Acute pain for postoperative patients in Kuwait - Assignment Example

? Ethical Approval of Research Council or other funding organisation (if applicable 1a. of proposed research project Acute Pain for Postoperative Patients in Kuwait: A Study of How Surgical Nurses Assess Postoperative Pain 1b. is this Project Purely literature based? NO 2. Project focus According to Strauss and Corbin, research itself is only one of four possible sources of the research problem. Research problem can come from literature or researcher personal and professional experience. Therefore, I can add that from my clinical experience in Kuwait, I believe that pain assessment is very weak and not clear. Nursing in Kuwait is under development and there are only one or two persons with a PHD in Nursing in Kuwait. This is very disturbing because it shows that the nurses in Kuwait are not as competent as the nurses in other countries. In this light, the aim of my research is to gather evidence based to develop the best practice in Kuwait. Last, there is no good practice or an international assessment which is perfect or universal. 3. Project objectives To explore nurse’s knowledge of pain assessment; To analyze the perceptions of nurses and patients of pain assessment in a Kuwait surgical setting; To identify potential factors that could affect how the patients respond to post-operative pain. 4. Research strategy (For example, outline of research methodology, what information/data collection strategies will you use, where will you recruit participants and what approach you intend to take to the analysis of information / data generated) Due to the subjectivity of pain experience a qualitative method will be used for this study, which seeks to provide a perception of how or why things are as they are. Data will be collected through face-to-face semi-structured interviews with nurses and separately with patients. This is only fitting considering that Hancock (1998) relates that data collection in a qualitative research involves direct encounters with individuals through one to one interviews. In-depth interview allows intensive exploration of a topic with someone who has had related experiences. Open-ended questions will be used during the interview. The questions to be asked during the interview are not prepared prior to the interview. The researcher in charge of this exercise formulates the questions during the interview. He/ she ask what they think is in line with the interview and recorded the responses given by the patient. This is in contrast with close-ended questions which may limit further exploration of the participants’ experiences. Purposive sampling will be used in this study. Typically the recommended sample for grounded theory is about 20 to 30 participants (Helfand, M., & Freeman, 2008). Determining the sample size depends on the quality and richness of the data. This research will aim to involve as many interviewees as possible to the point that the responses being gathered from the new interviews being conducted are the same as the responses gathered from your prior interviews. Recruitment Once College ethical approval is gained, the researcher will send a formal letter to the hospital administration in Kuwait and to the surgical unit supervisor or manager requesting permission to recruit patients and staff from the hospital. Once the approval is gained the researcher will then proceed to place a notice/poster in the surgical ward which will invite volunteers from among surgical nurses and patients who are willing to take part in the research or those who are readily available to become participants of the research.There is no ethical committee in the Kuwait hospital; therefore organizational approval will be gained from the Manager. Phase one: interviewing the nurses The research will involve registered nurses who work in surgical units. The nurses to be included in the interview should at least possess a bachelor’s degree from a recognized institution of higher learning in nursing and a minimum of three years working experience. Those are the requirements that should be met for the nurse who is to take part in the interview. It will take place in the office of the head nurse which is located in the wards. Only those nurses who are currently assigned in the surgical unit of the Kuwait Hospital will be eligible to participate in the study. The questions for nurses covers main areas of interest such as how one is to know when patients are in pain, the parameters or cues that the patients are to use to signal that they are in pain, the most common reactions of patients towards pain, how to assess the pain, and find out if all patients complain about their pain. Phase two: Interviewing the Patients The research will involve post-operative patients in surgical units. All patients are eligible to participate in the interview, but this will be limited to those patients who have fully recovered from the general anesthetic and are aver 18 years. The aim of interviewing the patients is to solicit their views and opinions about their experience of post-operative pain. Ultimately, the researcher seeks to understand the feelings, attitudes and influences related to the pain and the assessment of pain. All participants will be over 18 years old and patient under 18 will be excluded. For those who wish to participate, a verbal preapproval for the interview will be taken from them a day or two prior to the surgery. I will leave it for the patient to choose his/her preferred time after the recovery period and then have him/her sign the form of consent. If the patient is comfortable, then their name along with the