Evidence Based Nursing Research For Pain Management

Literature Review

Discuss about the Evidence Based Nursing Research for Pain Management.

This research article is very interesting and informative for a nursing student and provides useful knowledge that could be used in future clinical practices. Unrelieved post operative pain is a problem that despite numerous advances in pain management still is quite common (Allred, 2010). The very first line of the research article suggests a reasonable evidence for future research in music therapy being used for relieving post operative pains. In this quantitative article a positive paradigm is implied and deductive reasoning is used to test the hypothesis.

The literature review shows that there are no gaps in the literature but it never supports the need for this study. In this study the literature review provides the databases such as CINAHL and The Cochrane Library that were used in the previous researches that were done in between 2007-2012. It is quite up to date. Some primary sources are used in the study with the use of referencing tools that are used to test procedures that are used in this research article. The search criteria also included only 2007-2012 articles (Lin, 2011) (Pyati, 2007) (Tse, 2005).

This quantitative study stated the use of (RBC) relationship based care delivery model to support the study. In this article the three relationships in relationship based care delivery are explained. These relationships are care of colleagues, care of patients and families and care of self. The model is briefly explained to the readers. This model seems to be appropriate for the solving of the research problem as complementary music therapy belongs to the category of care of patients and families in the relationships based care model (Vaajoki, 2011). The RBC model and the hypothesis are not closely related. The concepts that are used in the study are quite consistent with the category to which the care of patients and families belong. In this article the operational definitions are quite consistent to the definition of care. The researchers never once referred back to the RBC model later in the study though according to the findings we can imply that they should have referred it. Therefore we can denote that the RBC model is there to support this research and not to guide this research process. (Vaajoki, 2013)

The aim of the study is to “determine the effect of music therapy on environmental noise perception, state of anxiety and postoperative pain. The research hypothesis and purpose statement is identifying the specified population and variables for research study. Hypothesis and purpose is properly stated and many previous studies were found to support the hypothesis. This hypothesis is not a null hypothesis therefore it is implied but not stated.

Aim and Hypothesis

The study by Comeaux and Steele Moses provides information about the sample and design along with the tools and measurements that were used for the data analysis.

The participants of the study were all postoperative patients that were admitted to the surgical unit of the Our Lady of the Lake Regional Medical Center (OLOLRMC). The eligibility criteria that were used included a 3 day hospital stay; the patient has to be oriented and alert. The age of the patients participating should be higher than 18. They should be able to speak and write English and should have hematology-oncology diagnosis (Heidari, 2015). According to the study the patients were assigned groups instead of being chosen randomly. The research article does not state explicitly about the type of sampling design that was used but it does suggest that it has a consecutive sampling. When randomization is not possible consecutive sampling is a better choice. The reasoning for the sample that was collected from an ongoing larger study needs the testing of feasibility and efficacy. As the small size of the sample being taken from a larger study does not support statistical conclusion validity. It was suggested in the study that future studies should be replicated with large sample size and different participant population. These changes will validate the findings. (Nightingale, 2013), (Selvendran, 2015), (Hudson, 2015), (Tan, 2015), (Bradt, 2015)

The research article did include some limitations that could result in weakness and sample bias. Data that was collected by the use of questionnaires showed that the questionnaires were tedious and repetitive. The answers of some questions clearly showed that some participants got irritated and upset by the questions. Race and gender were the key characters that were identified in this study along with the variables such as environmental noise satisfaction, anxiety stress and pain management satisfaction. The sample is limited to supporting postoperative patients that were meeting the inclusion criteria therefore generalizability could only be supported if the study was repeated with a different sample population of larger numbers.

The data was collected by self reports in the form of questionnaires that were called “ State Trait Anxiety Inventory” questionnaires. These questionnaires had 4 point scale called “Likert Scale” that was split in half in two forms. This 4 point scale was also used to measure patient’s environmental noise satisfaction level and patient’s pain management satisfaction. This method works best for the dependent variables measurement. The self report method adopted by the researchers was adequate only when the scales and forms collected relevant data from the participants. 

