NR505: Advance Research Methods: Evidence Based Practice, Study Guides, Projects, Research of Nursing

Download NR505: Advance Research Methods: Evidence Based Practice and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Running head: MSN EVIDENCE-BASED PROJECT PROPOSAL 1 MSN Evidence-based Practice Project Proposal Gwendolyn Bollinger Chamberlain College of Nursing NR505: Advance Research Methods: Evidence Based Practice May 2018 MSN EVIDENCE-BASED PROJECT 2 MSN Evidence-based Project Proposal Nursing research has provided significant knowledge to the nursing practice. It has shaped health care and positively impacted the health of people all over the world by promoting health and healthy lifestyles and by advancing health care quality. Today’s complex health problems require a multiple discipline approach. One of these health problems is the use of opioids to manage chronic pain. Family nurse practitioners will frequently encounter patients who are experiencing acute and or chronic pain and will be required to address this issue. The epidemic of opioid use and overdoses, practitioners are looking for alternatives for managing pain. This public health crisis has motived this writer to research the effects physical therapy has on patient’s who experience chronic pain in the hope of discovering that prescription pain medication can be reduced. It is necessary that all efforts are made to seek alternative options for pain management to increase patient’s functional ability, reduce pain, and improve outcomes. This paper will discuss research and evidence-based practice, identify a nursing concern, review PICOT/PICo questions, theoretical framework of evidence-based proposal, review research literature, research approach, design, sampling, and proposed implementation with a change model. Overview of Evidenced-Based Practice Project Zimmerman (2017) explains that evidence-based practice or EBP, is when clinical research is incorporated into the nursing practice to provide the best and most up to date nursing care possible. Evidence-based practices eliminates practices based on traditional and folklore approaches. It is a comprehensive process by which information is drawn from clinical experiences and other research which has been tested, studied, evaluated, and utilized to benefit MSN EVIDENCE-BASED PROJECT 5 years. The quantity of pain medications prescribed since 1999 has nearly quadrupled, yet American’s haven’t reported overall an increase of the amount of pain they feel. Cultural beliefs about pain can influence the change in pain management. The American culture tends to want what they want now. If they are in pain, the quicker they can get out of it the better. A pill can help to control their pain in less than an hour, where physical therapy, acupuncture and meditation take effort on the patient’s part and can lead to long-term pain management and may take months to master. We are reminded that if a patient gave low marks in the Press Ganey patient satisfaction survey that it could affect the hospital financially, so nurses and physicians administer and prescribe pain medication because it is a quick fix to the immediate problem and makes patient’s happy. However, pain medications are not frequently discontinued, patient education, and the lack of alternative pain control contributes to the long- term pain medication use, addiction, and the current opioid crisis in America. Changing the mentality at hospitals on pain management and patient education can both be an effective approach to the over prescribing of pain medication. Modify thinking from, “We are not a drug rehab” and “Just make the patient’s happy” to asking what is best for the patient currently and the asking why. Once the acute phase of pain is over the implementation of alternate pain control may help reduce long term narcotic and opioid use. A qualitative study was conducted regarding the perspectives of providers and patients on opioids and alternative treatments to manage chronic pain. Penney et al. BMC Family Practice (2016) suggests that educating patients on realistic expectations for pain management along with therapy options may lead to increased patient and provider satisfaction. This writer’s area of focus will be related to opioid use and chronic pain management. MSN EVIDENCE-BASED PROJECT 6 The quantitative approach will be used for this evidence-based project proposal. The reason this approach is the best one to provide information for my area of interest is because it is problem and knowledge focused. It can be used to focus on a specific population's and change standards of care to help improve patient outcomes. The purpose statement for this EBP proposal is: are there a more effective therapies then oral pain medication for adults over the age of 65 suffering from chronic pain? PICOT/PICo Question and Literature Search The PICOT questions for this quantitative research approach is: In patient's over the age of 65 who have chronic pain, how does alternative pain management therapies compared to oral pain medications affect quality of life over 6 months? The expected outcome from this research is that many patients would positively benefit from alternative pain management therapies and would not require pain medications to control their pain. This discovery would increase patient’s quality of