Managing Pain in Acute Illness: Research Paper Analysis Assessment 2 Answer

INTRODUCTION

Pain is one of the main symptoms for which an individual seek healthcare assistance. Within the healthcare settings, many disciplines and individuals are responsible for the management of pain. However, it cannot be denied that nurses play a vital role when it comes to the assessment, evaluation and management of pain. In an individual acute pain can lead to negative psychological and physiological implications which if not addressed in time may develop into chronic syndromes. There are several barriers within a clinical setting which may affect the positive outcomes of inpatient care. These may include deficits of the knowledge, failure in assessment, and lack of management principle knowledge with communication difficulties. This leads to potential lower optimal patient outcome in terms of quality of patient care. The purpose of this paper is to critically evaluate three published research study done with the aim of “knowledge assessment and management of pain and the role of nurses in it”. Further, the strengths and drawbacks of the study were purposed to be identified under various sections to conclude the validity of the subject topic and studies both.

Research study- Assessment and Management of Postoperative Pain among Nurses at a Resource-Constraint Teaching Hospital in Ghana by Mahama & Ninnoni, 2019

Authorship

In a research study or academic publications, authorship is claimed by individuals who have an intellectual contribution from the beginning to the completion of research work. The author is the one who takes all the public responsibility of the entire study, these responsibilities are for attaining data privacy of the respondent, interpretation and genuineness of the result. The author has to look into the matters other than research study itself including the acquisition of funds, laboratory support, administrative need and supervision of the work (Tarkang et al, 2017).

The study has two authors Faisal Mahama the primary author of the research article is associated with Nursing and midwifery training college, department of Nursing.

The other author Jerry P.K Ninnoni is associated with Department of mental health, school of nursing and midwifery. Both of these authors have a background of closely observing nurses and have the relevant qualification for the study. The author has also mentioned no conflict of interest regarding the publication of this paper. The author has also declared the paper to be funded itself hence validating and authenticating the authorship ( Picardi, 2016).

Aim/Hypothesis/research Question 

Pain is one of the greatest concerns among patients in the hospital settings and nurses plays crucial role in pain management as well as Assessment in post-operative cases. Aims and objective of the study is mentioned by the author stating “to study and analyse the knowledge of nurses in the assessment and management of the pain”. The author also mentioned postoperative acute pain as a major health issue currently in his country. He also mentioned studies that have been largely done on pain assessment by nurses but only restricted to HIV/AIDS and Cancer hence author identified a gap that existed in the area of research regarding the understanding of nurse’s assessment and management of post operating acute pain. 

The author has clearly stated the need for the study and identification of the gap in the current study but he fails to support this through an evidence-based strategy. In discussion and introduction need and gap of the research studies are not supported by a systematic review of past studies. The author has mentioned only 3 to 4 studies depicting past researches in the subject area hence validity and arguments on needs and gap of the study falls short by the author.

The author also states that study explores the understanding of nurses with pain assessment and management in post-operative pain in Ghana, the statement of the author indicates towards the hypothesis of the study however has not mentioned evidently.          

Research Design

The author has used qualitative design for the research study as the study was intended to explore the practices of nurses in the postoperative setup. Also to introspect the knowledge and management in nurses hence selection of studies seems justified. Qualitative research is a systematic process which is exclusively used for connecting the object to information regarding the subject and materials (Hannigan, 2018).

Although the choice of the qualitative research by the authors might be correct due to the selection of small sample size which is focused over a small area but for the qualitative study interpretation of findings could be difficult. This is because the data collected in qualitative research is difficult to be analysed based on statistical technique through a quantifiable method. As there are no commonalities among the identified variables, the process of statistical analysis becomes difficult in a qualitative design.

Research Methods

The study was conducted in a teaching hospital with a bed capacity of 2000 patients. The author states that it is the third-largest hospital in the area however he feels managing patient flow with study and logistics management was a challenge. The number of nurses was 1324; the technique used for the selection of participants in the study was the purposive sampling technique. The selection of the sample was based on the judgement of the author based on the peculiar characteristics of the participants. However, the selection of participants was not scientific but the author tries to diversify it by including the nurses with various experiences in the surgical intensive care unit of hospitals. The author has mentioned exclusion and inclusion criteria however it seems broader. In the end, only 12 nurses data was collected which could be a drawback for the study as a smaller sample size may interfere with the value of the result of the study.

The researcher interviewed with the nurses within the premises of the hospital which could create the pressure over the nurses and their privacy resulting in the biased responses. Written consents have been taking taken from all the participants which were a positive step.

