Running head: PICO PAPER
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PICO Paper
Ashley Snider
Ferris State University
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PICO PAPER
PICO Paper
The purpose of this paper is to determine how the PICO question interprets
evidence-based research for use of personal and professional practices in nursing. Also
interpreting our research findings on the PICO question and how it relates to the nursing
profession. In this paper, I’m going to look at different research articles and come up with
a conclusion based on evidence-based research as to which is the best medication route to
control postoperative pain.
PICO Question
In adult patients undergoing surgery, how effective is patient-controlled analgesia
pain medication compared to PRN conventional analgesia pain medication in controlling
postoperative pain? Each article selected portrayed evidence-based research in regards to
controlling postoperative pain in adults undergoing surgery via PCA pump or PRN
conventional analgesia pain medication. In regards to overall patient quality “patients
with PCA could have experienced feeling of control, which was particularly important
for helping them cope with pain on the fist postoperative night, when pain was very
severe” (Chang, 2004, p.538).
Using patient-controlled analgesia and PRN conventional analgesia pain
medication are both safe to use in postoperative surgical patients. Using patientcontrolled analgesia “allows the patient to self-administer small intravenous (IV) doses of
narcotic analgesia within preset limits” (Snell, 1997, p.681).
Research Findings
“PCA devices are now widely used in clinical practice, and are among the
recommended techniques for the control of pain in the postoperative setting” (Walder,
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2001, p.795). PCA devices in clinical practice are now becoming the norm by controlling
postoperative pain in adults. The only limitation found with the use of PCA devices for
postoperative pain control is the cost. “Devices are expensive, and material costs per
patient associated with this type of pain treatment are higher compared with conventional
analgesia” (Walder, 2001, p.795). With conventional analgesia pain medications, nurses
need to communicate better with patients about their pain levels and how to keep it under
control. “Nursing staff should also be aware of the need to minimize the delay between
analgesic doses with transition to alternative analgesics” (Snell, 1997, p.689).
To get adequate evidence on this topic, I chose three different research articles.
The first article chosen is a quantitative systematic review, which is “a rigorous scientific
approach that combines results from a group of research studies and looks at the studies
as a whole” (Nieswiadomy, 2012, p.324). Based on the evidence rating scale, the strength
of evidence presented in this article is at a level 1, with high quality evidence. What I got
out of this research article was, “with both PCA and conventional opioid analgesia there
was a large variability in pain intensity scores at 24 h and 48 h” (Walder, 2001, p.801).
Based on a visual analogue scale to rate pain intensity “pain intensity scores where
twelve times below 3 (i.e. moderate or less pain) with PCA, and seven times with
controls” (Walder, 2001, p.799).
The second article chosen is a meta-analysis of randomized control trials, which is
“a technique that combines the results of several similar studies on a topic and
statistically analyzes the results as if only one study had been conducted” (Nieswiadomy,
2012, p.320). Based on the evidence rating scale, the strength of evidence presented in
this article is at a level 1, with high quality evidence. What I got out of this research
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article was, patients using a PCA device postoperative had better pain control than
conventional analgesia. “Pain intensity on the VAS scale was lower in patients using
PCA verses those receiving conventional analgesia” (Hudcova, 2012, p.8). Postoperative
patients tend to be more satisfied with a PCA device then those patients using
conventional analgesia. Based on the research “PCA provided better pain control and
greater patient satisfaction than conventional parenteral “as-needed” analgesia”
(Hudcova, 2012, p.2).
The third article chosen is a meta-analysis of randomized control trials. Based on
the evidence rating scale, the strength of evidence presented in this article in at a level 1,
with high quality evidence. What I got out of this research article was, “patients are more
positive about PCA then IM, but are satisfied with either method of delivery” (Snell,
1997, p.682). Postoperative patients have different reasons as to why they prefer PCA to
conventional analgesia pain medication. “Reasons cited for PCA preference included not
having to wait, avoiding additional pain, and have a sense of control over the pain,
experiencing decreased sedation levels, and reduced anxiety” (Snell, 1997, p.682).
Recommendations to Improve Quality and Safety
Both quality and safety of care for postoperative patients using PCA devices and
conventional analgesia pain medications are an important part of pain control. The
quality of conventional analgesia pain medications differs from PCA devices. To
determine the quality of the pain intervention used to control postoperative pain a visual
analog scale was used. A visual analog scale is a normal pain rating scale that multiplied
the original scale. “For example is a patient was offered a five-point scale, selection of
the second point was scored as 50 on a zero to 100 scale (0 = no pain, 1 = 25, 2 = 50, 3 =
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PICO PAPER
75, 4 = 100).” (Hudcova, 2012, p.3). To improve safety of the pain interventions used to
control postoperative pain patients and nurses need to be knowledgeable on how to use
the PCA devices, “both patients and staff need regularly clear instructions” (Walder,
2001, p.795). Nurses also need to be aware of adverse effects of both the PCA devices
and conventional analgesics. “Bradypnoea, hypoxia, nausea and vomiting, sedation,
pruritus, and urinary retention happed with both PCA and control treatments, and there
was no evidence of any difference between the two analgesic techniques” (Walder, 2001,
p.801).
Conclusion
Based on the research found in the articles, PCA devices had better pain control
then conventional analgesics to control postoperative pain. “PCA provided better pain
control and greater patient satisfaction than conventional parenteral “as-needed”
analgesia” (Hudcova, 2012, p.2). Also found in the research, patients want to be in
control of their pain. Patients prefer the PCA device because of the instant availability of
the medication and better pain control. (Hudcova, 2012, p.9). Based on the research in the
articles, PCA devices give patients better pain control then conventional analgesics and
give them a sense of control.
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References
Chang, A. M., Ip, W. Y.,& Cheung, T. H. (2004). Patient-controlled analgesia versus
conventional intramuscular injection: a cost effective analysis. Journal of
Advanced Nursing, 46(5), 531-541.
Hudcova, J., McNicol, E. D., Quah, C. S., Lau, J., & Carr, D. B. (2012). Patient
controlled opioid analgesia versus conventional opioid analgesia for postoperative
pain. The Cochrane Colloboration, 6, 1-54.
Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). Boston: Person.
Snell, C. C., Bourbonnais, F. F., & Hendriks, S. D. (1997). Patient controlled analgesia
and intramuscular injections: a comparison of patient pain experiences and
postoperative outcomes. Journal of Advanced Nursing, 25, 681-690.
Walder, B., Schafer, M., Henzi, I., & Tramer, M. R. (2001). Efficacy and safety of
patient-controlled opioid analgesia for acute postoperative pain. Acta Anaesthesiol
Scand, 45, 795-804.
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