life, lead to a decrease in patient medication expenses, and reduce the number of patient who have opioid prescriptions. To determine if there are effective therapies which help patients reduce their pain without requiring pain medication, a literature review is necessary. Badenhorst, (2018) explains that a literature review involves a selection of sources, critical reading, extracting from the texts, and citing sources in the review. The literature review will help this writer to evaluate articles, identify research limitations, and recognize future research recommendations on this research topic. Collecting information about this research topic will ensure that the topic has not already been thoroughly researched. It will also help to justify an explanation which has been based on empirical result. MSN EVIDENCE-BASED PROJECT 7 This writer used several library databased and key search terms and phrases during the writing of this proposal. Library databased which were used are: AHRQ’s National Guideline Clearinghouse, CINAHL Complete, Medline Complete ProQuest Health Research Premium Collection, and the Joanna Briggs Institute. The key search terms and phrases used were: chronic pain, pain management, opioid addiction, and literature review. The minor search terms and phrases used were: addicted America, theoretical framework, and county health rankings. There are specialty organization such as the American Academy of Pain Medicine and the Society for Pain Practice Medicine which are relevant to this proposal. Theoretical Framework The theoretical framework to be use in this EBP proposal is Roy Adaptation Model. This model has five main concepts of nursing theory: the person, the nurse, the adaptation, the environment, and the health. The core concept of this framework is adaptation and the person is responsive to internal and external stimuli. This EBP proposal will use Roy’s Adaptation Model as a conceptual framework to investigate the relationship between chronic pain and the management of that pain to answer the research question. Research Literature Support PICOT statement: In patient's over the age of 19 who experience chronic non-cancer pain and take opioid pain medications for pain control, can non-pharmacological alternatives help to decrease the need for oral pain medications within 3 months? Klapwijk, Mathijssen, Van Egmond, Verbeek, & Vehmeijer, (2017) describes a prospective cohort study regarding the patient’s experiences during the first 6 weeks after having total hip arthroplasty (THA) using the fast-track protocols. The purpose of this study was to examine the first 6 weeks after having THA after discharge. The study design that was used was MSN EVIDENCE-BASED PROJECT 1 RA may be affected by several factors and the true effectiveness of the studied agent is hard to determine. Bid, Soni, Yadav, & Rathod (2017) describe the likelihood of the existence of central sensitization among chronic non-specific low back pain patients (CNSLBP). The purpose of this study is to compare the effects of McKenzie exercise program (MEP) and Conventional physiotherapy programs (CPP) to determine if any differences of outcomes occur. The study design that was used was a qualitative single-blind randomized control approach that utilized a simple sampling approach to recruit participants from a hospital that had CNSLBP for three months or longer, back pain did not radiate, and there were no deficits in neurological or lumbosacral sensory functions. Data was collected from assessment based on eight outcome measures, and were screened for errors, assumptions, and variances to ensure accuracy. Two different multivariance measurements were conducted to ensure accurate statistical findings. The results of the analysis indicated that in terms of pain relief, the experimental group showed better recovery compared to the conventional therapy group but did not do as well on their central sensitization score. This study supports that the McKenzi exercise program can be beneficial in the reduction of pain, central sensitization, and increasing function ability. The strength of this study is the qualitative design, which provided insight to how the two therapy approaches compared to each other. The limitation of this study that Bid, Soni, Yadav, & Rathod (2017) discuss is that the participants were selected form a single institution which limits the findings in this study and that having a more diverse sample may have provided different perspectives related to each therapy. Min-Yeong, Kyoung, Beom-Young, & Chan-Woo (2015), describes that one of the most common diseases experienced by modern society is lower back pain and the number of MSN EVIDENCE-BASED PROJECT 1 incidences is increasing. The purpose of this study is to determine if pain, balance, and stabilization of the lower back can be improved through thoracic mobilization along with lumber stabilizing exercises. The study design what was used was a qualitative approach which used simple sampling technique to recruit participants with chronic lower back pain lasting longer than 12 weeks. Data was collected from the visual analog scale assessment of pain, lumbar length, balance index, and X-ray inspection at the beginning and after the study was completed. The results of the analysis indicated that utilizing lumbar stabilization exercises