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Case Study: Critical Appraisal of Quantitative and Qualitative Research for Nursing Practice

Introduction. Unrelieved postoperative pain remains a common problem despite advances in pain management. Complementary music has been suggested as an adjuvant to the standard of care treatment for postoperative pain.

Purpose. The purpose of this study was to determine if music therapy was an effective adjunct to decrease state anxiety, and increase pain management and environmental noise satisfaction in the postoperative patient.

Method.A quasi-experimental nonequivalent control group design was used in this study with participants assigned based on room assignment rather than randomly. The control group, which consisted of participants admitted to the A hallway, received the standard of care. The intervention group, which consisted of participants admitted to the B hallway, received complementary music therapy in the form of preprogrammed MP3 players, in addition to the standard of care. Neither analgesia type nor route was controlled. Each participant was enrolled for a total of 3 days or until discharge, whichever came first. Outcome measures were collected upon enrollment (Time One) and for the next 2 consecutive days (Time Two and Time Three). Participants in the intervention group were encouraged to listen to a selection of nonlyrical low decibel (less than 60 db) preprogrammed music, for at least 30 minutes via an MP3 player after their prescribed analgesia was administered. State trait anxiety, as well as pain and environmental noise satisfaction, were assessed using the State-Trait Anxiety Inventory and two standardized questions from the Press Ganey survey.

Findings.Before the intervention was implemented, both groups were the same related to their average level of state and trait anxiety, pain, and noise perception. The patient’s state anxiety, pain perception, and noise perception were measured 1 day after the intervention was in place. A significant difference was found from Time One to Time Two in pain management (t = 3.938, p < .001 ) and environmental noise satisfaction (t = 3.457, p = .001), while there was no change in state anxiety (t = 0.373, p = .711 ). The intervention group experienced improved pain management (t = 7.385, p < .01) and environmental noise satisfaction over time (t = 4.371; p < .001); however, there was no improvement in state anxiety (t = l .47; p = .159). The findings suggest music therapy decreases pain and environmental noise perception, although there was no effect on state anxiety.

Conclusions.Use of music therapy improves patients’ postoperative experience by increasing their pain management and white noise satisfaction. This intervention was inexpensive and easy to implement in the clinical setting, and therefore recommended to improve postoperative outcomes in other facilities.

Comeaux, T., & Comeaux, T. (2013). The effect of complementary music therapy on the patient’s postoperative state anxiety, pain control, and environmental noise satisfaction. Medsurg Nursing: Official Journal Of The Academy Of Medical-Surgical Nurses, 22(5), 313-318.

Background.There is insufficient evidence on the effects of music therapy on state anxiety of breast cancer patients following radical mastectomy.

Methods. A Hall’s Core, Care, and Cure Model-based clinical trial was conducted in 120 female breast cancer patients from March to November 2009. A randomized controlled design was used. The patients who were randomly allocated to the experimental group (n = 60) received music therapy in addition to routine nursing care, and the control group (n = 60) only received routine nursing care. A standardized questionnaire and the State Anxiety Inventory were applied. The primary endpoint was the state anxiety score measured at pretest (on the day before radical mastectomy) and at three posttests (on the day before patients were discharged from hospital, and the second and third time of admission to hospital for chemotherapy, respectively).

Results.The pretest score revealed that the majority of the patients had a moderate level (77%) and 15% had severe level of state anxiety. The repeated-measure ANCOVA model analysis indicated that the mean state anxiety score was significantly lower in the experimental group than those in the control group at each of the three posttest measurements. The mean difference between the experimental and control group were -4.57, -8.91, and-9.69 at the first posttest, 2nd posttest, and 3rd posttest, respectively.

Conclusion.Music therapy is found to have positive effects on decreasing the state anxiety score.

Li, X., Zhou, K., Yan, H., Wang, D., & Zhang, Y. (2012). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: a randomized clinical trial. Journal Of Advanced Nursing, 68(5), 1145-1155. doi:10.1111/j.1365-2648.2011.05824.

