxiety, and unpleasant experiences. As nurses of the Obstetrics Department it is important for nurses to improve patient outcomes so patients can have an enjoyable birthing experience. MethodologyIt is important that nurses can locate research articles related to subjects and topics that interest them. There are numerous resources that can be used when researching literature for research articles. One common resources used includes nursing journals. Major nursing journals publish research data related to a nursing specialty or nursing research.Locating research can be obtained through data bases located on the internet. Many nurses use the internet instead of hard copy journals because it is easy and fast to access. The internet provides a remarkable amount of data although not all data provide is accurate and reliable sources. CINAHL, Cochrane Review, AHRQ and PUBMED are reliable data bases sources used to research information to the stated PICOT question defined within this paper. The CINAHL research data based produced two out of nine articles that were related to PCA usage to improve patient satisfaction with nursing care. The PUBMED database provided two out of nine articles were found based on outcomes of early oral analgesia in post surgical patients. The third data base included the AHRQ that provided one out of seven articles that were found on PCA pain management and nursing interventions. The last database use included the Cochrane reviews which include three out of ten articles on the topic of PCA versus conventional opioid analgesia. The data obtained from the first research setting displayed that further data was needed to conclude evidence to provide improved patient care.Discussion of LiteratureData can be placed into groups depending on the variables and quality that it displays. Determining the level of measurement is important for nurses to understand what level of measurement the data is displaying because it provides a the reader with the knowledge if the research is considered quality or not. There are six levels to the hierarchy of evidence for nursing intervention studies. Level one is the highest level of evidence that include systematic reviews from all relevant controlled trials and level six includes studies that include opinion of expert committees(Organ Health & Science University, n.d) Article OneArticle ones title is “Pain management after cesarean: A randomized controlled trial of oxycodone versus intravenous piritramide”. This study was provided by the American Journal of Obstetrics and Gynecology. The study was a randomized controlled trial that included two hundred thirty nine patients that agreed to the study. Patients were randomly selected to follow a designated care plan that includes intravenous pirritamide PCA or oral oxycodone. The tool to assess pain level included the visual analog pain scale at scheduled times after the cesarean. The results showed that general satisfactions with both treatment regimes were high and there should be a multimodal approach to treating post-cesarean pain (Dieterich et al., p 859). According to the hierarchy of evidence for nursing intervention studies this article is scored at a level two. This study is a qualitative study and subjects were randomly placed in to a treatment group. A qualitative research focuses on gaining insight about an individual’s perception to an event (Nieswiadomy, 2012, p. 45). This study assess whether oral analgesia is superior to addressing pain control than to patients who used PCA after a performed cesarean section. Limitations identified within this study included pain assessments that were not assessed if patients were sleeping during night time hours. Because the pain assessment was not addressed during the night hours I feel the results could have varied. This research article is a reliable source to nursing research although further research is warranted. Article TwoArticle two title is “Oral Analgesia in the treatment of post-cesarean pain”. This study was provided by the American Journal of Obstetrics and Gynecology. The clinical problem addressed patient satisfaction without oral analgesia following a cesarean section. This study included all women during a three month period that had a cesarean section with epidural analgesia. The tool measured pain levels included the visual analog scale. “A total of one hundred and ninety nine patients were enrolled and following a cesarean section one hundred and nine found oral analgesia satisfactory pain relief”(Jakobi et al, 2000).This article would be placed on a level “3” on hierarchy of evidence for nursing intervention studies. Level “3” includes research that is controlled trial without randomization. The experiment is ran in which subjects are nonrandom assigned to a treatment group (Organ Health & Science University, n.d). Limitations were not clearly stated or addressed within the study. Restrictions among the study included not address ages among the group of primary cesarean sections and not setting a scheduled to when pain levels were assessed. I would advocate using information presented in the article. This article is sensitive to nursing concerns that directly relates to the care provided to patients. Article ThreeArticle three is “Oral analgesia compared with intravenous patient-controlled analgesia for pain after cesarean delivery”. This study was provided by the European