date they choose for the exercise to take place can be recorded. If a patient agrees to participate in the interview, but afterwards declines and the consent had been recorded, it will just be cancelled. The findings will be used to aid in the improvement of the pain assessment by the nurses. As in any research, it is often significant to ?rst establish a clear schedule to the participants. Hence, Head nurse has to be informed earlier so that the head nurse can arrange a suitable time and place to allow the nurses and patients to participate in the research. Upon the approval, the interviews will take place during the morning session, a day after the surgery. It is preferable to conduct the interview in the morning because there is no distractions e.g. visit. This is to ensure that the patient is more composed, and hence the responses given will be accurate enough. But all in all, there is the one who has the final say on when to be interviewed is the patient. He/she should be given the chance to choose when they want the interview to be conducted. 24 hours after the surgery is preferable in that it gives the patient ample time to recover from the surgery and therefore they will be in a position to participate in the interview. The interview will take place in the surgical unit’s office, because interviews should be conducted in areas free from distractions and at times and locations that are most suitable for participants. The length of interviews varies depending on the researcher and participant. However, on average interviews last for 8-9 hours. Timeline: 01/2013 – 02/2013 Ethical approval from SalfordUniversity applied for and awaited. Meet with the hospital director and the head nurse of the surgical units and explain the study purpose and the methods which are going to be used to conduct the research to gain permission to do study. 3/2013- 6/2013 Subject to gaining ethical approval, nurse interviews will be conducted as well as patients’ interviews of pain assessment. The data collection and analysis of data will commence. 6-9/2013 Data analysis will be completed and research findings written up for peer-review. The data from the qualitative interviews will be analyzed using Strauss and Corbin’s (1998) approach. This involves three types of coding: open, axial and selective coding (p.217). Open coding relies on the comparison of the differences and similarities. It tags portions of data depending on their content (Strauss and Corbin, 1998, p.217). In axial coding, the researcher sub-categorizes the data under broader headings by seeking the relationship between the codes (Strauss and Corbin, 1998, p.217). Selective coding focuses on incorporating and filtering the findings (Strauss and Corbin, 1998, p.217). It concentrates its attention on just the core codes, which are the codes, emerged from open and axial coding (Strauss and Corbin, 1998, p.217). Other groups may come to light during analysis such as grouping nurse participants’ responses by their number of years in service as nurse. Ultimately, this analytic process will enable categories to emerge from the data which may be used later to develop understanding about the assessment and management of pain. 5. What is the rationale which led to thisproject? (For example, previous work – give references where appropriate. Any seminal works must be cited) Suboptimal pain management can lead to the development of harmful effects including worsening of pain that impairs the patient’s quality of life and social determinants (for example, affecting relationships and employment capacity); continuous pain leading to depression, anxiety and suicidal tendencies; and, constant pain that prolongs the body’s stress responses which can at times lead to health complications (such as suppressed immune functions, increased cardiac risk, increased susceptibility to hormonal imbalance( Canale, S. T., & Beaty, 2008) It is proposed that pain assessment is difficult and it is affected by a number of variables (for instance, knowledge of pain cues, consistent tools for pain assessment, and competency in pain assessment) that the nursing practice needs to understand the process more fully to be able to progress practice going forward. It becomes problematic since pain is subjective and all the other aspects that influence pain assessment are varied such as age, gender, medications, previous pain, culture, and so on (Carr et al., 2010; Khan et al., 2011), Therefore, appropriate assessment and management of pain are essential for good nursing practice to improve their health outcomes (Al-Khaffaf & Dorgan, 2005). No research has been conducted on the status of pain assessment by nurses in the hospital setting in Kuwait. This research proposes a grounded theory approach which will allow for an exploration of pain assessment strategies undertaken by nurses in a Kuwait hospital setting. The theory that will emerge from this research will provide a great understanding of the standard of pain assessment in Kuwait and how to improve such a standard. 6. If you are going to work within a particular organisation do they have their ownprocedures for gaining ethical approval (For example, within a hospital or health centre) NO If YES – what are these and how will you ensure you meet their requirements? There is no formal ethical approval process required in Kuwait hospitals. However the researcher seeks an authorization from the hospital administration and to the surgical unit. Before we are granted the approval by the administration, we have to assure them that all the ethical issues that we had considered are going to be implemented. This is important to ensure that data security is addressed. If not, then the hospital is going to gain a bad reputation of not guarding confidential information and this might paint a bad picture of the hospital’s administration. To avoid all this, it is vital to address the issue of ethics before conducting the research. 