Nursing: NURS 3044: Research Methodologies

Assignment Two: Clinical Scenarios

This assignment requires you to:

  1. Exclamation point imageDevelop your research question;
  2. Apply and describe your PICO/PIO framework;
  3. Develop your Search;
  4. Search an online Health database (to identify 4 relevant primary research studies/articles that will enable you to answer your research question); and
  5. Evaluate your research article (Discuss the best and worst chosen)

Please refer the Course Outline for full assessment instructions and the LearnOnline page for the assignment template. You must enter the relevant information from the chosen research articles into the appropriate table(s) of this template.

Note that the Harvard UniSA referencing style must be used for this assignment.

You are a community nurse who regularly visits Mrs Jones, a 45 year old woman who has previously been treated for breast cancer which included mastectomy, removal of 10 of the axillary lymph nodes, radiotherapy and daily Tamoxifen* prescribed for 5 years. Due to the side effects of the Tamoxifen she stopped taking it after 1 year.

Early this year, it was discovered that the cancer had re-occurred and metastasized to the lungs and spine. The doctor’s have predicted that she has approximately 6 months to live.

Mrs Jones is married and has a 9 year old son and a 7 year old daughter. Due to her condition she is unable to work, which is putting a financial strain on the family.

She has issues with back pain that is often hard to control, arm lymphoedema (related to lymph node removal during surgery), low mood, shortness of breath upon exertion and loss of appetite with accompanying weight loss.

She has expressed that she does not know how to tell her children about her imminent death and that her husband does not seem to be handling the ‘situation’ (of her condition and it’s outcome) very well. They do not have other family members close by who could provide support.

Mrs Jones has previously stated that her mother and aunty had died of breast cancer and that her grandmother had died of ovarian cancer. She has often asked whether there is some sort of link? Or whether the recurrence of the cancer was related to her stopping taking the Tamoxifen early?

 


* Tamoxifen is an oral medication prescribed to women after initial treatment for breast cancer. Estrogen can stimulate the growth of certain types of breast cancer. Tamoxifen is a selective estrogen receptor modulator which binds to estrogen receptors, blocking the actions of estrogen.

It’s common side effects include hot flushes and night sweats, vaginal discharge and weight loss or gain.

Less common bet serious side effects include blood clots, bone loss, endometrial and uterine cancers, mood swings and/or depression.

You are a midwife in a midwifery lead unit in a tertiary hospital. One of the women you are supporting is Annie Jones, who is 19 years old single woman living with her mother. Annie currently works as a check out operator in a local supermarket but is unsure whether she will be working once the baby is born. She says that her manager is not very supportive and has not shown any willingness to accommodate her sick leave for morning sickness and feeling unwell so far. The father of her baby is no longer on the scene but she says her family and friends are her supports.

At this first meeting with Annie you identify that she is about 12 weeks pregnant and while she is generally healthy and has a BMI of 20 she does admit she is a heavy user of tobacco, smoking more than 20 cigarettes a day and occasionally mixing tobacco and marijuana. She tells you that the marijuana seems to help her morning sickness and has no plans to stop. She also reveals through your conversations that she is continuing to socialise with her friends which includes drinking as she talks about her preference for mixer drinks including caffeine drinks (eg RedBull) and Vodka. She also tells you that she intends to keep fit through her pregnancy and want to continue her intense exercise program of long distance runs.

The pregnancy progresses as expected, apart from some concern that on abdominal palpation the baby appears a slightly smaller size for gestational age. Over the course of the pregnancy, you (as the midwife) have tried to engage Annie in discussing her birth plan and her plans for caring for her baby but every time this topic is approached Annie looks extremely worried and quickly changes the subject. She tells you she has no need for antenatal education classes as she has friends with young children and has been reading ‘stuff’ on-line. Annie goes in to labour at 39 weeks and presents at the Midwifery unit with contractions 3-4 minutes apart and 4cms dilated. She is extremely distressed about the impending birth and the pain she is in. She is offered both non pharmaceutical pain relief options such as a warm bath, back massage or fitness ball and pharmaceutical options such as gas or IM Pethidine, but she opts for an epidural, as her friends have advised her this is the most effective pain management for labour and birth. An IV and epidural is inserted and commenced by an anaesthetist and Annie is now comfortable but still distressed about the birth. She continues to dilate at approximately 1cm per hour until fully dilated and as the effect of the epidural is wearing off, feels the urge to start pushing.

