Critical Appraisal of Research

Critical Appraisal of Research
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Critical Appraisal of Research
Postoperative pain management is becoming one of the biggest challenges in patient satisfaction within clinical settings. Approaching postoperative pain with ideal strategies should help in overcoming the challenges. Postoperative pain management helps in minimizing acute pain from developing into chronic pain. Still, proper postoperative pain management should facilitate faster functional recovery as well as minimize patient discomfort. Mental, physical, and psychological health can all combine to reduce or worsen postoperative pain in patients. Presently, the debate is anchored on pharmacological or non-pharmacological approaches in dealing with postoperative pain. The choice of a pain management strategy depends on the assessed impacts of the regimens. Presently, the American Pain Society is encouraging multiple approaches to be accorded pain management with efficiency. This literature critical appraisal paper assesses non-pharmacological pain management regimens and their impacts on patients. In promoting evidence-based strategies for optimal postoperative pain management, inputs must be steered in developing holistic pharmacological and non-pharmacological interventions with a proper understanding of each strategy.
Background
Pain management is among the biggest challenges for surgical ward nurses presently. Every effort must be geared towards managing acute postoperative pain before the challenges deteriorate into chronic pain. Presently, 80% of patients report pain after surgery. In 75% of the reported pain cases, the patients can tell the severity as extreme, severe, or moderate. At least 50% of the reported cases indicate that the patients are not subjected to pain management regimens following their procedures (Reaza-Alarcón & Beatriz, 2019). That raises questions about the efforts that healthcare facilities are putting into pain management. The American Pain Society (APS) has noted the changes with concern. One of the inputs of APS towards revitalizing the trends was developing newer guidelines that are poised to help address postoperative pain through evidence-based approaches. The new approaches intend to include all the stakeholders in executing proper pain management strategies in prospects, including pharmacological and non-pharmacological modalities, transition to outpatient care, and pain management planning. The new guidelines demand a collective effort in dealing with postoperative pain.
The reliance on non-pharmacological methods (NPMs) in managing postoperative pain is gaining popularity in different healthcare settings. Evidence indicates a wide variety of NPMs that can help reduce postoperative pain (Khatib et al., 2017). However, even with a wide range of recommendations on the applications of NPMs, there is only limited empirical data to support the suggestions. There is a wide range of NPMs interventions that are becoming popular, including passively applied physical approaches. In the physical approaches, techniques such as heat and cold packs, transcutaneous electrical nerve stimulation, massage, and acupuncture are employed instead of pharmacological approaches to address the pain (McKay et al., 2019). The patient can also be subjected to physical activities such as light to moderate sportive activities, walking, or deep breathing. In some patients, psychological or spiritual approaches such as meditation, relaxation, visualization, imagery, and praying have been effective in postoperative pain management. Ultimately, a practitioner can choose distractions such as talking to people, listening to music, watching television, and enjoying time with friends and family members to manage acute pain. To surgical ward nurses, the choice of a non-pharmacological pain management strategy should depend on their understanding of the patient in terms of the patient’s interests and beliefs.
Surgical ward nurses face multiple challenges with pain management in their operational areas. High patient satisfaction is hardly achievable when acute pain grosses to chronic pain. On most occasions, practitioners attempt to combine both pharmacological and non-pharmacological inputs to deduce the problem and address it (Yaban, 2019). Notably, understanding the patient is a vital component in pain management. Practitioners need to relate with the patients deeply to explore what the patients believe or value. A deeper understanding of patients should help in developing suitable pain management approaches. Nurses must showcase the other insight on how much pain management intervention is needed for a particular patient. Even after undergoing similar surgeries, patients still experience pain differently, bearing the differences in the underlying physical, psychological, or emotional factors. Developing a pain management plan, hence, should be strict to the characteristics that a patient showcases.
PICO Questions
The critical appraisal will focus on two questions generated using the PICO format. The patients (P) are individuals in postoperative care who are experiencing different levels of pain. The intervention (I) is a non-pharmacological intervention to manage different kinds of pain. The comparison (C) focuses on assessing the similarities and differences when pharmacological interventions are employed solely. The outcome (O) emphasizes the effectiveness of the NPMs if used in managing postoperative pain. The PICO questions are as follows:
1 In postoperative patients with acute pain, how does non-pharmacological pain management strategies, compared to sole pharmacological approaches, affect the efficiency of pain management?
2 How do postoperative patients with pain receive better quality of life?
Search Strategy
Databases
The databases employed in the search for different pieces of literature are ProQuest and Google Scholar. The two databases are appropriate for this study because they have a wide range of articles. The databases are also sophisticated in their structure, with evident search portals that ease access to the needed articles. The other important element of the two databases is the characterization of articles. A researcher can easily classify the available sources based on their year of publication, authors, or titles. With all such factors, the two databases ensured efficiency in the search.
Search Terms
The search words or phrases were constructed based on the targeted information. “Post-operative”, “pain”, “management”, “pharmacological”, and “non-pharmacological” were the primary search terms in this study. In various instances, the need for more specific findings led to the use of conjunctions such as "and" and "or" for better outcomes. The use of single words or phrases delivered a wide range of sources assessed for their relevance in the study.
Inclusion Criteria
The articles would be included in the critical appraisal only if they met specific criteria. The first criterion was the date of publication. The publication date is an essential element because studies selected for this appraisal must reflect the present occurrences in the clinical setting. As such, the search focused on articles that were published between 2015 and 2021. Within that time frame, the articles would bear the relevance needed for dynamic clinical settings such as surgical wards. The second factor for inclusion was relevance to the PICO questions. The studies must have assessed the use of non-pharmacological approaches either solely or as the primary approach in managing postoperative pain. Focusing on a specific topic would ease conducting comparative analysis and assessing the content of the PICO question effectively. The third criterion emphasized the credibility of the sources. The articles must have been peer-reviewed and published in reputable journals to qualify for this critical appraisal. Any study that is not peer-reviewed would not be included. Ultimately, the assessment of the articles emphasized the research methods. Factors of the research methods, including the design and the sample size, would be necessary for addressing the different study approaches needed for this appraisal. The studies that met all the above criteria would be viable to the appraisal stage.
Boolean Search Table