7. Are you going to approach individuals to be involved in your research? YES If YES – please think about key issues – for example, how you will recruit people? How you will deal with issues of confidentiality / anonymity? Then make notes that cover the key issues linked to your study Purposive sampling will be used in this study. The research will involve nurses who work in surgical units and patients in the surgical units. Only those nurses who are currently assigned in the surgical unit of the Kuwait Hospital be eligible to participate in the study. Only registered nurses will be included. Doctors, midwives, pharmacists, nursing aides or nursing students will not be included in the sample population. Once the approval is attained, the researchers will then proceed to place a notice/poster in the surgical ward which will invite volunteers from among surgical nurses and patients who are willing to take part in the research or those who are readily available to become participants of the research. Putting up posters is important because it makes the patients aware of the research and they can be able to make their decision whether or not they are willing to take part in the process without them feeling like they are being pressured to do so. This will ensure that they give accurate responses during the interview because they chose to participate in the interview out of their own free will. 8. More specifically, how will you ensure you gain informed consent from anyone involved in the study? Informed consent will be an on-going process rather than a single detached event (NMC 2010). In nursing care, consent is the legal means by which a patient gives a valid authorization for treatment and care (Hackett & Montte, 2000). This NMC declaration can be applied in this case by ensuring that the semi-formal teaching prior to the actual interview as well as the interview it are done in a professional and respectful manner. This is logical because nurses must not expect that the participant is well versed in nursing research. A full and detailed participant information sheet will be provided. All participants will be given at least 24 hours to decide if they want to participate. The participants will be given sufficient time to process the information and the opportunity to ask questions if he/she wishes to (NMC 2010).There will be contact details provided for any concerns or questions that participants may have before, during and after the study. Written and verbal consent will be obtained on the day of the interview. 9. How are you going to address any Data Protection issues? See notes for guidance which outline minimum standards for meeting Data Protection issues During the actual interview, the researcher will inform the participant about the purpose of the interview. It is to be done by providing a participant information sheet which utilizes appropriate language for the age and comprehension of the participant group thus using options related to the consent form. It is during this stage that the ethical principle of veracity comes into play. Fry and Johnstone (2002) state that the principle of veracity implies the obligation to tell the truth and never deceive people. This means that in educating the participant as to the purpose of the interview, the researcher will disclose all the information related to the research in order for the participant to comprehend fully the nature of the interview. Confidentiality is a vital aspect of professional practice that protects human rights (NMC 2010). The duty of confidence occurs when a client discloses information to a healthcare professional in circumstances where it is reasonable to expect that such information should be held in confidence (NMC 2010). This NMC provision certainly applies to nursing research considering that the researcher is a (student) nurse and it is only reasonable to expect that the information disclosed by the participant during the interview is supposed to be held confidential. During the entire course of the interview until the data analysis, the participant’s identity was strictly kept confidential. An alias was used to refer to her during the analysis of data. Confidentiality will be maintained throughout the study by ensuring that no other persons than the researcher and his instructor will have access to the data collected from the participants. When Nurses’ professional views and opinions are shared to the researcher, the information is not to be traced back to them. Their identities will be kept anonymous by the use of unknown nick names such as ‘alias flower’ without having the need to divulge their true identities. Under this nick naming system, each participant will be given a nick name which will serve as his or her identity throughout the research. This nick names will also help increase recruitment because possible participants know that their identities will be concealed. Hence: All research participants will be provided with a research code, known only to the researcher to ensure that their identity remains anonymous and confidential. This will make the patients to gain confidence and therefore participate in the interview freely and give detailed and accurate answers. Names and contact details of research participants will be stored on a password protected computer, accessed only by the researcher. These are personal