Refinement of a Nursing Concern into an Evidence-based Practice Proposal Concern

Introduction

 The following paper will discuss the relationship and differences between evidence-based practice and research, identify a nursing concern for improvement, address a PICOT/PICo question for evidence-based practice, and conclude with a theoretical framework for the given project proposal.

Overview of Selected Evidence-based Practice Project

Evidence-based practice and research are two concepts that are interrelated which pertain to the utilization, identification, and knowledge from research sites that can be applied to clinical practice (Bussieres, Al Zoubi, Stuber, French, Boruff, Corrigan, & Thomas, 2016). The purpose of conducting research is to gain new knowledge or ratify the knowledge that exists which is based on theory.  Research is all about exploring, discovering, and investigating any given subject matter. Evidence-based practice uses the best research available along with clinical expertise to improve patient outcomes. Evidence-based practice takes the knowledge gained through research and applies it to the clinical decision-making process. Using evidence-based practice keeps nurses and healthcare professionals up to date on the latest health standards and policies. Evidence-based practice in nursing practice leads to positive patient outcomes. The main difference between research and evidence-based practice is that evidence-based practice is not about developing new knowledge in the same way that research does. When applied to nursing practice evidence-based practice translates the knowledge with one goal in mind, which is to improve clinical practice and provide optimal care to the patient (Jolinda, Jordan, Davis, & Williams, 2014).

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The area of focus for my specialty track is the Master of Science in Nursing- Family Nurse Practitioner track. As a Family Nurse Practitioner, I will be using the most current and up to date evidence-based practice in my nursing practice. As I continue to educate myself on current practices through the use of evidence-based practice, I will be able to deliver high-quality patient care which will lead to positive patient outcomes. According to Kueny, Shever, Lehan Mackin, and Titler (2015), evidence-based practice gives nurses the ability to make complex decisions based on findings from clinical expertise, patient perspectives, or high-quality research reports. Nurse practitioners are given the freedom to make decisions based on clinical expertise and evidence-based practice. As I move forward to becoming a Family Nurse Practitioner, I will continue to utilize evidence-based practice to promote change in my practice settings.

Identification of the Nursing Concern to be Improved

 A nursing concern to be identified in this paper is the use of alternative therapies versus opioids in today’s society. Over 100 million Americans are currently living with chronic pain which is why pain is one of the most prevalent reason for which patients seek medical attention in urgent cares, emergency rooms, and healthcare clinics (Tompkins, Hobelmann, & Compton, 2018). According to Penney, Ritenbaugh, DeBar, Elder, and Deyo (2016) chronic pain conditions affect nineteen percent of adults in the United States. Due to multiple circumstances, it has become common practice for healthcare providers to prescribe narcotic pain medications to treat patients with chronic and acute pain. The over prescription of narcotics has played a large role in the opioid epidemic, as many people who are prescribed narcotic pain medication become addicted to street accessible opioids such as heroin. Many people die or are hospitalized everyday as a result of opiate overdoses. According to Chen, Wang, Wang, Xie, and Ren (2018), currently in today’s society, opioids remain the most harmful type of drug which causes seventy percent of the world’s attributable drug abuse disorders.   

 There are many other alternatives to pain management that can be as effective as the use of opioids when treating patients with acute or chronic pain. Alternative therapies such as massage therapy, acupuncture, or trigger point injections have been shown as effective in the treatment of acute and chronic pain. Using alternative therapies will lead to less opioid addictions which in turn will result in less patient deaths from accidental overdoses. A recent CDC report concluded that non-opioid therapy such acupuncture or massage therapy is the preferred treatment of chronic pain (Dowell, 2016). The purpose of this project is to determine that alternative therapies to pain management will decrease a patient’s pain level on the numeric pain scale rating.  

PICOT/PICo Question and Literature Search

 During this evidence-based practice project proposal, I will be using a quantitative research approach. In a quantitative research approach, the PICOT study question to be identified is as follows: In adults with chronic pain, would alternative therapies to pain management versus opioids decrease pain levels using the numeric pain rating scale? If I were to be utilizing a qualitative research approach during this project, the PICo question would be as follows: How was the patient’s experience when using alternative therapies to manage pain? In my future practice setting as a family nurse practitioner, the expected outcome for this study will show the effectiveness of alternative therapies in managing patients with chronic pain versus the use of opioids. Many of my patients will see a decrease in pain levels when using therapies such as trigger point injections, massage therapy, or acupuncture. As I help my patients discover the use of alternative therapies, my goal is to prescribe less opiates to my patients with chronic pain conditions.

