Systemic Review

pain is the usual cause for persons to look for treatment. Inadequate pain management can cause delay in healing process. It can also leads to prolonged hospital stay. The acute pain management theory describe how nurse can manage pain with minimal effects from the pharmacological interventions and use of alternative methods of pain management (Good &Moore, 1996) The main factors are in the management of pain are Pharmacological, non-pharmacological, patient participation, education and different interventions. Effective pain management involves the application of non-pharmacological interventions and usage of pain medications. (McEwen & Willis, 2014). The pain management theory deals with management of pain in daily basis. It offers the knowledge about alternate methods in pain

The Indicated Review had 80 studies involving 11,337 students (Weissberg, Taylor, Schellinger, Payton, Pachan, Dymicki and Durlak,

Abstract of this article offer clear overview of the study, by explaining what was accomplish and what was the significant of the study. (Kagnovi et al Peer Research October 2017)

A. the literature review provided articles that were relevant and a number of relevant studies and theories were described throughout the study.

Trossman (2006) states that at least 50% of patients are suffering from moderate to severe pain at their time of death, that 70 million Americans experience pain throughout their activities of daily living and that nurses hold the keys to pain management. According to Abdalrahim et al. (2010) there have been countless evidence-based studies regarding pain management; nevertheless, the inability to control the patients’ pain has increased due to nurses often devaluing the information they receive from the patients about their current pain level, these actions are directly related to a withholding of

The evidence hierarchy is a ranking that distinguish the types of research evidence based on the strength of the evidence itself (Polit & Beck, 2012). It is mostly applicable to the research questions regarding the effects of clinical interventions. The evidence that are ranked based on the evidence that uses appropriate research methods, rigorously reviewed with minimized biases and has great clinical implications. The strongest evidence based on the evidence hierarchy is systematic reviews, which draws conclusions from many randomized controlled trails (Polit & Beck, 2012).

1. Is the article proposing to answer a specific clinical question or questions? What are the questions?

There are many versions of the hierarchical evidence levels. When deciding on basing clinical interventions on evidence, there are two specific models to look at. They both describe levels of evidence and are depicted as pyramids. The first is the 6S model, with the “more patient-specific” information listed at the top of the pyramid (Houser, 2015). The top of the pyramid has the least amount of information as compared to the base, it is more relevant, but it yields the least amount of information (2015). Conversely, the more abundant information found at the bottom is less relevant to the specific intervention in question (2015). Also, the searches conducted at the more basic levels typically take less time to yield results due to the broader relationship to the intervention in question (2015). The 6S model of hierarchical pyramid of evidence are listed as follows from highest to lowest:

While research has long paralleled medicine, the use of strong research evidence as the basis for clinical action is more recent (Houser, 2015). The historically accepted hierarchy of evidence separates evidence into levels of trust, from highest to lowest (Greenhalgh, 2010):

In the physical realm of patient-centered care pain, comfort, sleep, and rest are important aspects of the fourth dimension of patient-centered care. Patient-centered care is the complete focus of the medical team on providing respectful care to meet patient needs, preferences and values guide decisions on each individual patient care. To understand the subjective view of the patient, these four aspects are at the forefront of their needs within the hospital setting to provide the best patient outcome. Nurses provide good patient-centered care by actively partnering with patients to determine care priorities and plans to tailor their level of involvement, according to their preferences, and being flexible by changing the care plan as the situation changes including providing smooth transitions between care goals. By doing this, nurses can assist patients with all pain by providing comfort and assuring the patient that there will be no deficiency of their quality of sleep.

Although it is a systematic review, some of the research utilized were qualitative studies. The studies reviewed were a quasi-experimental study, a randomized descriptive study, a qualitative descriptive study, and a literature review. All were described in detail as a basis for the study performed in the article. The other studies used for research purposes in this study included one randomized controlled trial (RCT), one quasi-experimental study, one qualitative study, and three literature reviews. If all the studies used for research in the article were RCT’s or “a combination of RCT’s and quasi-experimental or quasi-experimental only” (jhnebp) this research would have garnered a ranking of level I or level II. The inclusion of even one qualitative study dropped the ranking to level

Morley, Briggs & Chumbley (2015), discussed a study conducted by Morgan (2006) which explored how patients with SUD felt during hospitalization. These patients reported nurses treated them with out respect and made them feel like junkies. Consequently, this affected SUD patients’ behavior during hospitalization. Due to these findings, the same researcher Morgan, conducted a study to explore nurses experience toward SUD patients in 2013. This study explored the reasons behind nurses’ negative attitudes towards SUD patients affecting pain control. Contributors behind the negative attitudes were different moral view between nurses and SUD patients. Furthermore, nurses stated that other factors affecting care to SUD patients includes their own

Moreover, I assisted many other patients who were in severe pain on my previous clinical placements. But as it said, pain is a subjective experience (Mills, Torrance & Smith, 2016). I think I successfully managed most of those patients and their pain levels. I also received pretty positive feedback from my buddy nurses and patients. But the story that I above mentioned was very challenging. However, what I learnt a lot from that particular experience. It made me realise that it is worthy to use Interpersonal skills, known as non- verbal and verbal communication. These skills are essential as advanced nurse practitioners must be able to assess and analyse what they are doing and critically reflect on their actions to improve patient outcomes

A study comparison table tool was used to help distinguish which studies contained the necessary information to thoroughly answer our research question. This tool allowed us to narrow our results to three worthy studies, Lui Y., Lui Y., Huang X., Du, Peng, Huang P., Zhang (2014); Mollamahmutoglu, Moraloglu, Ozyer, Su, Karayalcin, Hancerlioglu, Uzunlar, Dilmen (2012); Lee, Liu, Lu, Gau (2012). All three of the studies chosen were within the last four years

Systematic review can help researcher in accumulating knowledge from the range of studies. Systematic literature review can enhance methodological rigor and also shows opportunities for further research. A systematic review addresses a specific question, utilizes explicit and transparent methods to perform a through literature search and critical appraisal of individual studies from which we can conclude what presently we know and we do not know ( Briner and Denyer, 2012 ).