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the purpose of this Assignment is to give you a practical application to implement your PICOT idea, supported by the evidence-based research you have obtained in during your systematic review. You will apply evidence-based research findings, discovered from your clinical question, and then integrate those to support your suggested change in nursing practice. Directions: 1. Identify your refined PICOT question. 2. Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question. 3. Describe your systematic review and include an errors analysis. 4. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial. 5. Summarize the case study selected. 6. Describe the study approach, sample size, and population studied. 7. Apply the evidence from this review to your practice specifically in your overview. 8. Evaluate the outcomes, identifying the validity and reliability. 9. Discuss if the study contained any bias. 10. Determine the level of evidence identified in the review. 11. The length should be no less than 10 Pages in APA format. PICOT question What is the effectiveness of the Patient Controlled Analgesia (PCA) and intermittent nurse administered injections in helping reduce the postoperative complications as compared to using intermittent nurse administered injections within the healing duration after surgery? You may change the PICOT question up some but it needs to pertain to PCA use. Thanks!! Instructions: Enter total points possible in cell C12, under the rubric. Next enter scores (between 0 and 4) into yellow cells only in column Evidence-Based Clinical Question Sear Unsatisfacotry Satisfactory 1 2 Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Incomplete N/A Length Less than 7 pages 8 pages Format/Style Did not follow APA format Major errors with APA formatting Identify your refined PICOT question. Using PubMed and the Cochrane collaboration database, do a systematic review of your clinical question. Describe your systematic review and include an errors analysis. Determine an evidence-based quantitative article from the search that contains an evidence-based randomized control trial. Summarize the case study selected. Describe the study approach, sample size, and population studied. Apply the evidence from this review to your practice specifically in your overview. Evaluate the outcomes, identifying the validity and reliability. Discuss if the study contained any bias. Determine the level of evidence identified in the review. 250 Total available points = Rubric Score Grade points Low High Low 3,5 4,0 225 2,5 3,49 200 1,7 2,49 175 1,0 1,69 150 0,0 Comments: 1,00 0 etween 0 and 4) into yellow cells only in column F. d Clinical Question Search Average Excellent 3 4 N/A Score Weight Final Score Complete 0 5% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 5% 0,00 N/A Complete 0 5% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 10% 0,00 N/A Complete 0 10% 0,00 9 pages 10 pages 0 5% 0,00 Text, title page, and references page follow APA guidelines . Minor references and grammar errors Text, title page and references page follow APA guidelines. No grammar, word usage or punctuation errors. Overall style is consistent with professional work. 0 10% 0,00 100% 0,00 Final Score Percentage 4 Grade points Percentage High Low 250 90% 100% 225 80% 89,99% 200 70% 79,99% 175 60% 69,99% High 0 0,00% 150 0 59,99% MN504 Scientific and Analytic Approaches to Advanced Evidence Kaplan University Background  Patient Controlled Analgesia (PCA) is getting huge support as opposed to intermittent nurse administered injections.  PCA is effective because it gives full autonomy for patients to manage their pain.  PCA increase patient’s satisfaction.  PCA increase level of perception of situational control, reduce postoperative depressive symptoms, increase patient's level of satisfaction, lower preoperative anxiety, and it increases control over pain relief. PICOT Question  What is the effectiveness of the Patient Controlled Analgesia (PCA) and intermittent nurse administered injections in helping reduce the postoperative complications as compared to using intermittent nurse administered injections within the healing duration after surgery? Cochrane Library 1) Keywords: Patient Controlled Analgesia (PCA), intermittent analgesia dosing or intravenous injections= 2332 results 2) VAS pain intensity score, English, 5 years, academic journals, drug addicts= 499 results 3) A meta-analysis study -1 pertinent studies 4) 2 systematic reviews= (McNicol, E. D., Ferguson, M. C., & Hudcova, 2015), and (Weibel et al, 2017) CINAHL database 1) Keywords: Patient Controlled Analgesia (PCA), intermittent analgesia dosing or intravenous injections= 2112 results 2) 2 systematic review (Elliott, 2016), and (Pritchard, C., Smith, J. E., Creanor, S., Squire, R., Barton, A., Benger, J., ... & Rockett, 2017) PubMed Central 1) 2) 3) 4) 5) 6) 7) 8) Keywords: Patient Controlled Analgesia (PCA), intermittent analgesia dosing or intravenous injections= 4992 results 5 years, humans, English = 225 results Epidural analgesia= 5 results 1 systematic reviews (Elliot, 2015) Keywords: Patient Controlled Analgesia (PCA) vs. alternative analgesic methods =200 results 1 meta analysis study a randomized controlled study 2 systematic review (Bijur, P. E., Mills, A. M., Chang, A. K., White, D., Restivo, A., Persaud, S., ... & Birnbaum, A. J, 2017), and (Pritchard, C., Smith, J. E., Creanor, S., Squire, R., Barton, A., Benger, J., ... & Rockett, 