Question 1

Compare and contrast the clinical problem identified by each researcher.

Question 2

Identify the research design used in each study. Who used the more powerful strategy? How could the researchers have improved their designs?

Question 3

Why might Comeaux and Comeaux have selected their design?

Question 4

Who comprised the control groups?

Question 5

Compare the dependent variables.

Question 6

Compare the independent variables, describing variations in the study protocols.

Question 7

If you worked on a surgical unit, would you be willing to change your unit’s pain management protocols based on the results of these studies?

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Case Study Chapter 9

YOU BE THE JUDGE The patient, on the first day postoperative for a transurethral prostate resection, received a unit of packed cells early in the morning on the supposition that he was bleeding internally. That afternoon at 3:22 p.m., the patient’s wife informed the nurse that her husband was breathing “heavily” and requested that the nurse assess him. The nurse, according to the testimony of the wife, informed her that the doctor was aware of the patient’s breathing pattern and that there was nothing about which she should worry. The nurse did not leave the nursing station. The patient subsequently died related to a shock from the internal bleeding complicated by a reaction to the blood transfusion. In court some years later, this same nurse testified that she had called the surgeon immediately to report that the patient’s respirations were 50, that she had taken vital signs that were within the normal limits for this patient, and that she had obtained a pulse oximeter reading that was acceptable. She also testified that she kept calling the physician’s office to report these findings.

None of this nursing care was documented in the progress notes that the patient’s nurse placed in the patient’s chart the next day. The nurse testified that she had compiled the progress notes from scratch notes she had written during the previous afternoon. The nurse further testified that it was her practice to make handwritten notes during the time that she worked and then to type her progress notes on the hospital system the next day. Additionally, this nurse never documented taking vital signs during the critical 2 hours between the spike in the patient’s respirations and the time he was pronounced. The surgeon’s office nurse testified that a call was received from the hospital at 4:00 p.m. and that the surgeon immediately left the office for the hospital. The surgeon testified that he called the hospital from his car phone and that he immediately called a code as soon as he reached the patient’s room.

1. Did the lack of documentation affect the ultimate outcome of this case? 2. Was there negligence on the part of the nursing staff in the care of this patient? 3. How does the obvious contradiction in the testimony between the patient’s hospital nurse and the office nurse’s and physician’s account of what happened affect your decision in this case? 4. What standards for documentation did the patient’s nurse breach? 5. How would you decide this case?

Using the sample professional liability insurance policy (Guido, p. 193-194), locate the various provisions:

· Limits of liability

· Declarations

· Deductibles

· Exclusions

· Reservation of rights

· Covered injuries

· Defense costs

· Coverage conditions and supplementary payments

· Did you have difficulty finding some of the sections? Would this be a policy that you would consider purchasing for your own liability coverage? Why or why not?

YOU BE THE JUDGE During an unexpected heat wave, the administrator of a nursing home decided against turning on the air conditioner, which resulted in the death of four of the residents of the home. One of the deceased resident’s daughters brought a lawsuit against the home for a wrongful death suit. She was awarded a judgment of $275,000. She then filed a second lawsuit against the nursing home’s insurance company to collect payment on the judgment. The insurance company refused to pay, stating that the judgment underlying the lawsuit was professional liability and the insurance company did not cover the nursing home for professional judgment. The nursing home then filed a lawsuit against the insurance company for payment of this judgment. QUESTIONS 1. What provisions of an insurance policy would you consult to determine whether an insurance company should pay such a claim and what would the limits of the liability be? 2. Is the nursing home insurance company correct in saying that this is a professional judgment issue? 3. Which insurance company (the nursing home’s or the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment? 4. How would you decide the case?

Guido, Ginny Wacker, JD, MSN, RN. Legal and Ethical Issues in Nursing (Legal Issues in Nursing ( Guido)) (p. 198). Pearson Education. Kindle Edition.