N4325 Nursing Research Paper

In this assignment, students will be asked to create the initial steps of an evidence based practice project using your faculty / coach assigned topic and the article you found in Module Two. After completing the Module Four readings, the student will create a PICO question based on their topic. A PICOT worksheet has been included for you (below) to assist you with creating a PICO question. The student will locate several additional resources to answer their PICO question, and write this information into a paper using APA style. Please click on the link: Assignment EBP Project – Finding the Evidence (below) for more information, and watch your due dates and times carefully. I will attach the article to formulate the PICO from and to be included in the paper.N4325 Nursing Research Paper

It is without any doubt that delivery is an experience which is very painful.  This pain is often as a result of various psychological and physiological causes. Vaginal delivery has numerous benefits to both the mother and a newborn infant. For instance, it promotes a rapid process during the post-partum period. It also facilitates an early relationship between a mother and an infant.  However, they also highlight that; vaginal delivery can also be associated with perineal trauma which potentially affects the social, physical and psychological well-being of a mother during the period of post-partum. This pain can go to the extent of affecting the family life, sexual relations and breastfeeding of a mother.

In the short term, perineal pain can potentially result in discomfort feelings, insomnia, and interference with the care provided to an infant.  In the long term, perineal pain can progressively lead to stress, maternal depression and anxiety, dyspareunia, urinary incontinence and even fatigue, conditions which require a lot of financial and non-financial resources to manage. It is for this reason that healthcare providers are called upon to help women in managing their perineal pain to easily adapt to motherhood.

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            For instance, since perineal pain during the post-partum period affects mother’s comfort levels, healthcare professionals are expected to assess and regularly monitor perineal pain to facilitate easy adaptation to post-partum, continued lactation and easy bonding time between a mother and an infant. Senol & Aslan (2017) recommend that to address this issue and achieve the aforementioned outcomes, managing postpartum perineal pain using different pharmacological methods like local and oral anesthetics or nonpharmacological methods like ice packs, seat cushions, and ice baths may prove effective. This, therefore, leads to the following PICO Question:

PICOT Question

Among women of reproductive age, does ice cold application, compared to no cold application; help to reduce perineal pain, following a vaginal birth?

Knowledge Added from Nursing Quantitative Research Article

From the quantitative research article, it was understood that perineal pain which develops during the period of post-partum has a significant impact on the relationships of mothers, their infants, and respective families. Most mothers experienced pain when performing a range of activities such as lying down, walking and sitting preventing physical and psychospiritual comfort, relaxation and resting (El-Saidy,  Aboushady & Soliman, 2018).  In this context, psychospiritual comfort refers to feelings of self-concept, self-respect, self-awareness, and sexuality. Pain also prevents sociocultural comfort where patients may be limited to give guidance and counseling to those who need it the most or to provide care to infants in accordance with the religious beliefs and traditions of a family. These effects occur in equal capacity among primis and multiparous women (El-Saidy, Aboushady & Soliman, 2018).   However, an effective way that nurses can use to manage perineal pain is by using local cooling treatments such as ice packs and cold gel pads. The application of ice pads, however, follows a protocol which clearly outlines the frequency and duration of approximately 15-30 minutes.  Ice gels are very effective in reducing perineal pain following vaginal delivery.N4325 Nursing Research Paper

Reliability of the Quantitative Article Used

             According to Francisco, et al. (2018), reliability refers to the consistency of an assessment/ instrument used in a study. Therefore, it is a measure of the trustworthiness of a result as examined by a test-retest method.

The researcher used questionnaires to collect data alongside face to face interviews. Essentially the questionnaires were structured to only measure the level of pain before and after ice gel application, which the study purposed to assess (Senol & Aslan, 2017). To ascertain the responses provided, the effect of the application of the ice cold gel was measured using a non-contact thermometer before and after the gel application. This was test-retest reliability.

The validity of the Quantitative Article Used

Basically, validity refers to the accuracy of an assessment tool as to whether it measures what I ought to measure or not (Rahimikian, et al., 2018). The study used a randomized experimental study design which increases the applicability of its findings to be applied to the context of other populations which helped to ensure external validity. \The use of face to face interviews in asking women how they felt or their levels of pain before and after ice gel application guaranteed a face validity since the researcher could not only relate the responses provided with the respondent’s non-verbal responses. The study also included only women who had just delivered via vaginal birth and excluded all those who had delivered via any other means, especially the cesarean section, an approach he helped to ensure criterion validity.N4325 Nursing Research Paper

Strengths and Weaknesses of the Article Used

A major strength of this study is that it was a randomized controlled study which had a control group and an experimental group. The study also had a sample size which was sufficient that includes a mixture of women who were multiparous and primiparous. This, therefore, means that its findings can be applied to a wide group of people. Besides, the study used a multidimensional approach to evaluate the effects of the ice cold application which increased the reliability of the study findings. Strength is that the researchers used well-formulated questionnaires to collect data. Questionnaires are an accurate data collection tool with high reliability thus increases the validity of the  study findings.

            A major weakness of this study is that only a single non-pharmacological approach was used to establish some of the ways that perineal pain could be managed following a vaginal birth in women of reproductive age.  The researchers previously identified different non-pharmacological approaches such as the use of seat cushions. However, they failed to include it as a possible intervention in the study. This also results in a limitation of options for women who may not prefer the use of ice cold packs/gels. Another limitation is that the researchers clearly explained that cold gels were applied when in hospital but failed to include possible observations that were made at home.  This  affected the clarity of using the same intervention approach after discharge from the hospital.  

Summary

Based on the researcher’s background knowledge, the following PICO question was formulated. Among women of reproductive age, does ice cold application, compared to no cold application; help to reduce perineal pain, following a vaginal birth? As a change of practice for nursing, I would highly recommend that nurses should practice the use of cold gel application to reduce perineal pain among women of reproductive age following a vaginal birth.   Ice gel application is a highly significant approach used to reduce pain that is felt by both multiparous and primiparous women during the postpartum period of recovery when performing activities such as lying down, breastfeeding, taking care of infants, sitting and even urinating. It is necessary to manage the perineal pain since, in the short term, it can potentially result in discomfort feelings, insomnia, and interference with the care provided to an infant.  In the long term, perineal pain can progressively lead to stress, maternal depression and anxiety, dyspareunia, urinary incontinence and even fatigue, which significantly affects the family life, sexual relations, bonding and breastfeeding of a mother.N4325 Nursing Research Paper

References

El-Saidy, T. M. K., Aboushady, R. M. N., & Soliman, H. F. A. (2018). Effect of Applying Crushed Ice Gel Pads on Episiotomy Pain and Wound Healing Among Postpartum Primiparous Women. International Journal of Nursing Didactics, 8(07), 19-29.

Francisco, A. A., De Oliveira, S. M. J. V., Steen, M., Nobre, M. R. C., & De Souza, E. V. (2018). Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial. Women and Birth.

Rahimikian, F., Shahbazi, S., Mohammadi, S., & Haghani, S. (2018). The effects of ice pack application on pain intensity in the active phase of labor and on birth satisfaction among primiparous women. Nursing Practice Today, 5(3), 355-362.

Smith, C. A., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H. G., & Suganuma, M. (2018). Relaxation techniques for pain management in labor. Cochrane Database of Systematic Reviews, (3).

Senol, D. K., & Aslan, E. (2017). The Effects of Cold Application to the Perineum on Pain Relief After Vaginal Birth. Asian nursing research, 11(4), 276-282.N4325 Nursing Research Paper