Integrated Research Report

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Integrated Research Report

• Nursing 335 Introduction to
• Nursing Research
• Laura Tipton

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Topic of Interest

• PICO Question - In Post-op cardiac/thoracic
  patients, what is the effect of pharmacologic
  interventions compared with non pharmacologic
  interventions?
• This topic is significant to my own nursing
  practice. I work on a cardiac step down unit.
  When patients are coming out of chest/thoracic
  surgery they all have pain of some degree. Some
  people are hesitant about using pharmacologic
  pain control and I wanted to become educated on
  this because it is so important for breathing,
  activity, and healing to have good pain
  management post chest/thoracic surgery.

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Article 1 Summary

• Research Question To discuss/investigate the
  pain after a thoracotomy and what relieves it.
• Variables
• Independent Pressure on surgical site, activity,
  talking about pain
• Dependent - Pain Relief
• Subjects/ParticipantsConsent was obtained by the
  Akdeniz University and the University gave
  permission for the study to take place.
  Participants volunteered to participate. 70
  patients who underwent a thoracotomy, 68 of
  patients were male with the mean age of 49.9.
  They all received there surgery at Akdeniz
  University Hospital between November 2007 to
  November 2008. The mean duration of their
  surgeries was 90 minutes. The patients chosen
  were extubated without complication 2-3 hours
  after surgery.

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Article 1 Summary

• Research Design Quantitative
• Data Collection The Behavioral Scale filled out
  by the researcher
• The factors used were blood pressure, heart
  rate, O2 sat, and body temperature.
•  
• Verbal Category Scale patient discusses their
  pain
•  
• Each tool was tested and now is used in hospitals
  for assessing pain.

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Article 1 Summary

• Results There were marked increases in blood
  pressure and heart rate following surgery. The
  patients stated pain was the worst 2 hours
  following surgery with a marked decrease in pain
  the 48th hour following surgery. Factors that
  increased pain were movement, walking, position
  changes, coughing, and chest tube movement.
  Factors that relieved pain that received the
  greatest scores were drugs and position. Both
  pharmacologic and non pharmacologic interventions
  were noted to increase and decrease pain.
• Answer to Questions Both pharmacologic and non
  pharmacologic interventions were noted to
  increase and decrease pain. Sharp, stabbing, and
  throbbing pain was described following a
  thoracotomy.
• Threats Patients changing their response because
  they are being studied. The time frame when the
  data collection is taken. If the data is not
  taken say for instance the same time after a drug
  is given pain can be different for anyone.

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Article 1 Summary

• Conclusion Conclusion is that pain following a
  thoracotomy is intense and one of the most
  intense pain there is following any surgery
  because of what goes on during the procedure.
  Ribs are separated and nerves are cut, the chest
  tube can limit the movement of the diaphragm
  making breathing difficult. Immobilization is a
  huge concern for patients in the post op phase
  and this research study evaluated what
  interventions and activities can help with the
  pain
• Recommendations Talking to a health
  professional, changing position, receiving drugs
  before moving, creating a calm and quiet
  environment, and using pressure on thoracotomy
  site are all interventions for post op pain
  relief.
• Limitations Limitations were not noted in the
  research study. There could include the area and
  population tested. Pain threshold of each
  patient. The atmosphere would be different for
  each patient and their experiences would all be
  different. A huge limitation would include if
  there was existing pain before surgery for each
  patient

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Article 2 Summary

• Research Question The ability of critical care
  nurses to assess pain and promote pain relief.
• Variables
• Independent Critical care nurses knowledge and
  ability to treat pain, their techniques and views
  
• Dependent -Pain relief in post op patients
• Subjects/Participants Participants were
  volunteers and were encouraged to talk about
  their experiences. The head nurse of the ICU sent
  out 7 requests with critical care nurses and 6
  replied back they were interested and signed
  consent forms.
•  
• Ages were 31-48 years old and median years of
  experience was 12.

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Article 2 Summary

• Research Design Qualitative design
• Data Collection The data was collected through a
  private interview with each nurse. The interviews
  lasted 20-70 minutes. There was a questionnaire
  that was a guide to the interview. The nurses
  were asked to expand on their experiences with
  assessing, treating, and evaluating pain in
  post-op patients. How they felt about pain, about
  their relationships with patients, and how they
  felt about treating pain. This tool is reliable
  for a qualitative research design. The more
  quality in answers the better

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Article 2 Summary

• Results The results indicated that a good
  relationship is essential to treat pain, trust
  has to be in between nurse, patient, and doctor,
  nurse needs to see the patients experience as one
  of a kind, and that drugs is not effective alone
  in treating pain.
• Answer to Questions Critical care nurses use
  their Visual Scale and assessing abilities to
  treat post op pain. Pharmacology is definitely
  not the only intervention the nurses used. The
  importance landed on having a good relationship
  with the patient and using good communication
  about pain and treatment.
•  
• First choice of drug was morphine, it has been
  tested and viewed as effective. If that did not
  work on to the next and then a call to the doctor
  if pain is not relieved.
•  
• Older patients tend to not be able to communicate
  their pain effectively and the nurses have to use
  their assessment skills to help the patient relax
  and maybe use new positions to help them.