along with thoracic mobilizations had superior effects on stabilization of the lumbar region, pain relief and enhanced function in these participants with chronic lower back pain. The strength of this study was the study provided evidence that traditional physiotherapy was not able to reduce abnormal movements of the unstable segments in the lumbar spine compared to the lumbar stabilization exercises. The limitation of this study that Min-Yeong, Kyoung, Beom-Young, & Chan-Woo (2015) discuss is the limited number of participants which were selected to participate in the study which limits the findings of this study and that having a larger selection may have provided significant data related. Nielsen, Campbell, Peacock, Smith, Bruno, Hall, & ... Degenhardt, (2016) describe adverse side-effects, risks of misuse, dependence, and long-term efficacy related to opioid use in patients with chronic non-cancer pain. The purpose of this study is to review the use of non- medication pain therapies, examine barriers which limit access to non-medication therapies, and look at the use of non-medication-based treatments form pain used by the participants. The study design what was used was a qualitative prospective approach that utilized a cohort sampling technique to recruit participants through 1868 pharmacies who had been prescribed pharmaceutical opioids for non-cancer pain. Data was collected during telephone interviews, MSN EVIDENCE-BASED PROJECT 1 self-completed surveys and medication diaries which was statistically analyzed and tested to see if factors such as gender, income, health insurance, and age were a factor to determine what barriers were present. The results of the analysis indicated that non-opioid treatments were used prior to and after the use of opioids, indicating that the sample of participants did not use opioids as their main pain management. This study also revealed that only 16% of the participants accessed physiotherapy and only 15% saw medical and/or pain specialists. It also exposed that the higher opioid doses were linked to increased financial and access barriers to alternative treatments as well as being a young female with private insurance. The strength of this study is the large number of participants involved. This allows for the study to be a more accurate representation of the general population. The limitation of this study discussed by Nielsen, Campbell, Peacock, Smith, Bruno, Hall, & ... Degenhardt, (2016) is the study did not explore patient’s beliefs regarding different treatment approaches along with other barriers which may have been missed during this study. It also relied on self-reporting of access to health services which may not accurately indicate the number of services utilized. Burgess, Gravely, Nelson, Bair, Kerns, Higgins, & ... Partin, (2016) describes that numerous studies have revealed the racial disparities between blacks and whites experiencing chronic pain and the concern about blacks being undertreated due to lack of prescribed pain medication. The purpose of this study is to examine the pain outcomes among patient’s being treated for chronic pain at the Veterans Affairs (VA) vary by race and if opioid prescriptions are limited by these relationships. The study design that was used was a qualitative retrospective cohort study that utilized survey data from the 2007 VA Survey of Healthcare Experiences of Patients and from the VA National Patient Care Database to mail surveys for data collection purposes to individuals who had a new diagnosis of pain without having received an opioid MSN EVIDENCE-BASED PROJECT 1 interests and barriers to alternative pain medication without pharmacological use. The use of a grounded theory-informed approach was used to analyze some stages of the study. Other stages used multiple readers and transcripts were viewed a second time to identify key data which emerged from the study. The results of the analysis indicated that veteran’s perceived pain controlled all aspects of their life, they depended on opioids and experienced challenges in obtaining them, there is limited access to and poor beliefs related to non-pharmacological therapies, unsatisfied outcomes were also a theme among the participants, as well as the lack of social support due to inadequate interest in peer support. The strength of this study is the use of the qualitative study design, which examined perceptions and beliefs for patient’s experiencing chronic pain and non-pharmaceutical treatment of that pain. The limitations of this study that Simmonds, Finley, Vale, Pugh, & Turner (2015) discuss is the small sample size and participants were selected from only one institution which limits the findings of the study and that having more participants from different areas of the United States may have provided different perspectives. Silva, Melo, Amaral, Caldas, Pinheiro, Abreu & Vieira, (2015), describe osteoarthritis as a degenerative joint disease, which is especially common in the elderly, causing pain and disability. The purpose of this study was to explore the effects that an evidence-based exercise program has on pain and quality of life for patient’s suffering from osteoarthritis. The study design that was used was a qualitative single-center, single-blind approach which utilized a randomized sampling technique to recruit patients with