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Question
NUR2300 Evidenced Based Nursing Practice Semester 2, 2018 Assessment 1 - Written Due Date: 4th October 2018, 2355hrs
Total Weighting: 40% Marks /100 Word Count: 1600 words max Assignment Aim:
To conduct a systematic review of primary research, using a PICO (T) formatted clinical research question. To provide evidence from clinical research to inform changes or improvements to nursing practice. Present this evidence as a written research report and annotated bibliography.
Step 1. Develop a research question, using the PICO (T) format. This question should be related to one of the key chronic conditions listed by the Australian Institute of Health and Welfare (https://www.aihw.gov.au/reports-statistics/health- conditions-disability deaths/chronic-disease/about)
It is recommended that once you have developed your research question, you consult with your tutor.
Step 2: Conduct a literature search looking for Three (3) primary research articles which answer your chosen question. These articles should be presented as an annotated bibliography at the end of your systematic review/ research report.
Step 3: Write a systematic review, research report which answers your clinical research question. The report should include the following information:
- a) Research Question: Provide your research question and describe how you developed the question (100 words)
- b) Evaluationofresearch:Chooseoneprimaryresearcharticleandbrieflywritea critique of the research design, process, ethics and findings within the article. This section should demonstrate your understanding of research paradigms, methods and process. (200 words).
- c) Research Topic: Describe the research topic and how it relates to improving health outcomes for people with chronic conditions. (See National Strategic Framework for Chronic Diseases) (250 words)
- d) Literature Review: Discuss how the evidence you have found within the research literature (include all 3 articles plus any others) could make an impact on future nursing practice and the health outcomes for patients/clients. This should be a dissemination of research findings and the implications for changes to practice. (800 words)
Assessment 1 NUR2300 Semester 2 2018
- e) Recommendation Future Research: Provide a recommendation for future research including a suggested research methodology and research methods (200 words).
Submission instructions
All assessment must be submitted via the Turnitin link in study desk by the due date. Late penalty will apply to submissions without an extension. APA referencing must be used throughout. Any questions or concerns please contact your offer examiner or the overall examiner. Contact details are in your course study desk.
*Assignments must be submitted via the Turnitin link in study desk by the due date, students must review their text matching report prior to submitting the assignment for marking (please allow 24 hrs for this). All assignments that are in draft form after the due date will be accepted as the final submission and will be graded as such.
Assessment 1 NUR2300 Semester 2 2018
| Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Managing Lower Back Pain
Back challenges have adverse impacts on an individual’s quality of life. According to the Australian Bureau of Statistics 2014-2015, approximately 3.7 million individuals have back issues. The National Health Survey further estimates that about 70%-90% of Australians will face lower back challenges in their lifetime (Australian Institute of Health and Welfare, 2015). Prevention and management of the condition entail both pharmacological and non-pharmacological approaches such as maintaining healthy weight and physiotherapy. This paper, therefore, compares the effectiveness of exercise therapy and reducing obesity in reducing lower back pain and hospitalization among the aged patients.
Research Question
The Australian Institute of Health and Welfare (2015) note that the impacts of back pain range from negatively affecting the individual’s quality of life and huge financial burden. Notably, people with back pain report high levels of poor health and psychological stress. Considering the amount spent on managing the conditions, $ 560 million and $ 464 million are spent on admitted patients and out-of-hospital. Effective prevention and management of lower back pain entail various approaches. It is therefore imperative to examine their effectiveness with regards to enhancing the patient’s quality of life and reducing hospitalization. The PICOT question in this regard is: For patients above 65 years (P), how does exercise therapy (I) compare to weight reduction (C) in reducing lower back pain (O) over three months (T)?
Evaluation of Research
The study by Feitos, Lopes, Bonfa, and Halpem (2016) aimed at establishing the prognostic factors for physical therapy in managing lower back pain. The study employed a prospective observational approach and involved 113 participants with chronic lower back pain. The measurement outcomes included pain intensity and function of the individual measured by the Numeric Rating Scale (NRS) and Roland Disability Questionnaire (RMDQ) respectively. Main findings were that extraspinal pain is related to poor response to physical therapy. Drawing from these findings, this study recommended a rehabilitation therapy for patients with lower back pain. The quality of the study is centred on a strong background, high population, and methodology. Feitos et al. (2016) commence by recognizing the different lower back pain management approaches including pharmacological and physical therapy. The high number of participants is critical in providing sufficient results for analysis. To eliminate the risk of bias, the inclusion and exclusion criteria was used. Informed consent was also provided which promoted the ethical factor of the study. In addition, the study was approved by the research committee and local ethics. From the background to the methodology and discussion, the study is consistent and responds to the objectives which is a strength factor. However, the researchers do not identify the challenges they faced in the study which is a key aspect in scientific studies.