Annie has now been pushing for 1.5 hours but there is little progress and is exhausted. Upon assessment it is determined that the baby is stuck in the transverse position and will require forcep assistance. An obstetrician is called in and applies the forceps to assist the passage through the birth canal, however, as the baby is pulled out Annie sustains a 4th degree tear to the perineum. This is repaired in theatre under a general anaesthetic and Annie returns with her baby to the post-natal ward. Over the next few days you have noticed Annie struggle to establish breast feeding and connect with her baby. She tells you that she is tired and unhappy and that she is afraid the damage she has sustained will affect her ability to have further children or to lead a normal life. You plan support services for when Annie returns home and organise regular home visits by a Midwife.

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1. Develop your Research Question

Start by working through Topic 5 of the Research Methodologies course. These topics specifically focus on how to develop your research question.

For more information, view the short video from Laurier University below:  

The following provides an example that we will use to work through the steps for your assignment:
 

Suggested scenario/background information on the topic

You are a nurse working in home care. One adult patient has been suffering from chronic pain and was prescribed non steroidal anti-inflammatories to reduce pain levels. They have since stopped taking this medication, stating that their use of cannabis is more effective and has fewer side effects.

Research problem 

Many people advocate the use of cannabis in chronic pain management. As more countries and regions legalise this drug, this may potentially be an acceptable alternative for your patient in the future.

Research question

Is cannabis more effective than nonsteroidal anti-inflammatories to reduce pain in adults with chronic pain?

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2. Apply the PICO Framewok

Once you have finalised your search question, the next step is to identify the main concepts of your question. 

Example question:

Is cannabis more effective than nonsteroidal anti-inflammatories to reduce pain in adults with chronic pain?
 

The 4 main concepts are:

  1. adults with chronic pain

  2. cannabis

  3. nonsteroidal anti-inflammatories

  4. reducing pain

Use the PICO or PIO framework to break down your concepts into more precise groups by identifying your Population of Interest; Intervention; Comparison; and Outcomes. If you have not specified a Comparison, just leave it out- this is a PIO framework.


For our example question above:

P (Population)

adults 

chronic pain

I (Intervention) cannabis
C (Comparison) non-steroidal anti-inflammatories
O (Outcomes)

reduced pain

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3. Develop your Search Strategy

Next develop a list of key words. To do this, take your PICO concepts and consider alternative words for each. 

Again, using the above example:

Population

adult, adults

chronic pain, severe pain, chronic inflammation

Intervention

cannabis, marijuana, THC, tetrahydrocannabinol, cannaboid, cannaboids

Comparison

non-steroidal anti-inflammatories, NSAIDS, nonsteroidal anti-inflammatories, nonsteroidal antiinflammatories, non-steroidal anti-inflammatory, nonsteroidal anti-inflammatory, nonsteroidal antiinflammatories

Outcome

reduce pain, pain reduction, reducing pain, manage pain, pain management, managing pain

 

 Now combine your terms with AND / OR. You always combine terms that mean similar things with OR and terms that mean different things (different PICO concepts) with AND.


Using our example above:

 

 

AND

adult OR adults
 

chronic pain OR severe pain OR chronic inflammation

AND

cannabis OR marijuana OR THC OR tetrahydrocannabinol OR cannaboid OR cannaboids

AND

non-steroidal anti-inflammatories OR NSAIDS OR NSAID OR nonsteroidal anti-inflammatories OR nonsteroidal antiinflammatories OR non-steroidal anti-inflammatory OR nonsteroidal anti-inflammatory OR nonsteroidal antiinflammatory

AND

reduced pain OR pain reduction OR reduce pain OR manage pain OR managing pain OR pain management

Use of truncation, wild cards and phrases can make your search more effective.

