Opioids include narcotics that the physicians administer to chronically ill patients with the objective of alleviating their chronic pain pattern. The systematic utilization of various monitoring and screening procedures substantiates the safety and effectiveness of opioids for the chronically ill patients. The presented paper discusses various qualitative and quantitative research approaches and their relevance in validating the safety and efficacy of opioids for the patient population.
A range of philosophical assumptions leads to the selection of qualitative and qualitative research methods by the researchers. These assumptions are based on inductive or deductive research approaches, different research strategies (including case studies and experiments), and research methods (including observation and structured survey) (Wisdom, Cavaleri, Onwuegbuzie, & Green, 2012). Qualitative research studies effectively focus on the categoric assessment of the phenomenon of interest and through the analysis of textual data retrieved from observation or speech. The phenomenological assessment facilitates the meaningful analysis of the research data in the context of deriving calculated assumptions based on the research questions and hypothesis (Wisdom, et al., 2012). Contrarily, qualitative studies utilize statistical measures with the objective of undertaking a numeric assessment of research data. Quantitative studies acquire greater scientific credibility as compared to qualitative studies because of the high precision of their statistically quantifiable outcomes.
Quantitative studies utilize objective stance, numeric logic, and convergent reasoning approach to generate various inductive outcomes regarding the research problem. On the other hand, the qualitative research approaches facilitate the exploration of paradigms and trends to subjectively explore various aspects of the research question. Qualitative research studies deploy holistic, subjective, exploratory and inductive approaches for initiating the research inquiry. Contrarily, quantitative research studies deploy particularistic, objective, conclusive, and deductive approaches for the logical assessment of the numerical data. Qualitative studies usually utilize a purposive sampling technique for data acquisition. However, quantitative interventions in many scenarios use a random sampling technique (or randomization) for data collection and analysis (Rozveh, Gandomani, & Adib-Hajbaghery, 2015). The greatest advantage of using qualitative studies includes the chronological tracing of events and circumstances that resulted in the phenomenon of interest. Furthermore, qualitative approaches assist in the categoric exploration of human behavior to a considerable extent (Austin, 2014). The major methodologies deployed by the qualitative research studies include ethnography, grounded theory, and phenomenology. Contrarily, quantitative research studies facilitate the assessment of objective theories while statistically evaluating the interaction pattern between the selected variables.
The qualitative research initiates a process-oriented inquiry as compared to the quantitative research that focuses on the result-oriented inquiry of various scientific problems. Quantitative studies facilitate the assessment of the cause and effect relationship of numerous statistical variables. Qualitative studies rely on non-structured approaches (i.e. semi-structured interviews, document reviews, and focus group discussions) to acquire an initial insight into the research problem. However, quantitative studies use more robust and structured approaches (including structured questionnaires, surveys, observations, and interviews) to recommend a conclusive outcome regarding the research question and hypothesis (USC, 2018).
The contribution of quantitative and qualitative literature to the knowledge of patient safety issues regarding opioid-based chronic pain management
Becker, Merlin, Manhapra, and Edens (2016) performed a qualitative assessment of the case series with the objective of understanding opioid safety, misuse, and efficacy issues in the multidisciplinary healthcare environment. The findings revealed the significance of opioid administration in the context of chronic pain management of the treated patients. The study findings did not advocate the need for opioid therapy withdrawal in relation to the patient safety issues. However, the outcomes of the qualitative study revealed the need for multimodal treatment planning and biopsychosocial assessment to ascertain the safe and effective administration of opioids to the chronically ill patients. The study outcomes reveal the minimal risk of patient adversity following the evidence-based administration of the opioid to the eligible patients. The longitudinal retrospective cohort analysis by (Brennan, Re, Henderson, & Trafton, 2016) assessed the impact of extended implementation of opioid therapy guidelines on patient safety events across the Department of Veterans Affairs (VA) healthcare system. The findings of the quantitative study revealed the elevated potential of urine drug screening implementation in terms of minimizing the risk of opioid overdose and suicide episodes in the healthcare setting. These findings again reveal opioid administration-related minimal safety risk for the treated patients after the stringent implementation of the opioid-safety conventions across the treatment environment.