Research Topic
According to the Australian Institute of Health and Welfare (2018), back pain was the third leading burden condition in Australia in 2011. Notably, 3.7 million individuals reported the condition between 2014-2015. Further statistics by the Australian Aboriginal and Torres Strait Islanders Health Survey (AATSIHS) reveal that the condition was high by 1.2 times among indigenous people as compared to the general Australian population. Managing lower back pain entails different approaches. As noted by Feitosa et al. (2016), physical therapy is among the most effective approaches to managing the condition. Kloigaard, Manniche, Pedersen, Bech, and Sogaard (2014) discovered that patients have various preferences with regards to choosing lower back pain management approach. These authors note that the majority of patients with lower back pain prefer non-surgical approaches such as physical therapy and can wait for actual results from their preferred interventions.
Obesity and overweight are also related to lower back pain. According to Koyanagi et al. (2015), although there is a significant relationship between obesity and back pain in developed countries, there is a need for more research to provide conclusive results. This study further revealed that effective management of back pain entails different approaches including lifestyle change to reduce weight and promoting the individual’s quality of life. In line with the Australian Institute of Health and Welfare (2015), understanding the different management approaches aids in developing a holistic intervention that considers the various aspects such as weight management, exercise therapy, and home management. Besides, understanding these details is important for healthcare providers to develop competent skills in managing lower back pain.
Literature Review
Future nursing practice in managing lower back pain is centred on a comprehensive understanding of the condition and formulating profound interventions. According to Hopayian and Notley (2014), promoting patient satisfaction is centered on addressing their challenges. In lower back pain management, a key aspect entails developing interventions that are in line with the diagnosis and those suitable to the patient. From exercises to lifestyle management, Hopayian and Notley (2014) note that effective pain management is based on developing comprehensive interventions and applying the patient-centred model that also addresses the patient’s needs. Traeger et al. (2014) confirm the integrative management of lower back pain and notes that the condition is related to other disorders such as depression which should be addressed. Based on the results from Sydney metropolitan area, Traeger et al. (2014) noted that besides implementing evidence-based practices, it is essential to educate the patient on the condition and its management which entails addressing the presenting symptoms.
In lower back pain management, patient satisfaction is reflected in addressing the different health conditions profoundly and interaction with healthcare providers. According to Hensley and Courtney (2014) managing lower back pain is dependent on a comprehensive pain mechanisms approach that assists the patient with other conditions besides the chronic pain. Healthcare providers are therefore required to demonstrate competence in relating to the patient, identifying the different conditions the individual suffers from and using healthcare knowledge to formulate management strategies. Traeger et al. (2014) confirm the importance of enhancing nursing competence which is related to advanced healthcare management strategies. In this regard, more research and training programs are imperative for nurses to enhance their skills in managing lower back pain. Through these educational programs, health care providers enhance their awareness regarding the conditions, various symptoms and how they can be managed. Also, other skills such as interpersonal, communication, and leadership are imperative while relating to the patient which should also be included in the training programs.
Exercise therapy is core in managing chronic lower back pain. Among the various interventions to managing lower back pain is exercise therapy which entails controlled physical activities. Jorgensen, Afzali, and Riis (2018) point out that besides the pharmacological management approaches, non-pharmacological interventions are critical which include patient education and exercise therapy. The systematic review by Jorgensen et al. (2018) revealed the importance of exercise-based treatment in managing lower back pain although this was dependent on the degree of pain. In primary care, therefore, nurses are expected to demonstrate competence in formulating management strategies that incorporate exercise treatment. Seartle, Spink, Ho, and Chuter (2015) offer a contrary opinion and note that exercise treatment solely cannot manage lower back pain. Rather, a combination of non-pharmacological interventions is necessary including reducing the patient’s overall weight. Such a strategy fosters the effectiveness of the exercise. This introduces the importance of obesity and overweight management.
Lower back pain originates from other conditions such as obesity thus weight management should be part of the intervention plan. Weirtli, Held, Campello, and Weiner (2016) note that for patients with lower back pain and are disabled, obesity contributes to the severity of the symptoms. This is further confirmed by Koyanagi et al. (2015) who point out that health care providers must ensure that the patient’s Body Mass Index (BMI) is below the overweight line. Notably, managing weight reflects on a comprehensive lifestyle change which includes physical exercises, reducing smoking and alcohol intake, and diet management. This introduces the importance of lifestyle change for patients with lower back pain. Future nursing practice should, therefore, focus on developing lifestyle change interventions which aid in reducing the patient’s weight. As noted by Jorgensen et al. (2018), it is imperative to develop management plans that consider different and effective approaches. patients with lower back pain have reduced mobility, and their quality of life is adversely affected. Feitosa et al. (2016) therefore argue that health care providers should focus on addressing these challenges and align medication therapy with physical exercises to promote the individual’s quality of life.
