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Nursing Research

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jessie aguilar

on 29 April 2013

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Transcript of Nursing Research

Theoretical Framework Quantitative Research
Study Jessie Aguilar
Leanna Tabares
Kennjo Maceren
Lupita Gallegos
Anwell Tiongco
Lizbhet Nunez Findings consistent with previous research challenging bowel sounds as a reliable indicator for the end of POI; no association existed between return of BS and first flatus.

Findings related to the use of rocking chair as an effective intervention for resolution of POI were inconsistent with previous studies.

Implications:
Auscultation for the return of bowel sounds is a practice tradition that should be used with caution and possibly replaced with other, more reliable indicators for the end of POI.

Using assessment of first flatus, elimination of abdominal distention, NV, and tolerance of diet are more reliable indicators for end of POI. Research Design Experimental RCT
two-group post-test only design
chosen because POI resolution occurs only after surgery A decreased duration of POI in patients receiving standard care plus a rocking intervention in patients recovering from a cancerous gastrointestinal tumor removal.

There is no association between the return of BS and passage of first flatus following abdominal surgery.

Hypothesis was logical and derived from the literature but it was not a declarative statement Dependent Variable Resolution of POI s/p removal of gastrointestinal tumor surgery

Operational definition: End of POI by first postoperative flatus Independent Variable Rocking chair intervention

Operational Definition: Pt OOB to rocking chair for 10-20 minute increments for at least 1 hour/day Problem Statistical findings Hypothesis New Question What is the optimal daily ambulation distance needed to resolve POI sooner in patients recovering from a cancerous gastrointestinal tumor removal? Significance to Nursing Literature Review Research Confounding Variables Data Collection Threats Internal Threats External Threats Decrease post operative ileus duration following abdominal surgery.

A secondary aim was to assess auscultation of bowel sounds as a reliable indicator for the resolution of POI. Postoperative ileus (POI) occurs universally s/p abdominal surgery.
causes gas and fluid retention
increased hospital stay
increased healthcare costs
Daily auscultation of bowel sounds (BS) is protocol of postoperative patient's as an indicator of POI resolution
Auscultation is an accepted clinical practice Utilized MEDLINE, SCOPUS, and CINHAL
12 references within the last 10 years
26 total references for the review
Was thorough and provided background knowledge
Standard post-operative care
Meanings of bowel sounds
Nursing interventions to stimulate return of bowel function
Rocking chair intervention
Defined POI B.S. proposed method as return of bowel motility in 1905
Nursing research in this area has been limited Unknown Research Conflicting Research and among clinical practitioners regarding the resolution of POI
return of BS
passage of first flatus
absence of symptom cluster
Rocking chair effectiveness not officially established Known Research previous studies showed:
BS returned after 2.4 days
flatus and stool occurred day 5
In three previous studies, Rocking chair intervention:
effective in reducing duration of POI in C-sections and abdominal surgeries
proposed rationale is through vestibular nerve stimulation
Standard Post operative care
Get pt. OOB, to chair and walking beginning post op day 1
Increase duration each day until POI resolution No listed theoretical framework
Guiding Concepts
POI occurs universally following abdominal surgery
Rocking chair is a relatively new nursing- derived non-invasive intervention
Rocking chair intervention found to be effective in reducing POI duration in three previous studies in addition to post- operative care
No clear best indicator for resolution of POI
Prevalence of POI in presence of bowel sounds
Auscultation of BS is an acceptable nursing practice
Limited nursing research regarding BS and POI resolution
mainly case studies and surgical literature
reliability and validity needed None stated in the research article
Potential extraneous variables:
Standard postoperative care and rocking chair intervention
frequency/duration
demographics (age, gender)
type/route of postoperative pain medication
co-morbidities Structured observational
Primary researcher assessed for BS and first flatus at the same time q morning each day post op.
Reviewed medical charts q daily to identify if a RN or MD noted return of BS or first flatus
Maintaining Control/Decreasing collection bias
Researcher auscultated each quadrant for 5 minutes
Same time every day
one data collector
one structured data sheet
No mention of data collection methods for rocking chair intervention History not a threat
Maturation not a threat
Testing not a threat
Mortality not a threat
Selection bias: decreased by random assignment and inclusion criteria
Instrumentation possible threats
different nurses
stethoscope
identical rocking chair
length of time in rocking chair
documentation variations or possible ommisions Generalizability
specific type of abdominal surgery
selection effects decreased by randomization
Measurement effects not a threat (no pretest)
Reactive effects possible
Increased participation in post-op interventions ie Hawthorne Effect Sampling Design convenience sample with random assignment
sampling design does not appear adequate:
screening/recruitment methods unknown
no use of power analysis
sample demographics limited
no exclusion criteria listed
Inclusion criteria:
removal of cancerous gastrointestinal tumor
English speaking
cognitively intact
able to ambulate
able to sit in a chair
able to receive IV or epidural analgesia
Sample not adequately described:
inclusion criteria only
vague/broad inclusion criteria Measurement Tools Stethoscope Auscultation of BS daily
appropriate for assessment
inadequately explained
no mention of brand or type
no mention of reliability or validity
no mention of using same stethoscope Patient Self- Report
Measurement Patient reported first flatus
Pts were cognitively intact
Not reliable due to social desirability and disclosure of sensitive information
Potential Hawthorne effect Generalization The findings can be adapted to most abdominal post-operative patients
POI occurs universally in patients undergoing abdominal surgery Weaknesses Varying pain medications and side effects
i.e. Tylenol, Opioid type drug
Age of patients
Bowel function decreases with age
No measurement or data of implemented interventions Return of Bowel Sounds Indicating an End of Postoperative Ileus: Is it time to Cease this
Long- Standing Nursing Tradition?
Robert L. Massey The secondary aim, a correlational design was used to determine an association between the auscultation of BS and first flatus Research Design Subjects
randomly
assigned Rocking
chair
intervention Standard
Treatment Compare time to
resolution of POI Questions? Analysis
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