  • Use truncation (*) to search for word endings: cannab* finds cannabis, cannaboid, cannaboids

  • Use wildcards (?) to search for different spellings (zero/one letters/symbols only): colo?r finds colour, color

  • Use double quotes (" ") to keep phrases together: "chronic inflammation"


For our example:
 

adult?
AND
"chronic pain" OR "severe pain" OR "chronic inflammation"

AND
cannab* OR marijuana OR THC OR tetrahydrocannabinol

AND
"non?steroidal anti?inflammator*" OR NSAID*

AND
"reduce* pain" OR "manag* pain" OR "pain management"

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4. Search Databases

To find an appropriate database, look at the list of A-Z Databases. The link can be found on the Library's homepage underneath the search box. Suggested databases include:Question mark in a light globe

  • MEDLINE (discipline specific/all peer reviewed)

  • PubMed* (discipline specific – public version of Medline/not all peer reviewed)

  • CINAHL (discipline specific/not all peer reviewed)

  • Informit Health databases (discipline specific – and contains Australian material not found anywhere else/not all peer reviewed)

  • Scopus (multidisciplinary/not all peer reviewed)

  • Web of Science (multidisciplinary/all peer reviewed

* This database is freely available after you leave University, although Medline via Ovid is also available to staff in South Australian public hospitals. 

See below for a sample search on the Pubmed database, using our example topic. Additional database search videos are linked to below. These do not use the same example however.

Limits and filters may be applied to reduce your search results if you have too many.  Some useful limits include 'English Language' or date. Note the following about using limits:
 

  • Using a limit only applies to the database you are currently searching. If you have selected more than one, only the results from the filtered database will display.

  • If the database is bibliographic (abstract) only – it won’t find any full-text. Using a full text limiter will therefore yield 0 results.

If you limit your results, there is always the potential that you could miss some important/useful research. The video below will demonstrate how to apply limits and filters in PubMed. Most databases are similar.

You may want to save your search history in case you lose your results and need to re-run your search you can do this by

  • select one record

  • click on Print

  • select Include>Search History

  • click on Print Preview

From here you can copy and paste your search history into a Word document or print a copy. You can also mark relevant records and then print, save or export them.

The full text of a journal article can be found if the Library has access to the journal online. This can be done by using either the PDF link (if provided) or the 'Find it' function.

If you cannot find the full text of an article it may be because the University does not have access to it. If you can’t find the article you may need to find an alternative by looking back through your initial results.           

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5. Select and Evaluate your Resources

ScalesIdentification of relevant articles

Once you have identified potential articles, you need to start evaluating them to identify which four are the most relevant.

Title

The title can help tell you whether the identified article is suitable. Consider:

  • Does this seem to match my key words and combinations?

  • Does this seem to address my developed research question?

  • Is it a primary research study?*

If the answer to these questions is yes, keep the article for further consideration.

* You should reject literature reviews, commentary’s, study protocols, opinion and discussion papers.
 


Read the Abstract

It is unlikely that you will refine your results to exactly four simply by reading the article titles. You may need to read through the abstracts, considering the same questions as above. This process will most likely result in your final four.


Read the Article

Now download and read through all the full text articles you have remaining on your list. This should help you decide on a final four. See the next tab of this box for more detail on what to look for.


Reminder: Once you have your final four, save your search history. (See database searching section above.) 

Image source: Startupstockphotos.com

After you've looked at the title and abstract, go through the full text of the article to make sure it is of good quality. It is important to evaluate before you use it in your academic work.

 

Consider the following points when reviewing each paper:

  1. How well does each paper match:
    • your research question?
    • your systematic review methodology e.g. PICO?
    • your search terms?
       
  2. Where does each paper sit in the hierarchy of evidence that you are using, for example:
    • meta-analysis?
    • systematic review?
    • other?

Freepik 'Clapperboard', CC Licence: CC BY 3.0, Image source: Flaticon.com  
  Watch our video Study Help: Evaluating Information

 
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Referencing

Jason Grant 'Roadmap to referencing', January 2013 [Image source: UniSA Library]

Need help referencing? Follow the roadmap!

More help:

Image [Courtesy of UniSA Library]Store and organise all your references in one place throughout your studies.

In particular you can:

  • organise references in groups
  • quickly add (directly export) references into your 'Library'
  • easily find the full text
  • automatically create in-text citations and a reference list when writing assignments

The Library supports two Referencing tools: EndNote and RefWorks. See:

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Writing Academic Skills

View the Student Engagement Unit's Academic Skills website for help writing your assignment, or to make an appointment with SEU staff.