Answer

Research Critiques and PICOT Statement Final Draft

Introduction

            Varicose veins of the lower limbs are some of the key public health issues that are encountered in nursing practice. Varicose veins have associated complications such as chronic leg ulcers, limited mobility, and edema (Gong et al., 2020). Moreover, primary varicose veins may also cause symptoms such as swelling of the affected lower limb, and calf aching or pain, which may lead to lower the quality of life (Schwahn-Schreiber et al., 2016). The purpose of this final draft is to revise the PICOT (Population, Intervention, Comparison, Outcome, and Time) question and critique two qualitative studies (Gong et al., 2020; Schwahn-Schreiber et al., 2016) and two quantitative (Kinoshita et al., 2019; Tischer et al., 2019) studies that may be used to answer the revised PICOT question. Compression therapy should be considered as one of the standard evidence-based interventions for management of lower-limb varicose veins.

PICOT Statement: In patients with lower-limb varicose veins (P), does compression therapy (I) compared to lack of compression therapy (C) help in improving treatment outcomes with a three-month period (T)? 

Background

            This section provides a summary of the four studies include the problem, significance to nursing, purpose, objective, and research question (s) of each study. The four studies investigate the efficacy of compression stocking on realization of different outcomes. The purpose of Gong et al. (2020) was to identify the reasons that causes poor adherence to graded elastic compression stockings (GECS) for managing lower-limb varicose veins. Poor adherence to GECS initiated Gong et al. (2020) study. The objective was to develop an understanding of factors that drives poor adherence to GECS for intervention measures to be developed. The issue of poor adherence to GECS has significance in nursing practice since it may lead to poor treatment outcomes in patients who present with lower-limb varicose veins. Poor adherence to GECS may contribute to development of complications mentioned above. Nurses should work closely with patients so as to improve patient-adherence to GECS to help improve outcomes when managing varicose veins (Gong et al., 2020).

            Schwahn-Schreiber et al. (2016) conducted an observational study with the purpose of identifying the outcomes of using compression stockings in management of the issue venous disorders within an outpatient setting in Germany. The objective was to determine tolerability of the varicose vein patients to Mediven-medical compression stockings (MCS). Research question was to determine whether patients can tolerate use of Mediven-MCS or not. Research issue is important to nursing practice since varicose vein patients should be provided with compression stockings that can be tolerated comfortably to improve adherence as well as treatment outcomes (Schwahn-Schreiber et al., 2016).

            Kinoshita et al. (2019) investigated about the impact of use of compression stockings on oxygenation of the lower extremities. The purpose of the study was to use near-infrared spectroscopy to determine the level of tissue oxygenation upon use of compression stockings. The study was influenced by the concern that long periods of sitting may increase the risk of deep vein thrombosis. The study is of fundamental significance to the nursing practice since thrombi that are formed in the deep veins of the lower limbs may dislodge and be carried by blood leading to pulmonary embolism, which may be fatal (Kinoshita et al., 2019).

            Tischer et al. (2019) described post-operative limb swelling as a significant nursing problem, which may lead to negative effects. One of the effects of swelling after arthroscopic surgery is prolonged rehabilitation. The objective of the study was to evaluate the impact of compression stockings in management of post-operative associated swelling. The study has some significance in nursing practice since use of compression stockings can help reduce the length of rehabilitation care after arthroscopic surgery, which can in turn reduce the cost of care (Tischer et al., 2019).

Relevance of the Selected Articles to the Nurse Practice Issue

            The selected studies can each help provide an answer to the PICOT question in a way. Gong et al. (2020) study does not provide a direct response to the PICOT question but provide an insight on how to improve adherence to use of compression stockings for achievement of better outcomes. Poor adherence may hinder achievement of desirable outcomes (Gong et al., 2020). Gong and colleagues (2020) recruited patients who have been diagnosed with varicose veins and administered compression therapy but does not given a suggestion of outcomes measures but it provides the factors that affect adherence to compression therapy. Schwahn-Schreiber et al. (2016) helps answers the PICOT question since it indicates that medical compression stockings are well tolerated and can promote realization of subjective improvements in management of venous disorders. Participants in Schwahn-Schreiber et al. (2016) study are comparable to that targeted in the proposed study since they were using compression stockings to manage venous disorders.

            Kinoshita et al. (2019) helps answer the PICOT question since it focuses on determination the impact of compression stockings on oxygenation of the lower limb. Use of compression stockings should not lead to further damage such as poor circulation of blood (Kinoshita et al., 2019). However, Kinoshita et al. (2019) conducted their study among varicose vein patients but healthy volunteers instead. Tischer et al. (2019) also helps to answer the PICOT by describing the usefulness of compression stockings in reduction of post-arthroscopic surgical pain and swelling. Similarly, to the target population in the PICOT statement, Tischer et al. (2019) focused on varicose vein patients who had undergone arthroscopic surgery and were using compression stockings.