Methods

In design of the research is “Quasi experimental non-equivalent control group design” . The research question was only a therapy question as the randomized controlled trials were not used. Two groups were used one was an intervention group and the other was a control group. The strategy used to compare was effective in highlighting the relationship between patient’s outcomes and complementary music therapy. The intervention was accurately and clearly stated in the research article. It was clearly implied that the daily clinical staff were used as data collectors and were blinded to collect the completed packets. The patient was made aware of the research procedure by the clinical support team and therefore proper intervention fidelity was followed. The clinical support team consisted of direct care nurse, clinical research, clinical educator, specialist and program director for nursing research. (Kligler, 2016)

The study was done as a longitudinal study and the first day was stated as (TIME 1 ) of the study was the day of enrollment or the first postoperative day. TIME 2 was the second postoperative day followed by TIME 3. After TIME 3 it was found that usually the patient was either discharged or transferred and it was also noted that the patient was unrelieved by the post operative pain. As a pilot study a sample of 41 participants were used that enhanced the statistical conclusion validity. The dependent variables were statistically tested by Likert Scale and State Trait Anxiety Inventory. These steps ensured that the statistical conclusion validity of the study was protected. One flaw in the research design was that it had no control on the transfer or discharge of the patient’s therefore a patient outcomes can be affected by rival explanation. As the length of the study was only 2-3 days many concurrent events can give rise to internal validity issues such as partial completion of questionnaire while discharging or early discharge. Issues can also be caused by the fact that the study was not randomized. The external validity of the study is at question as many external factors such as medications taken by the patient to reduce pain were never considered.  Only causal interference was drawn by the study in the relationship between the dependent and the independent variables. (Krishnaswamy, 2016)

Numerous limitations were present such as not assigning patients randomly, patients who were present in control group could also listen to music and medications used by the patients were not monitored. It is quite possible that these limitations could have affected the patient’s outcomes and affected the study’s validity. Therefore even when the study is acknowledging the limitations a much larger study is needed to be conducted to validate the findings.

Sampling

Environmental noise and pain satisfaction was measured by two standardized tests by Likert scale and State Anxiety Inventory questionnaires were also given to the participants. The measurements tools that were used were reliable as they were used extensively in many other studies. The reliability of the scores coming from the Likert scale was adequate and the readings were above the 0.7 mark. The STAI questionnaire reliability was cited by another research article. Internal consistency was found on the Y 2 STAI questionnaire whereas the Y1 form was consistent for the 0.7 reading mark. Internal consistency, no measurements of validity for the measurement tools and low reliability are some points that do not support the hypothesis. The tests of the measurement tools were not used or not stated in the study.

Descriptive statistics were used to summarize sample demographic characteristics. These characteristics included race, and gender.  To calculate the mean differences in the group a paired T test was used, whereas the analysis between the groups was done by an independent T test. The statistics were correct and major variables were described in the study. In the study the T test was the inferential statistic. The use of parameter estimation was never supported by a confidence interval only hypothesis testing information was provided. Risk indexes and effect sizes were not included in the research article. The missing statistical information yields support for null hypothesis. The report yielded very less information about the evidence that can support the study. The chances of Type 2 error are plausible due to the minimal use of statistics to validate statistical information. (Hoareau, 2016)

The findings of the study were organised but were not explained fully for the readers. This insufficient explanation is not enough for readers to understand statistical significance. The tables that are given have appropriate headings and are summarized with huge amount of statistical data. Many tables are hard to understand and interpret without knowing the significance of the given symbols. The article explains statistical significance partially which is not enough to support the conclusion. 