Search Term

Google Scholar

ProQuest

Search Term 1

Postoperative

9,927

11,830

Search Term 2

Postoperative pain management

2,719

4,992

Search Term 3

Non-pharmacological postoperative pain management

351

406

Search Term 4

1+2+3

21

27

Chosen Studies
The chosen studies reached the threshold of all the criteria and bore complimentary relevance to each other. The first study is “Non-Pharmacological Methods and Postoperative Pain Relief: An Observational Study” (Koman et al., 2019). The study is a qualitative study that sought data from databases to systematically review various NPMs and their impacts on postoperative pain management. The study based its motivation on the increasing demand for NPMs in managing pain in postoperative care. The objectives stemmed from understanding the frequency of application of various NPMs and their effectiveness in pain relief. Koman et al. (2019) employed data from PAIN OUT, one of the largest postoperative pain registries presently. PIIN OUT works by encouraging patients to report their pain levels following their surgeries. The PAIN OUT database accorded the researchers with studies assessing the effectiveness of 15 different NPMs. The data would be adjusted based on different factors, including age and gender. The researchers also assessed the three most common surgeries in healthcare settings, including laparoscopic cholecystectomy, total hip replacement, and total knee replacement. The data included 14,676 patients from different European nations. 44% of the patients were reported to have used at least 1 NPM approach. The findings indicated that NPMs bear notable impacts on pain management. However, knee replacement patients showed that the NPM strategies employed were effective on more occasions than in other surgery patients. The study concluded that pain management using NPMs alone could attract more debates bearing the impacts of the strategies on different patients. Patients respond differently to different NPM approaches, making it necessary for healthcare professionals to understand their patients effectively before resorting to any of the above strategies.
The second study was conducted by Li-Hua et al. (2019) and employed a different approach in assessing the applications of non-pharmacological approaches in managing pain among postoperative patients. Li-Hua et al. (2019) study “Stratified pain management counseling and implementation improving patient satisfaction: a prospective, pilot study” assessed the viability of NPMs, especially as primary approaches alongside analgesics in managing acute pain among postoperative patients. Li-Hua et al. (2019) based their understanding because pharmacological approaches are fast becoming ineffective in managing pain among different patients after their surgical operations. Using pain management counselling would be vital in delivering the necessary inputs in overcoming pain following surgeries. The study was a prospective, controlled, pilot study with a sample size of 361 patients. All the patients underwent elective surgery. Of all the 361 patients, 187 (stratified group) received peri-operative pain risk assessment and counselling, while the other 174 (conventional group) received the conventional multimodal analgesia alone. Compared with the conventional group, the stratified analgesia group reported decreased pain intensity during motion at 24 h postoperatively and required lower dosages of rescue analgesia (P = 0.03). The total quality of recovery 40 questionnaire score and the scores for physical wellbeing and pain were significantly better in the stratified analgesia group than the conventional gro...