Appraising Evidence for Nursing Practice Research Critique: Article Writing Answers 2021

Appraising Evidence for Nursing Practice Research Critique: Article Writing Answers 2021

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Appraising Evidence for Nursing Practice Research Critique

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Research Critique Part II
Critique the same research study you used for Research Critique Part I. Use the Polit and Beck
(2018) textbook to critique and explain/define the terms for each aspect of the study. Chapter 4
provides an overview of a research critique. The last paragraph of each chapter (beginning with
chapter 5) discusses how to critique a specific aspect of the study. It is followed by a green box with
critiquing guidelines. Appendix C presents a study and then a sample critique of that study.
Write in narrative form (full sentences). Use six level one headings to organize the paper. APA forma
required.
When doing a research critique, it is acceptable to put the reference for the article on the bottom o
the title page. Do not cite the article within the body of the paper. All other resources (such as the
Polit and Beck textbook) must be cited and referenced as usual.
I. Research Design
o Identify and define the overall type of research design that was used in your study
(quantitative or qualitative). If qualitative, identify the specific type of research design
(phenomenological, ethnography, grounded theory, etc.) and provide a brief description
of it. If quantitative, identify the specific type of research design (true experimental, quasi
experimental, or non-experimental) and provide a brief description of it.
II. Sample and Setting
o
Who is the target population?
o
What are the inclusion (eligibility) and/or exclusion criteria?
o
Identify and discuss the type of sampling used in the study?
o
What is the setting and is it appropriate for the study?
III. Ethical Considerations
o
o
o
Was the study approved by an Institutional Review Board (IRB).
o
Was informed consent obtained in this study?
o
Discuss four of the major elements of informed consent. (This info will not be found in the
study. Use the textbook).
What is the purpose of an IRB?
IV. Data Collection
o What tools/instruments were used to collect the data (surveys, questionnaires, interviews
etc.)? Are the tools clearly described?
o
Were reliability and validity of the research instruments addressed in the study? Define
reliability and validity as it pertains to research instruments.
V. Results
Identify and briefly discuss one of the inferential statistical tests used to analyze the data
(not the descriptive statistics used to describe the characteristics of the sample).
VI. Discussion/Conclusions
o Did the researcher discuss the important study findings? What were they?
o
o
Did the researcher identify any study limitations? What were they?
o
What recommendations for future research studies were made?
o
What implications for nursing practice, education, or health care policy did the researche
identify?
All criteria are met with supporting information. Includes a minimum of one reference from
an English titled, peer-reviewed nursing journal (less than 5 years old) and one from the
course textbook.
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International Journal of Nursing Practice 2013; 19: 462–470
RESEARCH PAPER
Effect of systematic relaxation techniques on
anxiety and pain in older patients undergoing
abdominal surgery
Nahid Rejeh PhD MScN BScN
Assistant Professor, Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Health of the Elderly Research Group,
Tehran, Iran
Majideh Heravi-Karimooi PhD MScN BScN
Assistant Professor, Department of Nursing, Faculty of Nursing and Midwifery, Shahed University, Health of the Elderly Research Group,
Tehran, Iran
Mojtaba Vaismoradi MScN PhD BScN
Researcher, Faculty of Professional Studies, University of Nordland, Bodø, Norway
Melanie Jasper PhD MSc BNurs BA RN RM RHV PGCEA
Professor, Head of College, College of Human and Health Sciences, Swansea University, Swansea, UK
Accepted for publication September 2012
Rejeh N, Heravi-Karimooi M, Vaismoradi M, Jasper M. International Journal of Nursing Practice 2013; 19: 462–470
Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing
abdominal surgery
Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This
study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal
surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The
systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences
during recovery in ambulation after the surgery.
Patients’ satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant
differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups
after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after
surgery as well as offering a measure for increasing the patients’ independence in pain management control.
Key words: anxiety, older patients, pain management, relaxation technique.
INTRODUCTION
Correspondence: Nahid Rejeh, Faculty of Nursing and Midwifery,
Shahed University (opposite Holy Shrine of Imam Khomeini-Khalij Fars
Expressway), Tehran, Postal/zip code: 3319118651, Iran. Email:
reje@shahed.ac.ir
© 2013 Wiley Publishing Asia Pty Ltd
Abdominal surgery is recognized as a painful procedure,1 caused by ischaemia and release of neuropeptides
at the trauma site and throughout the nervous system
and due to the site’s proximity to the diaphragm and
doi:10.1111/ijn.12088
Pain management in older patients
cross-innervations in the abdominal area.2–4 Inadequate
pain management following abdominal surgery leads to
complications such as delayed recovery5 and ambulation6;
lack participation in the therapeutic plan; disturbed sleep
and appetite loss; prolonged hospitalization; and dissatisfaction with, and increased costs of, health-care services.7–9
Pain after surgery is intensely uncomfortable, which
exacerbates the anxiety response and might contribute
to psychological complications.5 Moreover, increased
anxiety activates tension and pain, possibly leading to
delay or cessation of therapeutic procedures.10 Anxiety in
postoperative patients can significantly affect the intensity
of pain and surgical outcomes, and could adversely affect
patient recovery. For instance, it might increase the intubation time, impair the inflammatory response, increase
cardiovascular workload and change the normal degradation processes in wound healing.11,12 From the psychological aspect, postoperative anxiety can cause an increased
sensitivity to noise. It can result in an exaggerated autonomic response, sensory overload and sleep deprivation