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 The purpose of a literature review for this evidence-based practice proposal is to gather all of the available information, evaluate them, and apply them effectively to clinical practice. A literature review provides the foundation of knowledge for the given topic. Prior to conducting a literature review there are steps to take in order to start. The first step is choosing a topic of interest to research, the second step is searching for the literature by finding connections and themes, the third step is to plan the literature reviews structure by finding the simplest approach, the fourth and final step combining all of the information gained by writing the literature review (McCombes, 2019). To start my literature review I have identified my concern and its relevance to my nursing practice. To conduct my research, I have used Google and the Chamberlain College of Nursing library tool. When using the Chamberlain library tool database to find research, I utilized the main search bar and typed in the key terms such as “alternative therapies”, “alternative therapies for pain management”, and “opioid epidemic”. Numerous articles were generated when using these key phrases. While using Google search engine the key terms I used were “Evidence-based practice”, “Research”, and “Differences between research and EBP”.

Theoretical Framework

 According to Grant and Osanloo (2014), the theoretical framework is one of the most important aspects in the research process and it serves as the foundation on which the research is constructed. The theoretical framework to be utilized during this evidence-based practice project is the Comfort Theory by Katharine Kolcaba. Katharine Kolcaba (2010) describes holistic comfort as “the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental)”. The theoretical framework used in the project is applied to the evidence-based practice proposal because alternative therapies help bring comfort to those patients who experience acute or chronic pain. The comfort theory is the best theory to be used for this project proposal.  

Conclusion

 In conclusion, alternative therapies are the better option for patients with chronic pain versus the serious side effects that may occur with the use of opiates. Thorough research was conducted to describe the relationship and differences between research and evidence-based practice, a PICOT question was identified, information was given on the steps of a literature review, and the Comfort Theory was identified as a theoretical framework for the proposed project.

Resources

• Bussieres, A., Al Zoubi, F., Stuber, K., French, S., Boruff, J., Corrigan, J., & Thomas, A. (2016). Evidence-based practice, research utilization, and knowledge translation in chiropractic: a scoping review. BioMed Central Complementary Alternative Medicine, 16: 216. doi:10.1186/s12906-016-1175-0
• Chen, Z., Wang, Y., Wang, R., Xie, J., & Ren, Y. (2018). Efficacy of acupuncture for treating opioid use disorder in adults: a systematic review and meta-analysis. Evidence-based Complimentary and Alternative Medicine. doi:10.1155/2018/3724708
• Dowell, D., (2016). CDC Guideline for prescribing opioids for chronic pain. Morbidity and Mortality Weekly Report, 65 (1): 1-49.
• Grant, C. & Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research: creating the blueprint for your “house”. Administrative Issues Journal: Connecting Education, Practice and Research, 4 (2): 12-26. doi:10.5929/2014.4.2.9.
• Jolinda, C., Jordan, R., Davis, C., & Williams, W. (2014). Exploring evidence-based practice research. Nursing Made Incredibly Easy!, 12 (4): 8-12. doi:10.1097/01.NME.0000450295.93626.e7
• Kolcaba, K. (2010). Comfort Theory. Nursing Theories. Article retrieved from http://currentnursing.com/nursing_theory/comfort_theory_Kathy_Kolcaba.html
• Kueny, A., Shever, L., Lehan Mackin, M., & Titler, M. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of Healthcare Leadership, 7: 29-39.
• McCombes, S. (2019). How to write a literature review. Article retrieved from Scribbr.com on July 20, 2019.
• Penney, L., Ritenbaugh, C., DeBar, L, Elder, C., & Deyo, R. (2016). Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study. BioMed Central Family Practice, 17. doi:10.1186/s12875-016-0566-0
• Tompkins, A., Hobelmann, G., & Compton, P. (2018). Providing chronic pain management in the “Fifth Vital Sign” era: historical and treatment perspectives on a modern-day dilemma. Drug Alcohol Depend, 173 (1): 11-21. doi:10.1016/j.drugalcdep.2016.12.002