Evidence based practice

Further Rests need to be conducted. Background Information Review of the Literature Discussion of Methodology Specific Data Analysis Conclusion 3. Based on analysis of 5 areas, assess whether the evidence presented in the research report supports the conclusion. The background information was general and brief. Although there were some noteworthy findings in the survey I did not feel that the subject was developed entirely. The discussion of methodology was short and described the obtaining of information with the trials.

The team was developed and the controlled trials, indexes to nursing literature and dissertation -abstracts as well and citation lists with researchers. The review of the literature was mixed with he specific data analysis from the surveys. It combined the two when talking about the studies found within the different surveys and took up most of the article. I feel that other questions related to the information and preparing the patient, nurse coaching plus distraction, parent positioning plus distraction, and distraction should be addressed.

Based on my analysis I would state the conclusion needs further review. The conclusion is not complete. There is preliminary evidence that a variety of cognitive-behavioral interventions can be used with children and adolescents to reoccurred however further studies will need to be taken in order to base the evidence due to other factors. The study had limited evidence of the numerous other psychological interventions. 4. Discuss ethical issues that may have arisen for the researcher while conducting the research for the article.

Ethically no one was hurt during this study so there are no specific issues but there are different types of families and different dynamics exist in each family. The parents may not have been able to help with holding, comforting providing the assistance needed to help with the psychological interventions. Every child perceives and can tolerate pain different and one child will use one form of distraction and another will prefer another form. Some children like to be distracted while others like to be engaged and watch the intervention. Pain is very subjective and as such it is very difficult to research.

Nurses are different is their approach as well and have many different personalities. Some may be very nurturing and take time to talk over the procedure while others may be matter of fact and don’t prepare the pediatric patient for the procedure. Some parents may not like the approach of the nurse in helping alleviate pain. 5. Discuss the type of research used for the study: Empirical evidence research and a Medicine search using mesh headings and manually identifying articles of interest. A. Explain whether or not other types of research would have been appropriate in the same situation.

I think that this type of research was the appropriate type of research. Surveys offer valuable information but did not address all areas psychological interventions. The background information the clinical trials were extracted but the quality was speculative. Although there were some noteworthy findings in the survey I did not feel that they offered straightforward commendations on reducing pain with procedures. Also, the survey did not inquire about the other factors of other interventions that could be used. Further research should investigate other aspects of the variety of cognitive behavioral interventions.

This will likely expand the number of strategies and actions available to the profession as well as nurse leaders to help the families and nurses reduce the distress with pain related procedures. B. Conduct a literature search to evaluate nursing care or management implications of a therapeutic nursing intervention by doing the following: 1 . Identify a nursing care or management problem for a therapeutic nursing situation. Reviewing alternative methods of alleviating procedural pain in children 2. Complete the attached matrix to list 10 primary research sources- (see attachment) 3.

Conduct a review of the 10 peer-reviewed research articles in which you: a. Develop an annotated bibliography of the articles b. Discuss whether the researchers present a case for the efficacy of a specified therapeutic approach. C. Identify whether the researchers chose tools that were similar or different. D. Discuss whether you believe the tools the researchers chose loud have affected their results. 4. Develop an evidence based summary of the McGrath & P], Skills, SIR… (October 18, 2011) Psychological interventions for needle related pain and distress in children and adolescents.

Published by John Wiley and sons. Retrieved November 8, 2011 from www. Cochrane. Org/reviews This article talks about reducing procedural pain with distraction and a combination of cognitive-behavioral interventions including hypnosis. The study was done with clinical trials with the most commonly studied needle procedures were immunization and injections. The efficacy was limited because of the other psychological factors including information or preparation, nurse coaching distraction, parent positioning plus distraction and distraction plus suggestion.