moderate to very severe knee pain related to osteoarthritis. Rheumatologists referred patients on stable doses of anti-inflammatory medications who had experienced pain around the knee in the last year. Data was collected from multiple assessments which were conducted at different times and analyzed by covariance MSN EVIDENCE-BASED PROJECT 1 (ANCOVA) which worked well since there were participants which dropped out of the study. The results of the analysis indicated the rehabilitation program was effective in improving pain control, quality of life, and functional ability. These results provided significant data which reflected that exercise is an important component when it comes to non-pharmacological treatments for patients experiencing pain from osteoarthritis. The strength of this study is the qualitative design, which provided insight to the importance exercise and a self-management program is those with osteoarthritis of the knee. The limitation of this study that Silva, Melo, Amaral, Caldas, Pinheiro, Abreu & Vieira, (2015) discuss is the short duration of the study since know osteoarthritis is a progressive disease and all participants, maintained function level over the course of the study which limits the findings of this study and that having a study longer in duration may have provided additional insight. Research Approach and Design The quantitative approach will be used for this evidence-based project proposal. The reason this approach is the best one to provide information for this writer’s area of interest is because it is problem and knowledge focused. It can be used to focus on a specific population's and change standards of care to help improve patient outcomes. The design used in this study with be quasi-experimental since participants will not randomly be assigned to groups and placed into either the control group of the experimental group. Flannelly & Jankowski discuss the importance of ethics when using this design especially when using humans as subjects (2014). Some studies in the past have discovered significant data during the study, which could alter a patient’s health. This is one area in which ethics need to be taken into consideration and the best outcome for all participants involved. One advantage of using the experimental design is that there is a comparison group with allows for comparison of results from the intervention group to MSN EVIDENCE-BASED PROJECT 1 the control group and provides strong evidence for the study. One limitation to this design is the lack of randomization among the entire population, which means variables and/or bias could be present. Sampling The target population for this research will be adults at least 19 years of age who have been diagnosed with chronic non-cancer pain and have been on opioid pain medications for greater then three months. By randomly selecting patient experiencing pain from different hospitals and offices from different ethnic/racial groups will ensure a probability sample. Participants will be selected using a stratified random sampling technique. Cook and Cook (2017), explains that this type of random sampling from subgroups within a population accurately reflects the population along specific characteristics. Sample size will be dependent on a statistical test call power analysis to determine the optimum number of participants. All participants are required to be at least 19 years of age, have been diagnosed with chronic non- cancer pain, have been prescribed an oral opioid pain medication for greater then 3 months, and have no evidence of neurological deficits. Exclusion criteria will be a diagnosis of substance abuse. One advantage of using this selected sample is the targeted population and the possibility of determining alternatives to opioid pain medication. One disadvantage to the selected sampling is that lack of randomization, which would could lead to bias and may not truly reflect the general population. Participant’s rights will be protected by providing each participant with full disclosure of the study and allowing them to refuse participation if not interested. Informed consent will be obtained from each participant which will provide information about the study, the potential risks and benefits of the research, that participants understand the information provided, that the MSN EVIDENCE-BASED PROJECT 2 Data Collection The overall study will involve four baseline assessments, an initial assessment, a six-week assessment, a twelve-week assessment, and then one annual. Baseline measures used in this study include self-report and close-ended questionnaires. Baseline assessment with be paired t tests to one another to see what impact therapy has on pain, quality of life, and functional ability. In terms of self-reports, participants will complete an online questionnaire that asks questions about background characteristics such as age, gender, height, weight, medication use, and where they rate their pain on a 0-10 numeric pain intensity scale. Gnambs, & Kaspar (2017), clarifies that unproctored assessments do not reduce social desirability distortions in self-report questionnaires, there for participants will be able to choose the location in which they take the self-reported assessments. Careful wording on the questionnaire is necessary for clarity and absence of biases. The