The results seems to support the hypothesis partially as we can see in the evidence provided “that at TIME 1 measurement participants reportedly were only little satisfied with the pain management from the past twenty four hours which clearly suggests that the participants were not satisfied with the care standard of the hospital. We can also note that at “TIME 1 the control group reported to have higher environmental noise satisfaction than the intervention group in which the music was being played”. Another reason to believe that the results supported the hypothesis partially was when “the two groups difference at TIME 2 in case of instate anxiety was not significant”. Which clearly showed that complementary music therapy had effect only on the patient’s environmental noise satisfaction and pain management while instate anxiety remained unchanged. This study included recommendations for future studies, nursing implications and limitations of this study. The implications included how effectively their findings could be implemented. Limitations included the bias and the factors that affected their results.

Design

The limitations that were evident in the study at first were lack of proper literature review. Another limitation would be no gap was established for the importance of the study and attrition was evident in the study. 

Conclusion 

After reading this study my thinking about the music therapy was stimulated as the study was well explained. But there was no relevance that was established by the researchers as no gap was presented in the research. The findings though did support the experiment and its importance. The strengths of the study would be its easy reading along with crucial information for future researches.

References 

 Allred, K., Byers, J., & Sole, M (2010). The effect of music on postoperative pain and anxiety. Pain Management Nursing , 15-25.

Bradt J, Potvin N, Kesslick A, Shim M, Radl D, Schriver E, Gracely EJ, & Komarnicky-Kocher LT (2015). The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: a mixed methods study. Support Care Cancer , 1261-71.

Comeaux, T.,& Steele-Moses, S. (2013). The effect of complementary music therapy on the patient’s postoperative state anxiety, pain control, and environemental noise satisfaction . MEDSURG Nursing , 313-318.

Heidari S, Babaii A, Abbasinia M, Shamali M, Abbasi M, & Rezaei M. (2015). The Effect of Music on Anxiety and Cardiovascular Indices in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial. Nurs Midwifery Stud. , 166-176.

Hoareau SG, De Diego E, & Guétin S (2016). Pain management and music therapy. Rev Infirm. , 31-33.

Hudson BF, Ogden J, & Whiteley MS (2015). Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery. Eur J Pain , 1447-55.

Kligler B, Teets R, & Quick M. (2016). Complementary/Integrative Therapies That Work: A Review of the Evidence. Am Fam Physician , 369-74.

Krishnaswamy P,& Nair S (2016). Effect of Music Therapy on Pain and Anxiety Levels of Cancer Patients: A Pilot Study. Indian J Palliat Care , 307-11.

Lin, P., Lin, M., Huang, L., Hsu, H., & Lin, C (2011). Music therapy for patients receiving spine surgery. Journal Of Clinical Nursing , 960-968.

Nightingale CL, Rodriguez C, & Carnaby G. (2013). The impact of music interventions on anxiety for adult cancer patients: a meta-analysis and systematic review. Integr Cancer Ther. , 393-403.

Pyati, S., & Gan, T (2007). Perioperative pain management. CNS Drugs , 185-211.

Selvendran S, Aggarwal N, Vassiliou V, & Ntatsaki E. (2015 ). Pirouetting Away the Pain With Music. J Clin Rheumatol , 263-6.

Tan M, Law LS, & Gan TJ (2015). Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Can J Anaesth , 203-18.

Tse, M., Chan, M., & Benzie, I. (2005). The effect of music therapy on postoperative pain, heart rate, systolic blood pressure and analgesic use following nasal surgery. Journal Of Pain & Palliative Care Pharmacotherapy , 21-29.

Vaajoki, A., Pietilä, A., Kankkunen, P., & Vehviläinen-Julkunen, K (2011). Effects of listening to music on pain intensity and pain distress after surgery: an intervention. . Journal Of Clinical Nursing , 708-717.

Vaajoki, A., Pietilä, A., Kankkunen, P., & Vehviläinen-Julkunen, K (2013). Music intervention study in abdominal surgery patients: challenges of an intervention study in clinical practice. International Journal Of Nursing Practice , 206-213.