Overall I feel that cognitive-behavioral interventions can be used with children to manage or reduce pain but because pain is very subjective it is difficult to determine. They did not measure pre-treatment heart rate, Blood pressure or oxygen saturations like some of the other reviews. The study needed more clinical trials to have better results and to determine a clear outcome. 2. So, AS, Gangly Sin Y… (2011)Touch therapy for pain relief: Published by John Wiley ND sons in the Cochrane Database. Retrieved November 1 1, 2011 from www. Cochrane. Rug/reviews This article is a review about how touch therapies (Healing Touch, Therapeutic Touch and Erik) have been found useful in pain relief for adults and children. The evidence although inconclusive was strong that using touch therapy reduces the amount of analgesia and pain reduction. The efficacy was also limited due to inadequate data. Future studies should focus on side effects and report the experience to the practitioner. The article was not credible because of the small number of studies and insufficient data. 3. Harrison D. Yamaha J, Adams-Webber T. ,Olsson A, Been J, Stevens B…. 2011) Sweet tasting solutions for reducing procedural pain: Published by John Wiley and sons. Retrieved October 6, 2011 from www. Cochrane. Org/reviews The focus of this article is to determine if injection pain or blood draws are reduced if taking small amounts of sugar water or older children chewed gum before a procedure. In this article the sample size was small and therefore inconclusive. The efficacy was limited because they only had four studies therefore there is insufficient data of the analgesic effects of sweet tasting solutions during a painful reoccurred.

They used similar tools as the other researchers but more quality research needs to be developed. Currently in our hospital the NICE offer sweet solutions on the babies pacifier before painful procedures so that indicates that there is some credibility in dipping the pacifier into a sweet solution before a procedure. 4. Sawn’, A & Thomas, R… (2007) Pediatricians attitude, experience and referral patterns regarding complementary/alternative medicine: A national survey. Published online 2007. Retrieved October 12, 2011 from www. Incubi. Nil. Gob/PC/ articles physicians and their referral patterns.

This was done with a survey of a 27-item questionnaire and 648 of 3500 responded (18%). This was limited because only one mailer was sent and only 18% responded. It was only limited to pediatricians and not nurse practitioners or family physicians who also survey. It did indicate that the pediatricians had had a positive impression towards CAM and that there should be more education on CAM both in medical school and through CAME programs. There is evidence that CAM’s are growing and can be integrated into pediatric care. This review was different in that it was sent out in a mailer. 5. Bikinis, T… (DCE. 09) Music therapy my reduce pain and anxiety in children: published by J Ivied based dental Pratt. Retrieved October 12, 2011 from www. Incubi. Nil. Gob/PC/articles This article is an abstract of a unapologetically method such as music can be used as an alternate or compliment to analgesic. This was done as a randomized clinical trail followed by interviews. The tests were measured by physical symptoms such as heart rate, blood pressure and respiratory rate. The result was positive in that music reduces fear and pain in children. I thought this was a credible article because it measured physical symptoms caused by fear and pain.

They use similar tools such as measuring vital signs and clinical trials. 6. Analog, K. , Kingston, S, Lament, A. , Makeover, P & Macarthur, C… (2011) the effectiveness of music in Pediatric Healthcare: A systematic review of randomized controlled trials: published online 2010. Retrieved October 12, 2011 from The aim with this article was to combine five electronic databases for trial designs from 1984-2009. The research used in this study was unblended; cluster randomized controlled study and computer decision support system. They had seventeen studies that met the criteria of the peer review articles.

The findings suggest the effectiveness of music as an intervention in pediatric healthcare. The findings offer limited qualitative evidence that music helped with coping, used to enhance cognitive abilities, facilitate communication and reduce the effects of trauma. It also indicates that music may also reduce symptomatically of painful procedures. This article was different because it combined data from other trials to form their opinion. I believe that forming an opinion is more credible with more data backing up the findings however this article did not give specific recommendations. . Rooster-Stevens, K, Answerer, S. , Archery, T & Kemp, K… One 2008) How do parents of children with Juvenile idiopathic arthritis WA) perceive their therapies? Published by department of pediatrics, Wake Forest University. Retrieved October 9, 2011 from www. Incubi. Nil. Gob/PC/articles This is a published abstract published to determine which complementary and alternative (CAM) therapies are commonly used with chronic medical conditions. The study describes the views of parents regarding conventional and CAM therapies. They used questionnaires in over 75 clinics in 30 days.

