In the nursing profession, research is essential for practice, with the latter being based on empirical evidence derived from the former. Two peer-reviewed research articles are referenced and criticized in this article critique in order to emphasize evidence-based practice in the nursing profession.
The work of Elizabeth Manias, "Complexities of pain assessment and management in hospitalized older people: A qualitative observation and interview study," which appeared in the tenth issue of volume forty-nine of the International Journal of Nursing Studies, is consulted for the qualitative article. In the article, the background section notes how pain is still a problem for older patients in hospitals and how little is known of the complexities that attend the care for such patients. As an objective, the author seeks to observe how pain is “assessed and managed” in older patients admitted for nursing. For the research design, Manias (2012) uses “a naturalistic observational design” to look at the interactions between the patients and caregivers. Nurses were also interviewed and observations carried out three times on the nurses and patients in “an Australian public teaching hospital.” Manias (2012) found out that nurses use simple questioning to find out the pain experienced by patients; she also established that nurses often use “fixed –dose paracetamol” before resorting to opioid medication for pain relief. Her research also found out that the management of pain was impacted by time of day which influenced the availability of nurses, and that complexities of pain depend on nature, level and location.
Researcher’s Conclusions
In her conclusion, Manias (2012) notes that the painful experiences of older patients are complex and a balancing act is needed to treat pain effectively while at the same time ensure no adverse effects occur from the administration of analgesics. The research also seems to conclude that administering analgesics in older patients (specifically those with communication deficits) is a procedure marred by intricacies.
Protection and Considerations
In the course of this research study, consideration had to be made regarding the privacy of the individuals under observation. For one, the interview carried out had to conform to the ethics of research, and as such be based on voluntary participation. Private and confidential information also had to be respected and their secrecy maintained through among other means, the application of anonymity.
Strengths and Limitations
By so carrying out her research in an operational environment, Manias (2012) was able to observe the actual behavior of the nurses and patients in the course of their interactions; a fact that increased the integrity of the research and subsequent findings. Further, the use of qualitative research, as in this case, helps relay intangible facts concerning the lives of nurses and patients; a fact that helps inform good nursing practice, as Cope (2014) notes. On the flip side however, the research fails to indicate numbers and therefore makes it difficult to identify what is the norm and what is an outlier.
Evidence Application
From the research study by Manias (2012), it is possible for nurses taking care of older adults in hospitals and caregiving settings to enhance their communication in a bid to discern the complexity of pain and as such administer analgesics appropriately.
Part II: Quantitative Article
Article Areas
For the quantitative research article, the article to be consulted and critiqued is “Pain Management in Patients with Dementia” by Wilco P Achterberg and eight others, and which appeared in the eighth volume of the Clinical Interventions in Aging journal that was published in November of 2013. In the background to the study, Achterberg et al. (2013) note that more than 35 million people worldwide have dementia; with 5% of those aged above 65 years and 50% of those aged above 90 having the disorder. With an increasingly aging population, the authors tout the incidences of the disease to rise globally. In the treatment and management of dementia, Achterberg et al. (2013) observe, pain poses a great challenge (in terms of treatment and care); with the incidences hitting 72% among individuals above the age of 85. The objective of the research is to explore the “perspectives of pain management in dementia” and to advance recommendations to be used in informing practice and future research efforts. The research design by Achterberg et al. (2013) uses a “comprehensive approach that includes an accurate, validated assessment tool which shows sensitivity to different types of pain and therapeutic effects”. In their findings, Achterberg et al. (2013) point out that pain is common among elderly persons (including those with dementia) and that there is a notable “lack of effective assessment and treatment across clinical settings” in those with dementia (and who experience pain). This quantitative research also notes that loss of the ability to communicate (among older persons with dementia) complicates the detection of pain in the severer stages of the disorder.
Researchers Conclusions
In their conclusion, Achterberg et al. (2013) point out that the loss of the ability to effectively communicate with others complicates pain detection in older adults with dementia. They further conclude that the development of an assessment toolkit could help nurses and other caregivers communicate with elderly persons suffering from dementia and who have difficulties communicating. Their research further concludes that the need exists to train, support and guide healthcare practitioners (particularly nurses) who treat elderly persons with dementia so as to empower their decision making abilities and reduce their reluctance to administer effective analgesic treatments for such patients.
Protection and Considerations
For this research study, the authors had to consider the intellectual property rights of the sources they consulted. Further, the privacy and confidentiality of information had to be upheld in the process of populating this research study.
Strengths and Limitations
Merits of this particular study lie in the identification of the need to train and empower caregivers and healthcare practitioners involved in the care and pain management among elderly persons with dementia. Strengths of the research also lie in the fact that it identifies representative facts such as the pain experienced by 72% of those above age 85 and outlying cases such as the 5% of those above 65 who suffer from dementia. The research however is weak to the extent that it does little to deal with qualitative frameworks (Creswell, 2013) such as the conceptual models to be applied in the management of pain among patients with dementia.
Evidence Application
From this research study, especially to the extent that it identifies pain among a great majority of those above the age of 85 to be the norm rather than the exception, the nursing practice can apply it in managing pain among older patients with dementia. In assessing dementia, the nursing profession could also incorporate the evidence presented by Achterberg et al. (2013) to the extent that dementia in those above the age of 65 is an outlying case, and hence further examination is necessary.
References
Achterberg, W. P., Pieper, M. J., van Dalen-Kok, A. H., De Waal, M. W., Husebo, B. S., Lautenbacher, S., ... & Corbett, A. (2013). Pain Management in Patients with Dementia. Clinical Interventions in Aging, 8, 1471.
Cope, D. G. (2014). Methods and Meanings: Credibility and Trustworthiness of Qualitative Research. In Oncology Nursing Forum, 41 (1).
Creswell, J. W. (2013). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Sage Publications.
Manias, E. (2012). Complexities of Pain Assessment and Management in Hospitalised Older People: A Qualitative Observation and Interview Study. International Journal of Nursing Studies, 49 (10), 1243–1254.
