clinical practice guidelines group output

8/14/2019 CLINICAL PRACTICE GUIDELINES group output

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YOUR NAMES WITH CREDENTIALS

EPIFANIO M. ELLAZAR RN, M.A.Ed

INSTRUCTOR III

NURSING RESEARCH COORDINATOR

URDANETA CITY UNIVERSITY

JUDITH A.LAYAO BSN,RN, MAN

UNIVERSITY OF THE CORDILLERAS BAGUIO

COLLEGES FOUNDATION

BAGUIO CITY

APRIL ANNE D. BALANON BSN,

UNIVERSITY OF THE CORDILLERAS

COLLEGES FOUNDATION

BAGUIO CITY

LUCKY P. ROAQUIN BSN,RN,

FACULTY

ST. TONI’S COLLEGE INC

TABUK CITY



•It has been

managemare sub opt

Schafheut2001) this u

accentuatea ra

ano

•Desp

iteconsiderableadvancements in thefield of painmanagement,research indicates

that a big proportionof patientsexperience extremelevels of pain aftersurgical intervention.

WHY DO WE

CONDUCT CLINICAL

RESEARCH ANDAPPLY EVIDENCE TO

PRACTICE?

To impro

care anOutc



1. This excessive incidence of post operative pain has been consistently in literature for over 40 years which illustrates the sigthe problem.

2. Nurses play a central role in the management of patient’s pain ( 2009) which underscores the explicit need for nurses to dexcellence in every area of pain management to enable the appr

effective management of patient’s pain.3. Furthermore, nurses lay a pivotal role in the management of pa

following surgery as they are the health care professionals whohour care. (Tsai et al. 2007).



0

10

20

30

40

50

60

70

80

90

Amputation Thoracotomy Inguinal Hernia

Repair

Coronary Bypass Cesarian Section Mastectomy Cholecystectomy Dental Surge

International Prevalence of Chronic Pain after Surgery

Series 1 Series 2 Series 3



Sub Procedures For Development:

Pain

Management

Pain

Assessment

b. non pharmacologicala. pharmacological0- 10 Scale

(Numerical Scale)

Painmanagement

rating

(medication)

Pain

Assessment

form

Painmanagement

rating

(treatment)



SEARCH FOR THE EVIDENC

WHERE DID YOU

LOOK FOR THE

EVIDENCE?

EXTERNALINTERNAL

The status of perioperative pain therapy

in Germany. Results of a representative,

anonymous survey of 1000 surgical

clinic. Pain Study Group. Chirurg 1998

Fletcher D, Fermanian C, Mardaye A,

Aegerter P. A patient based national

survey on postoperative painmanagement in France reveals

significant achievements and

persistent challenges.

Fletcher D, Ferma

Aegerter P. A pat

survey on posmanagement i

significant ach

persistent

The status of periop

in Germany. Results

anonymous survey

clinic. Pain Study Gr



Literature Search/Databases use

Key terms used: pain management, pooperative, pain assessment, pain monitorin

www

guidelin

g



Health care association of New JerStanford Hospital and Clinics

USE OF OTHER SOURCES

# of articlesRetained 4



HOW DID YOU DECIDE WHICH ARTICLES TO KE

EVIDENCE



EVIDENCE

SYNTHESIS(Based on Variable of In

independent or depende

P

I

O

C

Patients who are suffering from postoperative pain in the orthopedic ward who u

fractured limbs.

30-minute cognitive behavioral approach educational intervention

The intervention might play an important role in reducing the pain felt by the pat

underwent surgery for fractured limbs.

Usual care for pain management



Evaluation and Synthesis of the Evid

Complete

Citation, incl.

Funding &

country of

study

Wong, E., Chan, S., & Chair, S. (2010). The effect of educational intervention on pain beliefs and pos

relief among Chinese patients with fractured limbs. Journal Of Clinical Nursing, 19(17/18), 2652-265

doi:10.1111/j.1365-2702.2010.03260.x

Country: China

Research

Design

Sample

Design: Quasi-Experimental Design

Sample:

N=125

Patients from six orthopaedic wards in two regional hospitals. Patients who met the inclusion criteria

ambulatory before injury; a traumatic limb fracture and undergoing surgery; no history of chronic pai

mental illness) were invited to participate with informed written consent.

Intervention

Agent

(dose,

amount)

A 30-minute cognitive behavioural approach educational intervention (CBEI) was developed based on

behavioural theory and a qualitative study on Chinese patients’ pain experience.

First 5

minutes

Build up rapport with the

participant

Introduction

10 minutes Enhance patients’ knowledge on

pain and pain management

State the key points of benefit of good pain man

- Good pain relief can improve capability of act

speed up recovery

- Pain leads to all kinds of psychological discom

in vicious circle of tension and more pain

- Option of pain relief available after surgery

- Measures to do when pain is present

10 minutes To relax and regain self-control of

body

Demonstration & redemonstration of breathing

exercises skill

1 Sit up right or lie flat, fully breathe out by mo



QUANTITATIVE EVALUATION TAB

Study Citation, include

country & funding

source

Purpose

Question/

Variables

Design

Setting

Subjects

Subjects/Sample Findings Methods Data Analysis

Results

Implica

Practi

Limit

Citation:

Wong, E., Chan, S., &

Chair, S. (2010). The

effect of educational

intervention on pain

beliefs andpostoperative pain

relief among Chinese

patients with fractured

limbs. Journal Of

Clinical Nursing,

19(17/18), 2652-2655.

doi:10.1111/j.1365-

2702.2010.03260.x

Country:

China

Funding Sources:

Not included

Purpose,

research

question or

hypothesis

To examine the

effectiveness ofeducational

intervention in

improving

outcomes pain

barrier score,

pain level and

analgesic use

among Chinese

patients with

limb fractures

that had

undergone

surgery.