2017). Study Evaluation – One Citation Purpose Design & Method Sample & Setting Major Variables Measurement of Major Variables Data Analysis Study Findings Appraisal of Evidence McNicol, E. D., Ferguson, M. C., & Hudcova, J. (2015). Patient controlled opioid analgesia versus non‐patient controlled opioid analgesia for postoperative pain. The Cochrane Library. Assessment of Level I and II evidence to establish if PCA reduces pain after post operation surgery Systematic Review of 6 Level I or II studies A sample population of 2023 patients receiving PCA medication and 1838 patients receiving nurse injections at the hospital. A higher level of satisfaction is used as a parameter to measure the variation between opioid analgesia and noncontrolled opioid analgesia. Number of PCA satisfaction index is used to measure the variation in PCA and non-patient controlled analgesia. Scores over 0 to 24 hours were nine points lower (95% confidence interval (CI) -13 to -5, moderate quality evidence) and over 0 to 48 hours were 10 points lower (95% CI -12 to -7, low quality evidence). The study found that patient receiving PCA medication express a higher level of satisfaction as compared to those who are receiving nurse injections. Level I, strong evidence is found in PCA 0.95> as opposed to intermittent dosing. Summary: This is a systematical analysis of the effectiveness of PCA as compared to intermittent analgesia dosing. To justify the effectiveness of PCA, the study relied on a sample population of 2023 patients receiving PCA medication and 1838 patients receiving nurse injections. The article reveals that patient receiving PCA medication express a higher level of satisfaction as compared to those who are receiving nurse injections. The high level of satisfaction originates from the fact that the patients have full autonomy to control quantity of medications to their bodies as well as the duration of medication. Application to Practice: This study reveals that there is strong evidence for PCA as opposed to intermittent dosing. This is used to provide evidence to justify the need to embrace PCA in the healthcare setting. Study Evaluation – Two ) Citation Purpose Design & Method Sample & Setting Bijur et al, 2017). Comparative Effectiveness of PatientControlled Analgesia for Treating Acute Pain in the Emergency Department. Annals of Emergency Medicine. An assessment of PCA in pain management at emergency department. pragmatic randomized controlled study is used in this article. A sample of Six hundred thirty-six patients were enrolled for a pragmatic randomized controlled study. Major Variables Time, cost, and satisfaction indexes are major variables examined. Measurement of Major Variables Data Analysis Study Findings Appraisal of Evidence PCA pain management duration based on time frame set. The rate of decline in pain from 30 to 120 minutes was greater for patients receiving PCA than usual care (difference=1.0 numeric rating scale unit; 95% confidence interval [CI] 0.6 to 1.5; P95% CI for PCA patient but did not meet threshold for clinical significance. Summary: This provides a randomized controlled study where 636 patients were used to perform the comparative study on the effectiveness of PCA in pain management in the emergency department. The study reveals that PCA reduces the pain score as compared to traditional pain management such as intermittent dosing. Apart from minimizing the pain, the study reveals that PCA improves the level of satisfaction of patients. Application to Practice: This is a strong study in favor of PCA as compared to intermittent dosing. This study is used to justify why patients are now preferring PCA as opposed to intermittent nursing analgesia as a system for pain management. Study Evaluation – Three Citation Purpose Design & Method Sample & Setting Major Variables Measurement of Major Variables Data Analysis Study Findings Elliott, J. A. (2016). 6 Patientcontrolled analgesia in the management of acute pain. Handbook of Acute Pain Management, 110. Review evidence to create PCA recommend ations as a best method for pain managemen t A metaanalysis study is conducted with a sample population of six patients. The method employed is sampling techniques. The study is conducte d at hospital setting with a sample populatio n of 6 patients. Does not specify Does not specify There is strong correlation between PCA and pain reduction. The study found that PCA is effective as compared to traditional pain management techniques because there are potentially fewer fluctuations in plasma analgesic concentrations; these minimize the occurrence of adverse effects and inadequate analgesia Appraisal of Evidence Level I evidence, Level I, strong evidence, >95% CI, To support the need for application of PCA in pain management. Summary: This is a meta-analysis study. The study reveals that patients using PCA postoperatively demonstrates a high level of satisfaction as compared to those using intermittent intramuscular dosing. According to Elliott (2016), PCA use is effective as compared to traditional pain management techniques because there are potentially fewer fluctuations in plasma analgesic concentrations; these minimize the occurrence of adverse effects and inadequate analgesia. Application to Practice: This study is a combination of several studies to create a meta-analysis, which is considered strong evidence. PCA are used to reduce plasma analgesic concentrations; these minimize the occurrence of adverse effects and inadequate