The author has not given any details regarding the number and nature of the questions asked. But the author has mentioned that open-ended questions were asked from the respondent where the non-judgemental approach has been utilised. He has also included the observation of verbal and non-verbal body language of nurses during the assessment and management of pain. Data analysis is done by going through the answers of the nurses again and again and establishing the data collection in association with the aim and objective of the study. This is a process where the information from the nurses is collected, identified, differentiated and condensed. However, no statistical method has been used by the author for the data conversion and analysis but is rational due to the compact study sample size.

Results/Limitation of the study

The author has interpreted result under several headings like defining pain, knowledge of postoperative pain, assessment of pain through verbal sign and symptom of patient, facial expression, body language and last management of pain which includes both pharmacological and non-pharmacological management techniques. During his research study author finds inaccuracy of postoperative pain assessment thus resulting in abrupt pain management. The author has also concluded the suffering condition of the surgical patient due to unsatisfactory pain management and the requirement of more evidence-based approaches in learning module for the management of pain. However small sample size with an inadequate systemic review, no description of the questioner and lack of hypothesis in the study may weaken the authenticity of the result. Qualitative approach and sample selection may affect the generalisability of the study in a wider context

Nursing Knowledge and Attitudes toward Pain Management by Craig, 2014

Authorship

The author for the study is Joy Celine A.Craig who is a registered nurse and a student of Masters of Science in Nursing degree. The author has presented the acknowledgement to the principal Sir who is also a registered nurse and DNB. No conflict of interest as mentioned by the author. The author has done the research study within the university Premises with the help of other departments. This helps the author in close understanding of the relationship between the application and learning in terms of the knowledge in pain management by nurses. However, the experience of the author working in an acute ward was not clear.

Aim/Hypothesis/Research Question

In the study, the author has mentioned the purpose of the study, Aim, objective and the problem statement. The author mentions the crucial role of nurses in the management of pain. He also agrees that nurses need to understand the pathophysiology to recognise and manage the pain for the recovery of patients (Viveiros et al, 2018). Hence the author states that the study aims to determine the nurses' knowledge and attitude toward the post-operative pain. The research question has been mentioned by the author as-‘what is the nurse knowledge and attitude regarding pain? While establishing an evidence-based strategy, the author has reviewed various studies present in the subject area from the year 2003 to 2012. The author has discussed various literature that documented the attitude of nurses towards the management and knowledge of pain. The author mentions that literature indicates that nurses were aware of the pain assessment practices but not efficiently and consistently applying them on the clinical practises. This establishes the gap which exists between the practising and education among the nurses.

Research Design

The author has adopted a quantitative research design to observe the difference of the knowledge of pain assessment in clinical practice and its management outrunning to pharmacological treatment. Nurses selected were registered Nurses from medical Centre. The subjects were selected on the basis type of care they are currently working. The choice of the study seems validated as the author is not providing interventional support to observe the before and after situational changes in the knowledge of nurses within the research study.

However, no explanation for the choice of this study was presented by the author as well as the selection of the subject for the study seems broad-based( International Committee of Medical Journals,2015).

Research Method

The study was conducted in academic trauma Medical Center. It is 850 beds with 61 trauma/ICU/ Surgical care units. A sample of 384 post-surgical nurses post-surgical medical centre were selected. Out of 384 nurses, only 102 nurses responded to the questionnaire resulting in the response rate of 26.6% however the author has not mentioned the basis of the selection of the sample although he has determined the sample size and selection through statistical analysis done by the software. The author has kept the sample size and requirements broad in terms of nurses currently working in cardiac, surgery, palliative care, oncology, burn, medical-surgical unit, and trauma centres. This seems fair as the assessment of pain is required in every working ward of nursing practices.

 The study was implemented over 14 days period which might be shorter for the observation within a research study. The assessment is done by the knowledge and attitude survey tool regarding pain which is being used in the hospital setting as the indicator of perception of knowledge regarding pain. The author has provided a well-furnished knowledge regarding this in the appendix attached to the research study. This acknowledges the extensive work done by the author in evaluating the responses of the respondents. The threshold score was set to 80% this means that nurses must be highly competent and should possess a positive attitude towards the management of pain so that patient can receive a high quality of care and practises towards a favourable outcome. 

A demographic form has been attached in the annexure related to age, gender, education and years of experience. An exhaustive and longitudinal discussion of forms by the author is the strength of the study however the author has not much discussed the questionnaires and parameters (other than knowledge tool) on which the knowledge assessment has been done. Conduction of the survey within the hospital premises may also result in the response bias. The author has utilized and descriptive analysis for the statistical conclusion of the findings keeping standard deviation of variables and frequencies. Calculations are done based on the T-test and Kruskal Wallis test. Data analyses are done in the form of the categorical data represented in data. The exact data was analysed using SPSS version 21 with a standard deviation value of less than 0.05. The author has extensively explained and summarised the data analysis with the help of frequency tables, percentages and correlations. This section by far is the biggest strength of the research study as all the details are systemically projected within the research study which validates the reflection of results to be true.

