NURS 350 Week 2 Discussion Research in Nursing

NURS 350 Week 2 Discussion Research in Nursing

NURS 350 Week 2 Discussion Research in Nursing

 

When you critically evaluate a study, you must decide whether you agree or disagree with the researcher’s theoretical framework (the underlying assumption or theory that supported the formation of the hypothesis and the development of the research design). The following scenarios have two possible hypotheses, each driven by a different theory.

Choose one scenario and one hypothesis from that scenario. Identify your personal assumptions about this hypothesis and choose a nursing theory to support your assumptions. You may use information from http://www.nursing-theory.org/theories-and-models/ to help you. Defend your answer.

Scenario 1: A patient with chronic back pain requests a narcotic prescription.

1. Hypothesis: In patients with chronic back pain not caused by injury, what is the effect of eight weeks of physical therapy compared to oral narcotic medication on the patients’ perception of pain?

2. Hypothesis: Are patients with chronic back pain who are denied narcotic pain medications at increased risk of depression as compared to patients on a prescribed pain regimen using oral narcotics?

Scenario 2: A diabetic patient misses several follow-up appointments.

1. Hypothesis: In patients with type 2 diabetes, does the use of an educational diabetic phone app improve compliance with appointments, diet, and medication regimens?

2. Hypothesis: Do patients with type 2 diabetes with a low economic status miss more follow-up appointments than patients with type 2 diabetes with a high economic status?

Importance  Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

Objective  To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.

Design, Setting, and Participants  Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized.

Interventions  Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

Main Outcomes and Measures  The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19).

Results  Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance  Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.