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Article 2 Summary

• Conclusion Conclusion is that critical care
  nurses use analgesics for pain treatment as
  number one and that there is not enough time for
  non pharmacologic interventions.
• Recommendations The need for nurses to be
  competent in treating pain because it means
  shorter hospital stays and a better well being.
• Threats Could be the nurses feeling like they
  have to answer a certain way for the research
  report to reflect what they feel it should
  reflect.
• Limitations Limitations included in the article
  were that only 6 nurses were interviewed.

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Article 3 Summary

• Research Question To assess what nurses
  knowledge is when it comes to patient education
  for post op pain relief.
• Variables
• Independent Nurses knowledge of pain
• Dependent - Patients knowledge on post op pain
• Subjects/Participants Subjects were full time
  nurses in a large university affiliated hospital
  in Toronto Canada.
•  
• 22 nurses were interviewed form 40-50 minutes
  with a interviewer.

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Article 3 Summary

• Research Design A descriptive qualitative design
• Data Collection The pain belief scale used to
  assess nurses and nursing students beliefs and
  conceptions on pain. Nurses were to answer
  true/false/unsure for each question. 20 total.
  Possible points 20.

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Article 3 Summary

• Results The finding was that the mean score for
  the pan belief scale for nurses was a 14. One of
  the problem areas was the belief that 1
  intervention at a time works best. This was a
  false statement that many got wrong.
•  There was a misbelief that the younger
  population had more pain because they used more
  medication for pain and that the older population
  had less pain because they did not request has
  much pain medication.
• Answer to Questions There is a knowledge deficit
  for post op cardiac nurses for pain and pain
  management.

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Article 3 Summary

• Threats The study was done in Canada, education
  can be different and monitored differently. One
  hospital may have different policy/procedures
  than other hospitals.
• Recommendations The need for continuing
  education for cardiac nurses about post op pain
  and when to educate our patients.
• Limitations Limitations included that there was
  only 2 wards of the hospital interviewed that
  could affect the results. The strength was it was
  close to real life as possible. The nurses
  involved did not know the interviewer and the
  range of experience in nurses was very wide
  making it more real life as well.

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Article 4 Summary

• Research Question Will massage offer pain relief
  for thoracic surgery patients post op?
• Variables
• Independent massage
• Dependent - pain relief
• Subjects/Participants 160 participants were
  given a massage post thoracic surgery. Nurses
  identified with the massage therapist what kind
  of pain they were having and a therapist gave 4
  massages in the morning to have direct feedback
  to the doctors rounding.

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Article 4 Summary

• Research Design Quantitative
• Data Collection Patients were asked to rate
  their pain 1-10 pre and post massage.

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Article 4 Summary

• Results The decrease in pain was around -3.4
  after the massage. If a patient was asleep or
  somber they would skip asking the question
  because they were pain free.
•  
• Massage helped decrease pain and anxiety in post
  thoracic patients.
• Answer to Questions Massage decreases pain in
  thoracic surgery patients
• Conclusion No limitations were noted .Conclusion
  made were that massage will benefit this
  population of patients. There was a marked
  decrease in pain and anxiety.

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Article 4 Summary

• Recommendations Hospitals to start using
  massages for this patient population.
• Threats Only identifying patients that had
  relief. Not being able to massage patients who
  could not even move because they had so much
  pain.

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Conclusions from Research

• Post op chest/thoracic patients always have some
  degree of pain. Patients may not be educated on
  post op pain and not know how important it is to
  manage pain. This can lead to shallow
  respirations, less activity, and impaired gas
  exchange. It is very important after this kind of
  surgery to get moving after, lungs need exercised
  and strength to return to the body.
• Prior to surgery patients need educated on what
  pain is going to be like and how we are going to
  help manage it. Everyone has pain no matter the
  age of the patient. As nurses our job is to
  assess the patients pain and help manage it
  pharmacologically or not. Some patients may have
  never taken pain medication and need extra
  education on them.
• Nurses can use both pharmacologic and non
  pharmacologic interventions for pain but some
  times there not be enough time to sit down and
  try both.

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References

• EFFECT OF MASSAGE ON PAIN MANAGEMENT FOR THORACIC
  SURGERY PATIENTS. (2011). SportEX Dynamics, (30),
  5.
• Kol, E., Erdogan, A., Karsli, B. (2012). Nature
  and intensity of the pain following thoracotomy.
  International Journal Of Nursing Practice, 18(1),
  84-90. doi10.1111/j.1440-172X.2011.
• Lindberg, J., Engström, Å. (2011). Critical
  Care Nurses' Experiences A Good Relationship
  with the Patient is a Prerequisite for Successful
  Pain Relief Management. Pain Management Nursing,
  12(3), 163-172. doi10.1016/j.pmn.2010.03.009
• Leegaard, M., Watt-Watson, J., McGillion, M.,
  Costello, J., Elgie-Watson, J., Partridge, K.
  (2011). Nurses' educational needs for pain
  management of post-cardiac surgery patients. A
  qualitative study. Journal Of Cardiovascular
  Nursing, 26(4), 312-320.