Likert-type scale will be utilized with the closed-ended questionnaire. Eutsler & Lang (2015), explains that labeling all points on the scale helps to minimize bias, variance, and maximized the power of questionnaires. The close-ended questionnaires will be used to gain statistical data for analysis and subscales will be used to measure different aspects which will enhance data quality. Analysis Descriptive statistics describe features of data collected in a study by providing simple summaries describing the sample and the measurements. Each descriptive statistic reduces many discrete events, into a summary making it easy to understand, however it does have the potential to distort data and/or lose important details. Since multiple assessments will be obtained at different times, simplifying the amount of data collected, allows for easy comparisons of different assessments and provides a powerful summary of the data collected. By producing a MSN EVIDENCE-BASED PROJECT 2 descriptive index from a sample, such as percentage of pain reduction reported in this research, it provides a statistic. Inferential statistics are based on the laws of probability and can provide implications about a population given the data the sample provided. Making judgment of the probability that an observed difference between groups, such as the outcome of obese patients compared to those who are in a healthy weight limit, maybe used to infer the outcome from the general population in terms of their weight. Raebel, Newcomer, Reifler, Boudreau, Elliott, DeBar, & ... Bayliss, (2013) explain that obesity is associated with chronic noncancer pain and there is a need for improved pain management for this population even after bariatric surgery. By using inferential statistics in this study may provide insight for better pain management in the obese population. Evaluation This evidence-based project proposal has the potentially improve patient long-term pain management outcomes by discovering the effects that physical therapy has on patients who are experiencing chronic noncancer pain. If this study did show clinical significance in the decrease need for opioid pain medication when physical therapy was implemented, an effective alternative pain management program can be implemented. By reducing oral pain medication management, patients will have an increase satisfaction in the care they receive, an increase in quality of life, and a decrease in out of pocket expenses. Clinicians will have alternatives to pain management other than prescription pain medications which will in turn increase patient satisfaction and positive outcomes. Changes to the nursing practice which may result from this study is the hospital culture where a pain pill or intravenous pain medication is administered before alternative pain management options have been explored. Education on pain management for nursing staff would MSN EVIDENCE-BASED PROJECT 2 help to improve awareness to alternative pain management options, such as repositioning, using heat and cold packs, getting out of bed, and ambulating in the halls. If nurses would educate and encourage patients to find alternatives for pain management and use the the minimum amount of pain medications to find a controlled pain level. Discontinuation of pain medication once the acute pain phase is over instead of continuing pain medication when it is no longer required, is another change which would improve the nursing practice. This would require collaboration with practitioners and physicians if a new standard of care should be put into place. Dissemination of Results Publishing results from the research in an article or medical journal would allow others to view and review the findings. The evidence can be provided to nursing and other clinical staff to encourage new thinking an alter the culture of thinking that pain medication is the only pain control. Utilizing mentors for staff that need assistance in discovering adequate pain control for their patients can help guide new practice techniques rather then using traditional methods. Providing patients and families educational material would also allow them to understand appropriate use of pain medication and the risks and benefits which are associated with them. Patients and families also need to be education on the 0-10 pain scale and what a 10 truly represents. Assisting patient’s in determining what is a manageable pain level and what alternative options they should try prior to pain medications can increase awareness and encourage alternate pain management behaviors. When it comes to state and national levels the researcher can seek out a policy maker and explain the issue and the results of the study. Researching policymakers and their rules in the community and government is necessary to discovering who the appropriate policymaker the concern should be addressed with. Establishing early contact and building a professional relationship benefits all parties involved. By knowing and understanding what community resources are out there and what is not MSN EVIDENCE-BASED PROJECT 2 References Badenhorst, C. (2018). Citation Practices of Postgraduate Students Writing Literature Reviews. London Review Of Education, 16(1), 121-135. Bee, P., McBeth, J., MacFarlane, G. J., & Lovell, K. (2016). 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