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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.