Patient Undergoing Total Hip Arthroplasty: A Perioperative Pain Experience - Research Proposal Example

Research Critical Appraisal The primary research paper Patient Undergoing Total Hip Arthroplasty: A Perioperative Pain Experience by Margareta WarrénStomberg, PhD, RNT and Ulla-Britt Öman sought to assess pain experience of patients who have undergone total hip arthroplasty (THA hereafter), a surgical procedure involving the replacement of the hip joint with prosthetic implant, after a nurse trained in POPM preoperatively apprise and educate them on pain management at the surgical ward. Done in a small Swedish hospital within an unnamed period of time, the research entailed a survey, using a 17-item questionnaire, of 112 respondents between the ages of 37 to 87 years old of both male and female genders, all of whom speak Swedish. The actual research did not entail significant ethical concerns considering that much of it was presumably done personally and voluntarily by the respondents by filling up the 17-item questionnaire after informed consent was obtained. Aside from the individual informed consent, the researchers also acquired prior approval from Research Ethical Committee at the University of Gothenburg. The researchers, however, failed to state how they were able to gain access to hospital data regarding patients who are scheduled for THA. Privacy and confidentiality of medical records relative to medical research studies have always been problematic areas from the perspectives of patients (Lo 2009 82). It is notable, however, that the research has specifically excluded patients who are critically ill and mentally impaired. Employment of mentally impaired persons in research studies is ethically questionable considering that historically they have often been subjected to research abuses (Lo 2009 145). Pain management, which is the focus of the research paper, is an important area in nursing (Holzemer 2009 39) making the paper significantly relevant to the profession. Although the subject itself is well delimited, the research may not have successfully delimited the parameters of participating respondents considering that their ages ranged from 37 to 87 years old. The variance of pain experience between age groups is noted by the researchers themselves who made a vague reference to it on page 454 of the research paper. In addition, the paper fails to explicitly state its working theory at the beginning as such although the entire paper is obviously underpinned by it and refers to it under a different heading. It is evident that the research is trying to prove that a realistic expectation of the pain entailed by a THA surgical procedure is pivotal in the postoperative recovery of a patient, yet this statement is relegated under the heading “Background.” Nevertheless, the research paper is significant to the nursing profession because it serves to underscore the role of nurses as vital cogs in educating and assisting patients gain realistic expectations of perioperative pain after surgical procedures like THA. The research provides an extensive list of references, a significant number of which are dated from 2000 up to the time the research was submitted for application albeit there were a number which were dated as far back as 1991. Overall, the paper is well-researched and thoroughly supported. Proof of this is that the references include a significant number of primary sources published from known medical journals and only a couple of books. Journal and journal articles are often the best sources of medical research because they tend to offer specialised knowledge and make such excellent supporting evidence for research and practice (Gerrish & Lacey 2006 66). That the researchers succeeded in culling relevant and material references from among a wide literature available at present on the subject is a testament to the paper’s tightly defined framework. In a research study, the importance of a good theoretical framework cannot be overemphasised because without it, the research may be problem-based and lacks applicability in other settings (Mateo 105). In the research paper in issue, the theoretical and conceptual framework of the paper are established in the introductory part by establishing the progress of pain management through the years, noting that despite such progress however, pain management remains an important issue postoperatively. It then cited THA as one of the major sources of pain management issues preoperatively and postoperatively, and mentioned Quintrec et al’s comparative study of THA bound patients who received routine information of the procedure to a control group of patients also due for THA who underwent multidisciplinary information sessions on the procedure, of which a nurse constituted one of the staff. The result showed that those in the latter group had reduced preoperative pain and anxiety than the other. Evidently, the hypothesis of the present research paper naturally flows from the aforesaid theoretical framework. However, the research failed to explicitly tie this up with the conclusion of the paper. The research calls for the assessment of pain experience of the respondents after the THA procedure and the relevant pain management satisfaction which therefore calls for the application of the descriptive comparative design, employed by the research. Descriptive comparative designs essentially describe and compare variables with the use of descriptive and inferential statistics (Brink & Van der Walt 2006 104). In the present research, a pre-experimental intervention was used which was the employment of the POPM-trained nurse who informed the patients of the different aspects of pain management to be expected perioperatively. The research is longitudinal having been conducted through the course of a considerable period of time. Answering the 17-item questionnaires was left entirely to the prerogative of the respondents as implied by the paper, some of which were later mailed after the patients were released