This paper is all about nursing knowledge that was used in a researched PICOT question through health databases

The PICOT format is utilized by registered nurses in formulating clinical questions.  This paper is all about nursing knowledge that was used in a researched PICOT question through health databases. The Evidence Based Research (EBP) directs nursing care. Anytime a research is conducted, the new data is clearly communicated within the setting of healthcare. The field of nursing and other related personally are bound to collaborate professionally in order to support the Evidence Based Research and integrate it into their daily practices.  By using the PICOT question I was able to explore whether the use of operative versed in pediatric patients provides better postoperative pain control than when they are not using at all. The methodology and review of the research literature are noted (Niewswiadomy,  2012).   Moreover, the paper also highlights the significance in nursing, the future research on management of preoperative and postoperative.

Clinical question

As a nurse working in a local hospital in departments of recovery unit, prep, and surgery, I always come across pediatric patients who are having surgical procedures.   You find children below and above ten years are many.  The IV of Those who are under the age of ten years is started in the operating room under general anesthesia. On the other hand, the IV of those above ten years old is started in the preoperative area. All children below and above ten years, oral midazolam can be given to them preoperatively. Nevertheless, because of limited IV access, the IV midazolam is not issued but only oral midazolam.

Evaluation of the children is done by the anesthesiologist who also orders the midazolam, yet there is policy is set for that matter.   I noticed that there was a development of irregularities in the medication of children with midazolam before the surgery.  Anyone could notice that the children who were lucky enough to be medicated with midazolam preoperatively had better post-operative pain control.

The acronym PICOT is commonly known as a way to format questions when there is the question for discussion.   Usually, P represents the patients or population, I represent the area of intervention, C represents the current practice or comparison, O represents the desired intervention or interest, O represents the outcome and finally, T stands for time.  However, in regard to the PICOT question I am discussing, the representation of the acronym changes.  P stands for pediatric patients. I for the administration of oral versed, C stands for comparing not medicating preoperatively, O represent post-operative pain management and T is in the post-operative period.  I believe and we should all believe that the safety and quality of the pediatric patients who are going through surgical procedures would be improved if only there were reliable policies and procedures in place on preoperative medication.

 

Methodology

When I was researching the PICOT question, I used one database that is relevant to the medical/ nursing field.  In the database, I used the advanced search were possible and included phrase or words.   When I used the term versed, there was not much revealed in the articles but the moment I advance the search by including midazolam that provided more information.

Discussion literature

Article 1

“Pre-anesthetic medication with intranasal dexmedetomidine and oral midazolam as an anxiolytic. A clinical trial” this is an article that compares the trial between two medications for preoperative anxiety (Linares et al., 2014).  The trial was based on the children from the age of 2 to 12 year old. Moreover, it was a controlled, randomized, prospective and a double-blind trial.  In the trial, there were 108 pediatric patients whose anxiety was assessed by using a modified Yale scale.  When it comes to children, anxiety is closely related to pain perception and pain.

The trial was done in the year 2013 and I decided to only include the information that is based related to my PICOT question.  The research, however, was suggestive of the dexmedetomidine being superior compared to midazolam in terms of reducing anxiety.  Additionally, it can also reduce the pain perception for children.  Despite that little difference, the findings after the research was supportive and important to the issue of pediatric patients can have a better post procedure pain if only they were preoperatively medicated.  I would say that standardized practices should] be made available more research should be conducted.

Article 2

Preoperative management

Preoperative can be managed by establishing NPO status.  Anesthesia usually carries an inborn risk of the patients aspirating stomach contents and vomiting.  The NPO status should be discussed with the anesthesia team. Also, the team is to be consulted before unusual and complicate operations.  For instance, the procedures that entail the manipulation of the lungs or repositioning of the patient during operation. The anesthesia team should be notified if the patient in undergoing the surgery has a history of complications with malignant hyperthermia or previous anesthetics.

Moreover, the team should be notified if the patient has signs of an upper respiratory tract sickness because it increases the chances of post –intubation.  Preoperatively, discuss with the anesthesia team about patients who are to benefit from an epidural or caudal injection catheter injection for postoperative pain control.

In regard to medication of these patients, their current medication should be conditioned.  You find that the patients who have been on corticosteroids for a long time might not be able to mount a natural stress response because of a chronic dominance of the hypothalamic-pituitary-adrenal axis (Fazi, 2001).  Therefore, these patients should receive a dosage of corticosteroids for stress that is proportional to surgery stress at the time of preoperative period.   On the other hand, those patients who have been told to take antihypertensive drugs should do it continually but they must be monitored closely for intraoperative hypotension.   Examples of other drugs that should be continued at the time of preoperative are immunosuppressant, asthma drugs and antiepileptic.

Article 3

Postoperative management

During evaluation of a postoperative patient, pain is a common issue. Therefore one should try and differentiate between pain and anxiety patients with the pin from undergoing minor procedures like hernia repair is usually controllable with oral analgesics such as ibuprofen.  Controlling pain after surgery is more difficult.  Therefore, consider the use of IV or parent or nurse controlled analgesia (Gan, 2001).

A common problem that is encountered in the postoperative period is vomiting and nausea.  Four classes of drugs can be used to control this problem; the antihistamines, dopamine D2 antagonists, anticholinergic and 5-HT3 receptor antagonists.

Resuscitation of a child is indicated by urine output and hemodynamic status.   A normotensive child who is well resuscitated is not tachycardic.  On the other hand, the child who has tachycardia might be hypovolemic.  Therefore, it is significant to attempt to account for the influence of pain and anxiety which can increase the rate if the heart and blood pressure.

Many patients in the postoperative period do not require laboratory studies.  A complete platen count, blood count, as well as coagulation panel should be checked if the patient is ongoing a blood loss should be a major concern.  Moreover, the electrolytes have to check when there is important fluid loss or shifts.

 

Significance to nursing

It is important that the research topic is associated with the type of work the nurses perform daily.   The nursing practice can be potentially changed to increase the efficacy and safety of care through the support of EAP. In the world of today, the nurses have the ability to address a wide variety of health issues.  Nevertheless, for the profession of nursing to grow and develop, the nurses should act within their scope of practice as defined by the association of American nurses as well as the Code of Ethics for Nurses ((Black, 2014).  Nurses are lifelong learners, the practice and skills will change many times. Only communication will ensure that everyone in the healthcare team is on the same page so as to get the patient health care of high quality.  Through the Quality and Safety for Nurses, the nurses acquire quality nursing education. Personally, I have gained insight and knowledge that is essential to my line of work as a nurse.

Conclusion

Through the PICOT question, supportive as well as non- supportive data was available which was educative to me and others out there.  I have learned how to handle pediatric patients, how to give them medication. Moreover, it has directed me on how to advise them on the right thing to do when it comes to managing pain after surgery.  This research is important to all nurses who are taking care of children.