The mixed method (i.e. quantitative and qualitative) assessment by (Leece, et al., 2017) emphasized the significance of opioid self-assessment package in the context of undertaking medication safety practices related to opioid guidelines implementation and opioid prescription in medical facilities. The findings of the qualitative study by (Hurstak, et al., 2017) advocated the need for improving opioid therapy knowledge and prescription behavior to effectively enhance the quality of opioid safety interventions in the healthcare settings. The study outcomes nowhere revealed the need to discontinue opioid therapy in response to patient safety concerns in the clinical setting. The study recommended significant measures including opioid overdose prevention counseling, prescriber customization, prescription drug-monitoring program, caregivers’ counseling, pharmacy customization, and routine opioid screening to control the opioid therapy-related patient safety events in the healthcare settings. The outcomes of the quantitative study by (Lin, et al., 2017) revealed the need for minimizing the outpatient prescription frequency of risky opioid combinations. However, the findings did not substantiate the requirement of avoiding opioid administration during chronic pain management in the secondary and tertiary healthcare settings. The qualitative study by (Penney, Ritenbaugh, DeBar, Elder, & Deyo, 2016) described the complex chronic pain management paradigm governing the opioids therapy administration in accordance with the treatment benefits and intricacies of medical decision-making. The study outcomes also revealed the requirement of establishing safety-limits to facilitate the standardization of opioid therapy for pain management.
The systematic study by (Gudin, Mogali, Jones, & Comer, 2013) categorically evaluated the pharmacologic consequences of the co-administration of benzodiazepines and opioid therapy during chronic pain management. The study findings revealed the need for therapeutic drug screening, therapeutic monitoring, treatment adjustment, medical necessity documentation, treatment compliance evaluation, and aberrant behavior screening for minimizing the frequency of patient safety issues and opioid treatment complications in the healthcare setting. Therefore, the qualitative and quantitative evidence-based literature majorly acknowledges the therapeutic outcomes of opioid-based pain management therapy for the chronically ill patients. Studies also recommend various safety management approaches to effectively control various patient risk factors related to the use of opioid therapy in the healthcare settings. The findings consider opioid therapy as an integral component of chronic pain management interventions. In summary, the reported qualitative/quantitative studies do not recommend the complete avoidance of opioid therapy in the context of the reported safety events and associated healthcare complications.
Alternative arguments from the opposite team members indicate the requirement of discarding the use of opioid therapy for chronic pain management to effectively enhance the patient safety outcomes. Alternative arguments concord with the evidence-based findings that reveal a high frequency of adverse patient outcomes opioid analgesics’ administration, particularly in post-operative settings (Costello, 2015). Alternative arguments also advocate the high risk of opioid dependence (i.e. misuse and abuse) in the pain management settings. However, alternative arguments could not radically defy elevated use of opioids in the treatment of various types of pain patterns (including cancer pain of high-severity). The arguments also revealed opioid tolerance as a significant complication that substantially reduces the effectiveness of opioid therapy in the treated patients. Opioid-related adverse drug reactions include pruritus, urinary retention, respiratory depression, vomiting, nausea, sedation, and constipation (Cazacu, Mogosan, & Loghin, 2015). The co-administration of opioids with other medicines also leads to drug-drug interactions in the treated patients. Most importantly, opioid-based immunosuppression substantially elevates the risk of infections and associated co-morbidities. Furthermore, long-term opioid administration increases the risk of chronic disease conditions including myocardial infarction, opioid endocrinopathy, and hyperglycemia. Furthermore, withdrawal of opioids therapy increases the physical and emotional stress level of the chronically ill patients. This eventually leads to the development of transient left ventricular dysfunction and associated Takotsubo cardiomyopathy (or stress cardiomyopathy) (Cazacu, et al., 2015). Alternative arguments also provided little evidence regarding the limited efficacy of opioids in improving pain management outcomes for the elderly and physically disabled patients (Megale, et al., 2018).
Alternative arguments undoubtedly raised numerous safety issues and debatable complexities related to the use of opioid therapy in the healthcare settings. The reported safety concerns and patient risk factors require substantial mitigation through the consistent implementation of evidence-based guidelines and safety conventions. Despite the reporting of numerous health-related issues, safety concerns, and treatment complexities physicians and healthcare professionals reportedly utilize opioid therapy for chronic pain management of the seriously ill patients. I understand that the requirement of enhancing the opioid administration skills in the context of expanding my future nursing practice. Nurse professionals need to practice evidence-based guidelines and safety conventions while evaluating the candidature of chronically ill patients for opioid therapy. The nurses also require to promptly record the opioid therapy-based adverse events and coordinate with the concerned physicians for mitigative actions. Nurses need to consistently evaluate and monitor the patient condition (including vital information) in the context of minimizing the risk of safety episodes and eventual complications. They should acquire thorough knowledge regarding drug-drug interactions and opioid dosage adjustment guidelines and accordingly administer opioid therapy through multidisciplinary coordination. Nurses require exploring various qualitative and quantitative research studies to learn and identify opioid safety guidelines and facilitate their implementation in the nursing practice. This paper evidentially reveals the need for opioid medication administration for chronic pain management. Therefore, minimizing/avoiding the use of opioid therapy will not prove to be a rational measure to establish patient safety in the healthcare settings.
References
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