Method of Study

            The two studies conducted by Gong et al. (2020) and Schwahn-Schreiber et al., (2016) utilized qualitative research methodologies; whereas Kinoshita et al. (2019) and Tischer et al. (2019) employed quantitative research methodology.  Gong et al. (2020) phenomenology study used qualitative approaches such as face-to-face, in-depth, and semi-structured interviews; whereas, Schwahn-Schreiber et al. (2016) conducted an observational study for an 18-month period to investigate the outcomes of compression therapy. Kinoshita et al. (2019) used near-infrared spectroscopy to assess the effect of compression therapy on oxygenation of the lower limb. Use of tools such as near-infrared spectroscopy resulted in generation of objective data (Kinoshita et al., 2019). Tischer et al. (2019) conducted a randomized controlled trial that involved use of optical 3D measurement to quantify improvement in swelling of the lower limb following arthroscopic surgery with/without the use of compression therapy.

            Qualitative and quantitative research methodologies are characterized by certain benefits and limitations. One of the benefits of using the qualitative research methodology is its potential to generate a deep understanding of a given problem; however, the findings generated from a qualitative method may be not be open for generalization. On the other hand, one of the benefits of using a quantitative research methodology is that the outcome of the study may not be affected by the subjectivity of the researcher. However, a quantitative study may be more expensive to carry-out compared to a qualitative study (Queirós, Faria, & Almeida, 2017). 

Result of Study

            Gong et al. (2020) found that lack of essential GECS knowledge, socio-psychological factors, and few recommendations by nurses and doctors contribute to poor adherence to compression therapy. Nurses and doctors should then educate patients about the role of compression therapy in treatment of varicose veins as well as take center role in promoting adherence (Gong et al., 2020). Schwahn-Schreiber et al. (2016) found that it is rare to achieve transient skin tolerability with the use of medical compression stockings for managing venous disorders. However, use of medical compression stocking may promote realization of subjective improvement in treatment of venous disorders (Schwahn-Schreiber et al., 2016). Kinoshita et al. (2019) found that use of compression stockings may help improve oxygenation of the lower-limb skeletal muscle; when one sits down for three hours. Besides, compression stockings may reduce the loss of intracellular water. Improved oxygenation of the skeletal muscle may help promote realization of better treatment outcomes (Kinoshita et al., 2019). Tischer et al. (2019) found that use of compression stockings leads to significant reduction of post-operative swelling following arthroscopic surgery. In nursing practice, compression therapy may be considered for reduction of post-operative swelling and pain (Tischer et al., 2019).

Ethical Considerations

            Major ethical considerations in conducting research include getting of informed consent from research participants and maintenance of privacy/confidentiality of personal identifiable information (Kaewkungwal & Adams, 2019). In three studies, which are Kinoshita et al. (2019), Schwahn-Schreiber et al. (2016), and Tischer et al. (2019) study, the investigators ensured that had obtained written informed consent from each participant before conduction of the study. Similarly, Gong et al. (2020) ensured that all participants had provided informed verbal consent using a standard script before conduction of the interviews. On the other hand, the four (Gong et al., 2020; Kinoshita et al., 2019; Schwahn-Schreiber et al., 2016; Tischer et al., 2019) articles were published in way that it protects privacy or confidentiality of participants since no personal identifiable information were included in the publication.

Outcome Comparison

            Anticipated outcomes for the PICOT question may include shorter length of hospitalization, lower cost of care, improved management of pain and swelling, and improved satisfaction of care as a result of the use of compression therapy among patients diagnosed with varicose veins. The outcome of Tischer et al. (2019) study is more specific the anticipated findings of the proposed study since it describes the effect of compression stocking in reduction of arthroscopic post-operative pain and swelling. Gong et al. (2020) findings are not specific for answering the PICOT question but may inform strategies for improving adherence to compression therapy. Schwahn-Schreiber et al. (2016) study may help answer the PICOT question in that compression therapy is described as have a positive effect in improve subjective outcomes in managing venous disorders. Lastly, but not the least,  the findings of the Kinoshita et al. (2019) study are specific in answering the PICOT question since it states that compression therapy can improve oxygenation of the lower limb skeletal muscle and can help reduce the loss of intracellular water.

Conclusion

            Compression therapy is an evidence-based nursing approach for treatment of patients who present with varicose veins. The approach should be included as one of the standard practices for managing venous disorders since it seems to result in beneficial outcomes. Benefits include improved oxygenation of the lower limb skeletal muscle, reduced loss of intracellular water, improved management post-operative pain and swelling, and positive subjective outcome of care. The proposed study will attempt to identify other benefits associated with use of compression stockings compared with lack of compression stockings.