journal of Obstetrics & Gynecology and Reproductive Biology. This study was to determine if oral analgesia or PCA devices provide superior analgesia after cesarean delivery. This study included ninety three patients who were randomly assigned to one of the two pain management regimens. The tool used to determine pain control included the Visual analog pain scale zero to ten. This study concluded that patients who used oral analgesia without a PCA experienced less pain in six hours and twenty four hours after a cesarean delivery (Davis et al, 2006). They also concluded that women had less nausea and drowsiness at six hours but slightly more nauseated at twenty four hours (Davis et al, 2006). This research article is considered to be a credible source and is ranked “ two” on the grading scale of research. According to the hierarchy of evidence for nursing intervention the type of evidence included a randomized, controlled trial (Oregon Health & Science University). Level two research is used to answer questions about the effectiveness of a current nursing intervention. This study divides the patients into two groups with two different treatment plans and then compared the results. This study was designed to improve patient outcomes and guide nurses to use appropriate interventions. I feel nurses can use this article in their practice of care.Significance to NursingNurses are required to maintain a professional role and communicate effectively with all members of the heath care team. Communication among nursing is a vital skill to have to advocate appropriately for patients. There are different forms of communication that include nonverbal, verbal, and written communication. Communication is a lifelong learning process and it is necessary to build therapeutic relationships with patients, families and colleges. Through communication we can improve patient safety and the quality of care. The failure to communicate effectually can causes liability issues, decreased patient outcomes, and safety concerns for the patient. Nurses should maintain values of sincerity, integrity, and respect for others. Nurses should be autonomous and assertiveness when communicating new information to provide the highest quality of care.Evidence-based nursing practice means nurses make clinical decisions based on the best research evidence, there clinical expertise, and the health care preference of their patients/clients ( Nieswiadomy, 2012, p. 5). The POCOT question presented addresses concerns of direct patient care to improve quality outcomes. Research findings can provide measureable outcomes to improve cost effective care and determine the effectiveness of an intervention among a specific group of people (Nieswiadomy, 2012, p. 7). A popular resource nurses use to increase their knowledge is a resource located on the internet known as Quality & Safety Education for Nurses (QSEN). The purpose of QSEN institute is to provide nurses with comprehensive, competency based resources to empower them with knowledge, and skills to improve quality across healthcare systems (QSEN, 2014). It is mandatory that nurses continue to expand their knowledge base through research. The American Nursing Association (ANA), Scope of Standards of Practice (2010) states, “the Registered Nurse integrates research findings into practice” (Chitty and Black, 2011, p. 340). All three articles used in the research were creditable sources and related to improve direct patient care. The process of using the PICOT format is a constructive format to intergraded current evidence. Article one “Pain management after cesarean: A randomized controlled trial of oxycodone versus intravenous pirityamide” offered valuable recommendations related to the results of the study. These results concluded that multimodal approach should be used while treating post cesarean pain. The concept “one size fits all” cannot be applied to provide nursing care because people have different cultural backgrounds, values, and beliefs. This information provided in all three articles can be incorporated into nursing care to improve care provided. ReferencesChitty,?K.?K., & Black,?B.?P. (2011). Professional nursing: concepts & challenges (6th?ed.). Maryland Heights, Mo: Saunders/Elsevier. Davis, K., Esposito, M., & Meyer, B. (2006). Oral analgesia compared with intravenous patient-controlled analgesia for pain after cesarean delivery: A randomized controlled trial. American Journal of Obstetrics and Gynecology. 194, (4), 967-971. DOI: , M., Muller-Jordan, K., Stubert, J., Gunther, K., Wagner, K., & Gerber, B., (2012). Pain management after cesarean: A randomized controlled trial of oxycodone versus intravenous piritramide. Journal of Gynecology and Obstetrics. 286, (4), 859-865. DOI: 10.1007/s00404-012-2384-5Ferris State University.(2014). Research in nursing 350 syllabus. Retrieved from , P., Weiner, Z., Solt, I., Alpert, I., Eldor, J.,& Zimmer, E. (2000). Oral Analgesia in the treatment of post-cesarean pain. European Journal of Obstetrics & Gynecology and Reproductive Biology. 93, (1), 61-64. DOI: (00)00256-6Merz, C. L., (2014). Ferris State University PICO Worksheet. Retrieved from Health & Science Univeristy. (n.d). Hierarchy of Evidence for Nursing Intervention Studies. Retrieved from URL: Institute. (2014). About QSEN- The new QSEN. Retrieved from ................
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