leading to physiological problems, and therefore delayed
self-care after surgery.11 A higher level of pain intensity in
postoperative older patients, longer hospitalization and
poorer ambulation after discharge from the hospital have
all been linked to increased anxiety.13 Hospitalization and
surgery are among the most important causes of anxiety in
older patients.2 Therefore, designing strategies to reduce
pain and anxiety after surgery and provide an environment conducive to smooth healing and recovery is
needed. Anxiety and pain levels in postsurgical patients
should be assessed so that proactive nursing interventions
are implemented.14
Diverse interventions to promote relaxation, such as
drug therapy, patient education, massage, aromatherapy
and reflexology, have been designed.15,16 Although there is
no standard intervention to be applied to all older patients
in order to manage their pain and reduce their anxiety,
preventive approaches using both pharmacologic and nonpharmacologic approaches should be considered to gain
optimal pain and anxiety control during hospitalization.7
Specifically, non-pharmacological methods have been recommended as adjuvant to analgesics for reducing the
intensity of pain after surgery.5 Older patients generally
suffer from moderate to severe postoperative pain.13 Furthermore, the side effects of opioid drugs are experienced
in these patients more frequently.17,18
Non-pharmacologic nursing measures after surgery
could help the patients both reduce their anxiety
463
and diminish the intensity of their pain.14,19 Nonpharmacologic pain management includes a series of
effective interventions such as relaxation.13 Relaxation
exercises reduce the intensity of pain after surgery and the
level of anxiety, and thereby prevent the occurrence of
complications after surgery. The use of relaxation exercises in postsurgical pain prevention can increase patient
satisfaction with nursing care.1 For instance, it has
been shown that techniques such as deep breathing and
jaw relaxation reduce patients’ pain after abdominal
surgery.5,6 Relaxing muscles as a relaxation technique
reduced patients’ anxiety by preventing the transmission
of pain messages to the spinal cord.20 Furthermore,
relaxation techniques are often the preferred methods for
pain management by patients.21
The systematic relaxation technique as a therapeutic
intervention has been utilized across patient ages ranging
from 21 to 65 years.6 However, few studies have explored
whether systematic relaxation techniques can reduce
anxiety and pain in older patients undergoing abdominal
surgery.
BACKGROUND IN IRAN
In the Iranian health-care system, there are no pain management teams, and there is no algorithm or protocol to
address the problems of postoperative pain. Pharmacological interventions, especially the prescription of opioid
drugs, are the main methods of controlling postoperative
pain, and are only prescribed by physicians. In addition,
nurses have no direct collaboration in the management of
pain in the health-care team.22 Therefore, systematic
relaxation techniques as an adjuvant to the traditional
methods for pain management can empower Iranian
nurses to take a central role in the delivery of high-quality
care to patients.
The majority of studies conducted in Iran on pain management have addressed the barriers to pain management
and its ethical consequences.23,24 Previous Iranian studies
focused on the effect of non-pharmacologic measures on
moderate to severe essential hypertension,25 anxiety of
primigravid women26 and anxiety of female dormitory
students.27 However, no Iranian studies have been conducted to investigate the effect of relaxation techniques on
postoperative pain in older patients.
The basis for conducting this study, concentrating on
relaxation in patients during hospitalization and improving patients’ self-care, emanates from two theories:
© 2013 Wiley Publishing Asia Pty Ltd
464
N Rejeh et al.
1. Florence Nightingale’s focus on environment, health
and wellbeing: Nightingale proposed that nurses
provide a therapeutic environment to nurse the person
rather than the disease.28 A therapeutic environment
provides an integrative network of physical, spiritual
and psychological factors, which contributes to the
creation of a healing or a healthy place for hospitalization.29,30 Florence Nightingale advised using relaxation
techniques such as encouraging rest, pleasurable
sounds, and limiting disturbances and unnecessary
noises.31,32
2. Dorothea Orem’s focus on self-care: suggests that
helping people to maintain a balance between activity
and rest (a universal self-care requisite), is a legitimate
concern of nursing. The meaning of activity and rest,
the requirements and potential measures for meeting
this self-care requisite, and the factors that might
influence the process are explored. Orem proposed
that self-care action regulates human functioning
and that self-care can be learned for health-related
purposes.33,34
AIM
The purpose of this study was to investigate the effect of
systematic relaxation techniques on the pain and anxiety
of older patients undergoing abdominal surgery. The
answers to the following questions were sought: (i) Do
patients in the experimental group experience less pain
than patients in the control group?; and (ii) Do patients in
the experimental group experience lower anxiety levels
than the patients in the control group?
METHODS
Study design and samples
A convenience sample of 124 older patients undergoing
elective abdominal surgery between April 2011 and
December 2011 were recruited from general surgical
wards of a university teaching hospital in Tehran and
enrolled in a randomized controlled trial (RCT). The
RCT is a classic and precise method for examining the
effects of an independent variable on a dependent one by
comparing them in experimental and control groups.28
The sample size of 62 participants per group was achieved
based on a power analysis for the covariance using a
moderate effect size, power of 0.90 and a = 0.05. Two
patients dropped out of each group due to transfer of ward
or surgery cancellation.
© 2013 Wiley Publishing Asia Pty Ltd
The following inclusion criteria were used to select the
sample:
Aged ⱕ 65 years;
Being orientated to time, time and place;
Having no cognitive, affective, verbal or aural
impairments;
Not using a relaxation therapy technique before and
during the conduct of the study;
Having no substance abuse and opium addiction;
Being hospitalized for at least one night before the
surgical procedure; and
Being able to communicate in Persian and having the
willingness to participate in this study.







