Essay Sample on Nursing Practice

Consider issues related to your nursing practice. What stands out to you about your specialty area?

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In my nursing practices, pain management among surgical patients is the most outstanding issue. Complications tend to be more common among the surgical patients that require management. However, once the anesthesia wears out, patient and their relatives complain more about pain and this has driven my focus on how to manage pain among this group of the patient by comparing the most effective pain management strategy. For the sake of this EBP, I am inclined to question and compare the effectiveness of various pain medications. Therefore; I will compare the PCA and PRN pain medication among the postoperative patient in managing the postoperative pain.

What questions or concerns do you think are especially in need of attention? Why?

Post-operation pain can be a major problem to both nurses working in the emergency room, and intensive care units, as well as the relatives of the patient who is worried about the patient's status and the patient himself immediately the anesthesia, wears off. The goal for the postoperative pain management is to completely eliminate pain or reduce the pain with very minimal side effects. There are different agents (Opioids versus Nonopioids), routes (oral routes, intravenous routes, neuraxial routes, regional routes) and the modes (PCA versus PRN) of the postoperative pain. Even though the multimodal approach to managing postoperative pain is the most preferred pain management approach, it is important to consider the unintended side effects of uploads such as nausea (Tan, Law & Gan, 2014).

Many researchers ignore the side effects of some medication as they focus on improving pain scores. Therefore, my focus would be to choose the most effective pain management approach between PRN and PCA pain medication with the aim of improving pain scores and reducing the side effects of the medications (Zhong et al., 2013). Additionally, Sinatra (2006) also argued that most of the enhanced recovery protocols aimed at reducing the length of stay in the surgery have also considered the Opioid side effects especially when the multimodal Opioid sparing regiments are used (Keller et al., 2014). I believe that creating familiarity and document the efficacy of the two agents as well as the route of administration would contribute to effective pain management under the EBP.

How would you most like to contribute to the knowledge base of your profession?

As a DNP, I believe that data-driven evidence-based practices is the most effective way to manage pain amongthe postoperative patients. I have also realized that most of the current literature mainly focuses on nonpharmacological pain management among postoperative patients. Therefore, I am to fill this academic gap by research, collecting data and analyzing the data to provide evidence-based results on the issues under consideration which would be useful for both practitioners and researchers (Garimella & Cellini, 2013). I also believe that the research finding implication would significantly change postoperative pain management practice.

EBP Questions/ PICOT question

Among the postoperative elderly patients (P) is Patient-controlled analgesia (PCA) for pain (interventions of interest) more effective than the pro re nata (PRN) (C)in controlling post-surgical pain (O) during the recovery times (T)

References

Garimella, V., & Cellini, C. (2013). Postoperative Pain Control. Clinics In Colon And Rectal Surgery, 26(03), 191-196. Doi: 10.1055/s-0033-1351138

Keller, D., Ermlich, B., Schiltz, N., Champagne, B., Reynolds, H., Stein, S., & Delaney, C. (2014). The Effect of Transversus Abdominis Plane Blocks on Postoperative Pain in Laparoscopic Colorectal Surgery. Diseases Of The Colon & Rectum, 57(11), 1290-1297. Doi: 10.1097/dcr.0000000000000211

Sinatra, R. (2006). Peripherally Acting Mu-Opioid-Receptor Antagonists and the Connection Between Postoperative Ileus and Pain Management: The Anesthesiologist's View and Beyond. Journal Of Perianesthesia Nursing, 21(2), S16-S23. Doi: 10.1016/j.jopan.2006.01.016

Tan, M., Law, L., & Gan, T. (2014). Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Canadian Journal Of Anesthesia/Journal Canadien D'anesthesie, 62(2), 203-218. Doi: 10.1007/s12630-014-0275-x

Zhong, T., Ojha, M., Bagher, S., Butler, K., O'Neill, A., & McCluskey, S. et al. (2013). Transversus abdominis plane block following abdominally based breast reconstruction: study protocol for a randomized controlled trial. Trials, 14(1), 424. Doi: 10.1186/1745-6215-14-424