Result/ Limitation of the study

The results of the study are elaborately discussed based on tables keeping in mind the projection of separate sections. The result is reflected in the form of the total score and the score percentage each participant received. The study found an unfortunate indictment in information, knowledge and attitude of nurses regarding the pain however the findings of the study are congruent with already established studies. There is a lack of knowledge and understanding of the assessment of pain which acts as the barrier for any required pain management. However, the generalisation of the study results could not be established owing to sample size restricted to adult nursing units only which may introduce the bias into the study results. Also, the study does not investigate the knowledge of the nurses regarding more complex problems which could be associated with other conditions and nonverbally imparted.

Evaluation of Evidence-Based Nursing Pain Management Practice by Song et al, 2015

Authorship

The first author of the study Wenjia song is the doctorate student in the nursing university, the second author holds a similar educational qualification and background. Another author Debra B.Gordon is also a nurse working in the Department of Anesthesiology and Pain Medicine followed by Christine Hoyle who is a professor in Psychology and Community Health Nursing University and Ardith Doorenbos assistant professor in bio-behaviour Nursing and Health in university. The authorship id diversified and expertise. Authors have a varied background from where they can evaluate, understand and cover multiple aspects of the research study topic.  Proper acknowledgement to the supporting contributor has been provided. The section has strength in terms of knowledge, experience and background of authors.

Aim/Hypothesis/Research Question

Aim of the study has been mentioned by the author in the abstract itself. The author states the aim of the study “to test the evaluation tool for nursing cancer pain documentation and describe the frequency and quality of nursing pain documented via the electronic medical system”. For establishing the need of the study author have stated the problem in the introduction section. The author mentions pain in cancer patient impairs daily functioning causing poor quality of life and lower productivity (Viveiros et al, 2018). Hence implementing the evidence-based pain management can improve the outcomes, reducing the stay at the hospital, resource management and improvement in patient satisfaction (Miyashita,2018). For establishing the gap author has stated the literature from 2004- 2014. However, the discussion of the study has not been supported and only a few studied are described.

Research Design

The descriptive cross-sectional study design is used for the review of the records of the patient, the use of the tool was done to assess the nursing documents related to the record of the patient in the oncology department. Approvals of study conduction have been done through the ethical committee.  Due to the exploration of the human subjects’ ethical clearance provides the authenticity of the study (Weiss & Davis, 2019). Also, the choice of a cross-sectional study is justifiable as the author is observing the pattern of pain management by the nurses for modifying the tools hence no present interventions has been provided by the author. Also in a cross-sectional study, the researcher measures only the outcome or exposures within the participants at the same given period.

Research Method

The study was conducted in an academic medical centre in a unit of 28 bed among the 470-bed hospital. Overall 46 registered Nurses working on this ward during the period of study was considered as a sample. The study was conducted for 1 month April to May 2013. 22 patients record were selected by the author to study evidence-based pain management in nursing care. Patients were selected in the basis age, duration of pain. The EBPM behaviour of the nurses was calculated based on the score assigned as per the tool through pain management policies and protocols. The author has reviewed nursing notes, flow sheets, medication records, care plan etc (Guerard & Cleary, 2017). however, the smaller choice of the sample size with the restricted clinical setting of only cancer department may interfere with the generalizability of the study. 

Results/Limitation of the study

The result of the study has concluded the poor level of nursing documentation which may result in suboptimal patient care. The study also shows the requirements of staff education and quality reviews so that necessary interventions can be provided. However, as the limitation of the study these study results could not be authenticated and generalised to a larger population. These limitations include inadequate documents which may cause under-reporting of facts. The study found that institutional heads can provide guidelines periodically to nurses for better pain management policies as well as evidence-based pharmacological, non-pharmacological interventions (Silverman & Gulati, 2018).

CONCLUSION

All three studies which have been critically reviewed in based on various sections have shown a greater deficit in the knowledge for assessment of the pain in the acute illnesses which impose a greater impact on the management of the pain. Nurses should be provided educational support and training toward the management of pain so that necessary interventional steps can be taken by the nurses for better patient care. All three studies have varied drawbacks and strengths; a study conducted by Craig, 2014 was well represented in all aspects of the essential elements of the research paper. In a review of Mahama & Ninnoni, 2019 result and finding could not be well established limiting to small sample size. The study by Song et al, 2015 used evidence-based quantitative approach for establishing the study. The findings of the studies further establish the ground or future studies required for empowering nurses towards better patient care.