Measurements
The following instruments were used to gather data:
Demographic information questionnaire including age,
gender, educational level, economic status, religion,
occupation, marriage, health insurance, health histories, treatment period, surgical incision (length, location, direction),and any existing diseases—gathered
from the patients’ medical records; and
Visual analogue scales (VAS) to assess the patients’
intensity of pain and the level of anxiety. The VAS pain
and the VAS anxiety scales each consist of a 10 cm
unmarked line on which the patient places a slash to
represent a rating of the level of pain or anxiety experienced at the time.35 The VAS has been considered
appropriate for use in studies with older adults because
it has the least number of questions and is less tedious
to complete than other complicated instruments.18,20
The VAS pain scale had labels of ‘no pain’ and ‘worst
possible pain’ as its anchors. Correspondingly, the VAS
anxiety was labelled with ‘no anxiety or worry’ and
‘worst possible anxiety or worry’ at either end of the
10 cm line. The VAS anxiety scale has been demonstrated
to be significantly associated with standard psychological
tools for the assessment of anxiety.36 These scales were
applied in other studies to assess the short-term efficacy
and safety of two kinds of traditional Chinese herbal
patches,37 assess the efficacy of pain management regimens
in patients with acute postoperative pain, but its usefulness has not been confirmed in postoperative pain
studies.38 In addition, the scale has been used to assess the
performance of four self-report measures of anxiety in an
older adult population39 to investigate the impact of selfadministration of midazolam for postoperative anxiety.35


Pain management in older patients
Relaxation techniques
The relaxation techniques included patients reading
relaxing sentences, slowly without music, using an introductory tape and earphones while they rested in bed
concentrating on relaxing successive muscle groups for
10–20 min without any muscle contraction.5,6 The implementation of the technique took 5 min, repeated three
times.
Two bilingual linguists, who were fluent in both
languages, translated the content of the audiotape from
English (the original language) to Persian separately.
Another expert reviewed the translations to identify
inconsistencies. Minor revisions were suggested, resulting
in one Persian version of the scale. This was translated
back from Persian to English by two bilingual language
experts. The back-translated version and the original were
compared and found to be highly similar in meaning and
content. An expert panel, consisting of eight health-care
providers (a physician, two faculty members of a nursing
school, two nurse managers, a psychologist and two clinical nurses), was asked to listen to the audiotape and rate
the content of the Persian version based on its clarity and
simplicity. Further minor changes resulted and were
pilot-tested with five patients. This final version was used
for the data collection.
Intervention
The surgical ward head nurses were asked to identify
older patients who met the inclusion criteria. Participants
were randomly assigned to experimental and control
groups according to file numbers (even numbers to the
experiment group and odd to the control group), balancing for sex, age and chronic pain.40
All participants were provided with information about
their surgery and the current ward protocols regarding
ambulation afterwards. The systematic relaxation techniques were applied based on previously published
protocols.5,41,42 The experimental group patients were
given an audio tape containing the technique’s instructions, whereas patients in the control group received
normal care. The audio tape included information about
the relaxation techniques, their benefits and importance—
these were repeated during their use. The participants
listened to the tape until they were confident that they had
mastered the techniques and could apply them correctly.
They used fixed earphones to prevent distraction and
improve concentration.
465
The participants were asked to report the intensity of
their pain and anxiety using the VAS scales at four times
(before the intervention, following the 15-min recovery
period from initial ambulation, and 6 and 12 h after the
intervention).
To assess and compare levels of analgesics used, the
intake of opioid drugs during the first 12 h after initial
ambulation was converted as the number of milligrams of
morphine administered by staff nurses and recorded in the
patient’s file.
Data analysis
The data were analysed using descriptive and inferential
statistics via SPSS software version 15. The Student’s
t-test and repeated measurements were used to examine
the differences in pain and anxiety between the groups,
and during the study period. P value >Approximate cost: $8 per page.
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