from the hospital. The implication is that the researchers had no control over how each respondent interpreted the questions; hence, the research’s internal validity cannot be wholly measured. Internal validity is best measured when the researchers have complete control over the subjects as mice in the laboratory (Berg & Latin 2007 12). Since THA is considered one of the sources of major pain experiences, the research, with a sufficient sample size of 112 respondents, may be a good basis for generalisation of pain management in perioperative surgical procedures. However, the research notes a variance of variables in pain experiences among the young and the old as the sampling involves both genders with ages ranging from 37 to 87 years old. Since the paper does not specify the actual number of respondents belonging in the age groups, it would be difficult to tell if such numbers meet the representativeness of a good quantitative sampling. A good quantitative sampling must be representative of the population, implying that the research must have the same number of young respondents to respondents in the old age group as there are the same numbers, more or less, of female to male respondents (Polit & Beck 291). Most qualitative studies make use of self-report methods, a method which involves obtaining opinions, characteristics and experiences of people (Fitzpatrick & Wallace 125, 126). The present study albeit essentially qualitative in that it aims to obtain perceptions and experiences of respondents is actually quantitative because it seeks to measure pain management satisfaction and evaluate pain experiences of THA respondents. Quantitative research is characterised, among others, by a structured or predetermined methodology, empiricism, the quantification of a phenomenon as opposed to the unstructured or open methodology, rationalism, descriptive approach of the qualitative method (Kumar 2005 17). Despite its quantitative methodology, the research lends itself to the self-report method and employed the best possible mode of collecting the data, as this was the least invasive mode considering the perioperative condition of the respondents. Had an interview been employed, the researcher, out of ethical considerations, would have to wait at the time the respondents were already truly recovering, the gap of time diminishing memory of the pain. The use of Q sort is not advisable as it is time-consuming (Watson 2008 327) and may present a burden to the perioperative respondent; neither is the vignette approach appropriate because it opens to the possibility of response biases (Loiselle et al 2010 241), and; projective techniques entail the employment of stimulus-situations which may add burden to suffering of the perioperative respondent (Kothari 2008 107). Needless to say, since the questionnaires were self-administered, the research did not involve observational methods and which is not really, in any case, relevant to the research because it is an empirical approach at culling pain management issues whilst data collection was conducted by the researchers themselves who, judging from their credentials, are quite qualified to do the job. The research itself does not warrant the integrity of the data, which is understandable considering that the questionnaires were impliedly self-administered and left to the device of the respondents. This fact can be inferred from page 453 of the paper which states that “The completed questionnaire was mostly handed in before the patient left the hospital or returned by mail in prepaid envelope within a week after discharge from hospital.” From the data gathered, however, it can be said that congruence exists between the conceptual variables and as operationalised, considering that the collected data shows that the respondents have a high pain management satisfaction rating. However, that conclusion cannot be said to be actually valid because there is no other set of data which it can be compared with to arrive at valid conclusion that perioperative pain management is likely to be more successful when patients undergo pain management sessions under a POPM-trained nurse than those who did not. The research paper Patient Undergoing Total Hip Arthroplasty: A Perioperative Pain Experience is aimed at measuring pain management satisfaction of perioperative respondents after a THA procedure through evaluation of their respective pain experiences. Although it calls for the individual experiences of pain, the approach methodology employed is quantitative considering the empirical intent and structured design of the research. Evidently, the researchers took an extra step to ensure that ethical considerations are not breached considering the sensitive nature of the research requiring respondents, in their most vulnerable state, to contemplate and answer questions pertaining to the pain they were actually experiencing. As earlier stated, the paper employs the descriptive comparative design which makes the research easier to read. It employs thorough and extensive references, citing journal articles and reports from such credible and specialised sources as the Journal of Arthroplasty, British Journal of General Practice, Journal of Bone and Joint Surgery and Clinical Journal of Pain, among others, thereby giving credible medical and scientific support to it. The paper lays down a strong conceptual and theoretical framework at the onset but however, fails to tie this up to the conclusion at the end of the paper which gives the paper a less consolidated overall finish. In addition, the underpinning thesis is not explicitly stated in the paper leaving readers to determine and construe for themselves the hypothesis underlying the paper. Finally, although the result of the research convinces the reader of the merit of teaching patients realistic perspective of perioperative pain, the paper fails to provide him with a comparative set of variables that would justify such a conclusion. 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