It determined that 88% use dedications, 67% use heat, 54% use extra rest and the CAM therapies included 48% management techniques 33%. The tools were similar in that questioners were used. Because the article covered so many areas it wasn’t credible but it was informative. 8. Evans, S, Tsar, J, Seltzer… (Cot. 2008) Complimentary and alternative medicine for acute procedural pain in children: Published online BMW complement alter. Med 2008, Retrieved October 12, 2011 form www. Incubi. Nil. Gob/PC/articles This is also an abstract article about the use of CAM and alternative medical therapies in treating children and their painful procedures.

They have shown evidence that CAM has a place in pediatric medicine and have become increasingly important in treating children’s painful procedures yet it is still not clear if it has a place in pediatric analgesia. The modalities tested were Music therapies, acupuncture, laughter therapy and massage therapy. Standardizing these into intervention used is the next step toward implementing CAM into practice. They used an over view of other published material which was the same as number four. This article is fairly vague because they did paint a clear picture of the procedures.

I live other tools could have been used to better prove the efficacy of this article. 9. Line, Y, Lee, a, Kemp, K & Beard, C (DCE. 2009) Use of complementary and alternative medicine in pediatric pain management service: a survey. Published online December 6, 2009, retrieved from www. Incubi. Nil. Gob/PC/articles A telephone survey that included questions on the provision of complementary and alternative medical therapies in their pediatric pain programs to pediatric anesthesia affiliated with major universities. Out of forty three anesthesia fellowship programs 100% responded to the survey.

Thirty eight (86%) offered one or more CAM or their patients. Those therapies include biofeedback, guided imagery, relaxation therapy, massage, hypnosis, acupuncture, art therapy and meditation. The efficacy for this survey indicates that there is a trend moving toward alternative medical therapies in tertiary pediatric pain management. It also suggests that safety and efficacy in CAM use is urgently needed. This article used similar tools such as surveys and I liked the percentages with each CAM. They had very good response from the survey and did a good Job compiling the research. 0. Pat, O, Calmness, C, Dolores, J, Laconic, F and Compulsive, (2009) MEAL errors Nitrous Oxide for venous accumulation in children. Published by department of pediatrics Anesthesia, La Timing University hospital. Retrieved October 12, 2011 This article compared MEAL cream with nitrous oxide for providing pain relief during venous accumulation in children. In a sample of 40 random children they compared the two and measured visual pain scores, heart, rate, blood pressure and oxygen saturations that were compared before and after.

There was no statistical difference between the two groups and both provided adequate pain relief during venous accumulation as demonstrated with low pain scores. This article was also credible because they used similar tools such as monitoring vital signs to measure the outcome. The researcher did a good Job at presenting their case and the MD orders it before painful procedures but I enjoyed reading this article to see that there are other products that are similar. 5. Recommend a specific nursing strategy based on the theoretical models and evidence found in review.

In the ten articles I reviewed I found a trend toward finding alternate solutions to pain control in children with several modalities including distraction, massage, sweet assisting solutions, MEAL cream, nitrous oxide, music therapy, distraction, relaxation therapy, massage, hypnosis art therapy and meditation. I work with pediatric patients every day and use a variety of these methods based on the developmental age of the patient. I would love to see some standards developed based on these trials, formulate interventions, creating treatment manuals and determining treatment efficacy as a function of the child’s development.

There is a movement towards CAM (complimentary and alternative treatments) in pain control. I feel that pain has many psychological factors and when nurses use and implement simple rooms of distraction as well as prepare the child the outcome will be far less emotionally scarring and traumatizing in associating this event with procedural pain. Most of the children I work with have the same procedure every week and I would never attempt to start a procedure before applying MEAL cream which contains leading to numb the area because the emotional trauma that it causes.

Why not alleviate some of the fears and pain in these little children? I am an advocate for trying anything that will help reduce or eliminate this type of pain in children 6. Explain why you believe it is important to use a theoretical model for nursing. It is important to use theoretical models in nursing research because this technique helps researchers and the people reading about the research, to answer the questions that they had about different aspects in nursing. You first create a theory and then you research about your theory.

As nurses we are taught to “critically think” about everything we do and say. We are taught to always question why we are performing tasks under different protocols and time frames. It is important in nursing to remember to always ask why. Getting back to theoretical models, it is important to test and prove via research that theories about different patient cares are sound/efficient. In nursing school we used the acronym ADAPT for nursing theoretical models. It stands for assess, diagnose, perform, implement, and evaluate.

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