information and they should be secured to avoid any unauthorized party from accessing it. All interview data collected will be anonymous and coded, hard paper copies of data will be stored in a locked filing cabinet within a locked room, accessed only by the researcher. This is to deter another party from accessing the information. It enhances security of the confidential information. Data stored electronically will be stored on a password protected computer, accessed only by the researcher. All data transported on computer discs, CD’s and USB memory sticks will be anonymous identified only by a code and encrypted to protect against loss. All publications of data will be written in a way so as to disguise the identity of the research participants involved. Data will not be used which can identify an individual unless prior consent has been obtained from the individual involved. Data will be stored and archived for a maximum of 3 years, after the graduate award has been made, to allow verification of data from external sources if necessary, or longer if used for further research. Transcribing will be used. 10. Are there any other ethical issues that need to be considered? For example - research on animals or research involving people under the age of 18. All participants will be over 18 years old. There are no animals involved in the study. To avoid implications for obtaining informs consent,: The first step is to obtain an authorization from the patient before the surgery. This enables those patients who are willing to take part in the interview to prepare for it. It will not be ethical to take the patient by surprise, so seeking their consent before the surgery is vital. Then retake an approval from the patient after the recovery period by signing consent for the research. This ensures that the patient is not pressured to take the interview against their wish. It is important to be sure that the patient wants to do this out of their own free will and the way to go about it by them signing a consent form. During the interview, if the patient is not comfortable enough to continue, then the researcher should stop the interview and give the patient some time to relax. An approximate time of 20-30 minutes would be appropriate. Thereafter, if the patient feels like he/she wants to go on with the interview, then they can proceed. But in the event that the patient is not willing to go on with the interview, then the researcher should not force the patient to go on, but stops the interview at that point with the information that they have been able to gather. After the interview, if in the data gathered a particular nurse is accused of being negligent, then the researcher should approach the hospital’s administration and discuss the issue immediately so that necessary measures are taken. By doing this, the well being of the patient is also catered for. 12. How many subjects will be recruited/ involved in the study/research? What is the rationale behind this number? Sampling qualitative research usually relies on small numbers with the aim of studying in depth and detail (Miles and Huberman 1994, Patton 1990). Initially, the research sample size was determined based on the research aims and objectives (Ezzy 2002, Reed et al 1996). The aims and objectives for this research are to seek the richness of the data about a pain and pain assessment. Therefore, the sample derived purposefully rather than randomly (Ezzy 2002, Mays and Pope 1995, Reed et al 1996). At this time the decision was made based on the concept of saturation. This is whereby the number of interviews increases to the point that the new data being gathered does not paint a new picture. At this point, the responses that you get from conducting the new interviews match the ones that you got from your previous interviews. This is the best method for ensuring that you get almost accurate answers to your questions. When you limit the number of interviewees you must shut the door to some interviewers who might have answers that could possibly be of great help in your research. So this method ensures that one has exhausted all the possible answers. 13. Please state which code of ethics has guided your approach (e.g. from Research Council, Professional Body etc). Please note that in submitting this form you are confirming that you will comply with the requirements of this code. If not applicable please explain why. Since Kuwait does not have any professional bodies that regulate nurses, the RCN guidance on ethics for nurses will be used to support the adherence to ethical processes in this project. References Al-khaffaf, H., & Dorgan, S. (2005). Vascular disease: a handbook for nurses. Cambridge, UK, Cambridge University Press. Campbell, W. C., Canale, S. T., & Beaty, J. H. (2008). Campbell's operative orthopaedics. Philadelphia, PA,Mosby/Elsevier. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-323-03329-9..50013-1&isbn=978-0-323-03329-9&uniqId=230351754-4. Gaynor, J. S., Hackett, T. B., & Monnet, E. (2000). Medical & surgical emergencies: the Reg Pascoe refresher course for veterinarians, 7-11 August 2000. Sydney,NSW, Post Graduate Foundation in Veterinary Science, University of Sydney. Helfand, M., & Freeman, M. (2008). Assessment and management of acute pain in adult medical inpatients a systematic review. [Washington, D.C.], Department of VeteransAffairs, Health Services Research & Development Service. Zaffagnini, S., Dejour, D., & Arendt, E. A. (2010). Patellofemoral pain, instability, and arthritis clinicalpresentation, imaging, and treatment. Berlin, Springer. http://public.eblib.com/EBLPublic/PublicView.do?ptiID=603566. Read More