Nurses should demonstrate awareness of the patient’s beliefs and cultures for profound interaction and managing the condition. According to Feitosa et al. (2016) individuals with lower back pain express different concerns regarding the rehabilitation programs. Kloigaard et al. (2014) point out that patients have different preferences in considering lower back pain treatment approaches. In this regard, it is essential for healthcare providers to effectively relate to the patient and understand their concerns and preferences and therein develop interventions that are in line with these needs. Kloigaard et al. (2014) for instance discovered that while there are patients who may prefer pain management using opioids, others are interested in therapeutic approaches and can wait for long durations for the symptoms to reduce. In this regard, healthcare competence such as cultural, interpersonal, and communication are essential in managing lower back pain. This involves understanding the patient’s condition and preferences and developing interventions that meet these needs.
Recommendation Future Research
Based on the literature review above, patient satisfaction in the developed intervention is centred on the effectiveness of meeting their needs and preferences. This entails managing the pain and enhancing the quality of life of these individuals. However, the relationship between patient knowledge and self-management remains under-evaluated. Therefore, future research should focus more on enhancing patient awareness and effective management of lower back pain. Among the key aspects to include in the education programs are the causes of the condition, symptoms, and different treatment strategies. Conducting these awareness programs is critical in changing patient perception and preferences on the management strategies. According to Kloigaard et al. (2014), patient preferences to non-pharmacological interventions is related to limited awareness, fear, and beliefs which can be addressed by educational programs. The study would adopt the qualitative methodology to examine the patient awareness and effectiveness in managing lower back pain upon implementation of the awareness program. Interviews would be conducted before and after the implementation of the awareness program. Among the core aspects that would be evaluated are knowledge on condition, its diagnosis, and management. In addition, the survey would examine the most preferred management approach by the patient before and after the education program.
Conclusively, back pain is a common chronic condition that affects approximately 3.7 million Australians. As a result, effective management approaches of the condition are essential including pharmacological to non-pharmacological such as lifestyle change and exercise therapy. The above analysis reveals that comprehensive management approach is required although patient awareness programs should be implemented to address the disparity in patient’s beliefs regarding the condition. (2017) study employed, there are very little room for generalizing the study’s findings.
References
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Australian Institute of Health and Welfare (2015). Musculoskeletal factsheet: back problems. Arthritis series no. 21. Cat. no. PHE 185. Canberra: AIHW. ISBN 978-1-74249-725-9 (PDF) 978-1-74249-733-4 (Print) ISSN 1833-0991 Australian Institute of Health and Welfare (2018). Back Problems Snapshot. Retrieved from https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/who-gets-back-problems Feitosa, A. S., Lopes, J. B., Bonfa, E., & Halpern, A. S. (2016). A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain. Revista brasileira de reumatologia, 56(5), 384-390. Hensley, C. P., & Courtney, C. A. (2014). Management of a Patient With Chronic Low Back Pain and Multiple Health Conditions Using a Pain Mechanisms–Based Classification Approach. journal of orthopaedic & sports physical therapy, 44(6), 403-C2. Hopayian, K., & Notley, C. (2014). A systematic review of low back pain and sciatica patients' expectations and experiences of health care. The Spine Journal, 14(8), 1769-1780. Jorgensen, J. E., Afzali, T., & Riis, A. (2018). Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol. BMJ open, 8(1), e019742. Kløjgaard, M. E., Manniche, C., Pedersen, L. B., Bech, M., & Søgaard, R. (2014). Patient preferences for treatment of low back pain—a discrete choice experiment. Value in Health, 17(4), 390-396. Koyanagi, A., Stickley, A., Garin, N., Miret, M., Ayuso-Mateos, J. L., Leonardi, M., ... & Haro, J. M. (2015). The association between obesity and back pain in nine countries: a cross-sectional study. BMC public health, 15(1), 123. Searle, A., Spink, M., Ho, A., & Chuter, V. (2015). Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation, 29(12), 1155-1167. Traeger, A. C., Moseley, G. L., Hübscher, M., Lee, H., Skinner, I. W., Nicholas, M. K., ... & Hush, J. M. (2014). Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial. BMJ open, 4(6), e005505. Wertli, M. M., Held, U., Campello, M., & Weiner, S. S. (2016). Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry. BMC musculoskeletal disorders, 17(1), 140.
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