Variables

Independent or

Correlates:

Educational

Interventions

Dependents

Pain beliefs and

postoperative

pain relief

Design:

Quasi-Experimental

Setting:

6 orthopedic wards

in two regionalhospitals in China

Data collection

lasted for nine

months until March

2007.

Who?

A patient with a

fractured limb

receives emergency

orthopedic surgery if

the fracture cannotbe solved by

external fixation

with a cast or splint.

Demographics

(major variables)

Gender, Age,

Educational Level,

Employment, Injury

Type

Selection Criteria:

Patients who met

the inclusion criteria

(age ‡18;

ambulatory before

injury; a traumatic

limb fracture and

undergoing surgery;

no history of chronicpain or cognitive or

mental illness) were

invited to

participate with

informed written

consent.

Patients were

randomly assigned

to experimental and

control groups.

Size (power

analysis)

N=125

n=62 (Experimental)

Briefly describe the

findings

A total of 125

participants

completed the study

(62 in theexperimental group,

63 in the control

group). The

participants were

homogenous in their

demographic data

and baseline clinical

characteristics.

The experimental

group had a

significantly lower

pain barrier and

lower intensity of

pain, between-

subject effect and

interaction effect.

The post hoc Tukey

test showed a

significant effect for

the day 2 –4 periodand the day 4 –7

periods. There might

have been an

intervention effect

on pain outcomes

with the

experimental group

having a statistically

higher frequency of

analgesic use at day

2, but there was no

significant

difference between

the groups at day 4

and day 7.

Intervention/

Procedure

A 30-minute

cognitive behavioral

approach

educationalintervention (CBEI)

was developed

based on cognitive

behavioral theory

and a qualitative

study on Chinese

patients’ pain

experience.

Instrument/Scales:

The VAS (Visual

Analogue Scale) is

used to determine

the acute pain level

experienced by the

subjects. The

Modified Pain

Barrier Scale was

used to measure

pain barrier at T0and T3.

Data Collection:

Patients who met

the inclusion criteria

were invited to

participate with

informed written

consent. Ethical

approval was

obtained from the

university and the

study venues. All of

the healthcare

professionals

Statistic Used:

Repeated measure

ANOVA was used to

determine the Pain

VAS scores. t-test

was used todetermine the

results Pain barrier.

Fischer’s test and

chi-square test are

used in Analgesic

Test.

Important statistical

findings:

Pain VAS Exp Grp:

T0 = 55.8 (13)

T1 = 46.0 (21)

T2 = 29.8 (18)

T3 = 22.7 (17)

p = 0.0008

Pain VAS Control:

T0 = 61.10 (23)

T1 = 54.10 (21.2)

T2 = 42.70 (20.4)T3 = 30.8 (21.2)

p = 0.0008

Implicatio

Practice:

Nurses ca

brief but e

education

interventipatients w

sustained

fractures.

Limitation

possible

explanati

findings:

Randomiz

among six

might indu

sample bi

Hawthorn

might be p

as the exp

group mig

that they

education

Environm

factors (ligsurgeon s

experienc

patient’s o

condition

have influ

outcomes

DRAFT A SECTION OF THE



DRAFT A SECTION OF THE

GUIDELINES

Pain

Assessme

nt

0- 10 Scale

(Numerical Scale)

Pain

Assessment

form

PAIN ASSESSMENT FOR OLDER A

ELLEN FLAHERTY PhD APRN BC

DARTMOUTH HITCHCOCK

MEDICAL CENTER

Heartford Inst

Nursing New

ISSUE # 7

Th NRS i th



The NRS asks the patient to

rate the pain by assigning a

numerical value with zero

indicating no pain, and 10

representing the worse painimaginable.

The NRS is the

well used too

Verbal descrip

scale, Faces pscale revised

The NRS had good internal

consistency with Cronbach’s Alphacoefficient of 0.85-0.89

Test re test reliability for each

range from 0.57-0.83

The overall stre

of this scale isability to quickly

reliably screen

pain



PAIN RATING SCALEPAIN SCREEN

TOOLS

PAIN ASS

TREATMENT PLAN DEVELOPMENT AND

IMPLEMENTATION

EDUCATION AND

TRAINING

PAIN ASSESSMEPAIN RATING TOOLPAIN SCREEN TOOL

ALTERNATIVE INTEPHARMACOLOGIC

APPROACHES

NON PHARMACOLOGIC

APPROACHES



Stakeholders



Potential Challenges and Facil



Pilot Unit

BGH



Evidence-based Practice Chang



Educational Plan



Definition of OutcomesMeasurement of outcomes



Data Collection



Data Entry and Analysis



Implications for Nursing Practic

1. To what extent would the benefits support the time and einvolved in implementing the change in practice?

2. How costly would it be to start this change in practice? Tosustain?

3. To what extent would the benefits of the changes be prop

to all the difficulties inherent in implementing this change4. How will decide whether to adopt, adapt, or discard?



Questions??

clinical practice guidelines group output

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