analgesia. Study Evaluation – Four Citation Purpose Design & Method Sample & Setting Major Variables Measurement of Major Variables Data Analysis Weibel et al, 2017). Patient‐contr olled analgesia with remifentanil versus alternative parenteral methods for pain management in labor. The Cochrane Library. To offer awareness to nurses and patients on the need to embrace PCA in pain management . Randomized controlled trials (RCTs) and clusterrandomized trials comparing PCA with non-patient intermittent dosing. A sample of Twenty RCTs with 3569 women were included. The setting was hospital. Pain duration and satisfaction index are the major variables used. Time duration is used for measuremen t of pain management There is strong evidence of effect that PCA Study Findings Appraisal of Evidence PCA provided stronger pain relief at one hour than other opioids administered Level I, There is strong evidence of effect that PCA provided stronger pain relief at one hour than other opioids administered IV/IM (SMD -1.58, 95% CI -2.69 to 0.48, three trials, very low-quality evidence) Interpretation Four Summary: This is a systematic review and meta-analysis assessment of the safety and efficacy of PCA use as compared to intermittent dosing for labor pain management relief. The study reveals that patients in labor using a PCA is very safe and an effective strategy for offering pain relief after undergoing childbirth. According to the study, PCA use is effective because it allows patients to manage their pain. Unlike the intermittent dosing, PCA use is effective because it reduces interruption which might arise during the absence of the nurses. Application to Practice: This study is a combination of several studies to create a cluster-randomized trials, which is a level I strong evidence. It used in the practice to offer awareness to nurses and patients on the need to embrace PCA in pain management. Study Evaluation – Five Citation Purpose Design & Method Sample & Setting Major Variables Measurement of Major Variables Data Analysis Study Findings Appraisal of Evidence Pritchard et al, (2017). The cost‐effectiven ess of patient‐contro lled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital. Anesthesia, 72(8), 953-960. Assessment of Level I and II evidence to establish if PCA reduces pain after post operation surgery as well as whether it reduces the cost incurred by the patient. Sampling technique and Pain scores were measured hourly for 12 hours using a visual analogue scale. Emergency Department at the hospital is the setting. The Sample population are participants suffering pain from traumatic injuries. Time and satisfaction index are the major variables used. Time duration was used. There is a significant different between PCA patients and noncontrolled treatment in pain management . It is found that PCA reduce postoperativ e depressive symptoms, increase patient's level of satisfaction, and lower preoperative anxiety. Level I evidence, Level I, strong evidence, >95% CI, high implications for practice change Summary: This study offers an interesting perspective on the cost-effectiveness perspective of PCA use as compared intermittent dosing used in pain management. The study reveals that PCA use reduces postoperative depression as well as reducing preoperative anxiety. The lower postoperative anxiety and depression indexes originate from the fact that patients tend to develop full trust and perception towards a PCA pump which is used to administer the medication. The article states that intermittent medication is not effective because patients tend to have the perception that nurses are not administering the right medication nor at the right time. Application to Practice: This study provides evidence to justify that PCA use reduces postoperative depressive symptoms, increase patient's level of satisfaction, and lower preoperative anxiety. Conclusions  In conclusion, PCA use has been shown to be more effective in managing and treating pain as compared to intravenous injections or intermittent intramuscular injections administered by nurses to the patients.  Studies have also concluded that PCA use increases levels of perception of situational control.  PCA use reduces postoperative depressive symptoms, increase patient's level of satisfaction, and lower preoperative anxiety.  PCA use also increases control over pain relief.  PCA use include not having to summon nurses and not having to receive nurse injections. References  Bijur, P. E., Mills, A. M., Chang, A. K., White, D., Restivo, A., Persaud, S., ... & Birnbaum, A. J.     (2017). Comparative Effectiveness of Patient-Controlled Analgesia for Treating Acute Pain in the Emergency Department. Annals of Emergency Medicine. Elliott, J. A. (2016). 6 Patient-controlled analgesia in the management of acute pain. Handbook of Acute Pain Management, 110. McNicol, E. D., Ferguson, M. C., & Hudcova, J. (2015). Patient controlled opioid analgesia versus non‐patient controlled opioid analgesia for postoperative pain. The Cochrane Library. Pritchard, C., Smith, J. E., Creanor, S., Squire, R., Barton, A., Benger, J., ... & Rockett, M. (2017). The cost‐effectiveness of patient‐controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital. Anesthesia, 72(8), 953-960. Weibel, S., Jelting, Y., Afshari, A., Pace, N. L., Eberhart, L. H., Jokinen, J., ... & Kranke, P. (2017). Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labor. The Cochrane Library.
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