Issues and Challenges associated with Nurse-Samples for Students

Question: Disucss about the Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Answer: Research is an integral part of nursing since nursing professionals are better placed to bring improvement in their practice. Suitable nursing research entails the critical appraisal of peer-reviewed articles to understand the suitability and applicability of the study results in practice. The present paper is a critical appraisal of the article authored by Conway et al. (2012) titled Issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study with the help of the Critical Appraisal Skills Programme (CASP) Tool for qualitative research. Conway et al. (2012) aimed at exploring the challenges and issues faced by nurses in relation to nurse-administered procedural sedation and analgesia in cardiac catheterisation laboratory as explained by senior nurses. The authors pointed out the rationale behind selecting the topic and the relevant background information. Administration of sedative and analgesia for the medical procedure is called as procedural sedation and analgesia (PSA). Nurses have a significant role in the management of sedation since the cardiologists verbally prescribe the administration of drugs and an anaesthetist or other medical practitioner is usually absent (Godwin et al. 2014). Considerable research has highlighted that nurse-administered PSA in the cardiac catheterisation laboratory (CCL) is safe. However, there exist chances of suffering complications such as hypotension and hypoxia. In addition, a significant proportion of the patient population has reported discomfort and pain despite PSA. Further, PSA management is complex (Deftereos et al., 2013). According to Conway et al., (2014) there has been limited research that identified factors influencing the ability of nurses to assist optimal PSA titration. The researchers understood the importance of such research for developing strategies that can improve patient care process for those receiving nurse-administered PSA in the CCL. The authors through the present research, therefore, hoped to contribute to the constrained literature available on this valuable nursing topic. The study had a qualitative study methodology that wanted to highlight the perspective of senior nurses practising at the CGL setting about PSA. Since there was a need for gaining diverse nurses perspectives having relative experience in this field, two studies were carried out concurrently. It is was justified to use qualitative research methodology for the present research since the research question was to highlight perceptions, feelings and beliefs of the study participants. According to Nieswiadomy and Bailey (2017), qualitative research methodology has the emphasis on looking at variables in the natural setting which in the present case was senior nurses nin the CGL setting. Further, the data collected through this type of research is dependent on human experience, and it can be stated that generated data is more powerful and compelling than that generated through quantitative methodology for the same research question. An exploratory study design was selected for the present research which has certain limitations to it. Exploratory studies have the intention of merely exploring the questions considered for research and do not offer conclusive and final solutions to the problems already existing (Houser 2016). Further, such studies generate information whose interpretation might be subjected to bias. The participants for the study were recruited from the CGLs in public and private hospitals. These hospitals were from both regional and urban areas in two countries- Australia and New Zealand. Recruitment of the participants was done via a professional organisation involving CGL nurses in these two countries. An email invitation was sent to the probable participants. The three inclusion criteria were as follows; nurses employed as either clinical nurse manager or nurse unit manager, clinical nursing educator and senior nurses having minimum experience of three years. The researchers did not mention demographic details of the participants such as gender and age. Further, there has been no mention of sampling technique used, and this is noteworthy since sampling method influences the reliability of the study results (Nieswiadomy and Bailey 2017). Data collected for the research was done with the help of semi-structured and in-depth interviews. The interviews were valuable for enabling rich understanding of the experiences and viewpoints of the participants. Two researchers were responsible for carrying out the interviews. Though the same nurses took part in the two studies, the methodology was different from each other. The researchers, however, did not indicate the exact procedure of the interview and the whether they used a topic guide. Though a schedule for the interview was present, the researchers had flexibility in exploring the answers provided. Digital recording of the data was done, and verbatim transcription was also carried out. Analysis of transcription was done separately for the two studies. There was no mention of data saturation. Researcher bias plays a very crucial role in research for giving validity to the study (LoBiondo-Wood and Haber 2017). In the present case, the association between the study participa nts and the researchers was not critically examined. Ethical approval for the study was provided by the university human research ethics committee, signifying measures for the protection of the participants safety, rights and freedoms. The concern of informed consent of the participants was not addressed by the researchers. For human participants, it is ethical to receive the documented informed consent of the individuals after explaining them the purpose and significance of the research (Nieswiadomy and Bailey 2017). The researchers carried out thematic analysis for the data analysis with the help of the guide by Braun and Clark. According to Ward et al. (2013) thematic analysis is beneficial for qualitative studies to highlight the main patterns and themes arising from the study, capturing the primary elements of the data. Transcription and subsequent re-readings of the transcripts were beneficial for immersion in the data. The study findings articulated different themes from the analysis. These were lack of access to anaesthetists, challenges in effective monitoring of patients, limitations of sedative medications, and the impact of increasing complexity of procedures on sedation requirements. The study highlighted that nurses are concerned about the value of their practice in situations when current guidelines are not of much value within CGL settings for patient care. The research was valuable since it highlighted that nurses are required to demonstrate advanced skills and knowledge for monitoring adverse effects of sedation. The relevance to clinical practice lies in the fact that nurses face significant challenges while monitoring patients at the time of PSA. The study recommended that patient education is necessary to make them knowledgable about what is to be expected from the sedation procedure (Conway et al. 2012). The study had certain limitations. The sample size from each geographical area of Australia and New Zealand took part in the study, and certain areas of the two countries were not a part of the research. It might have been possible that institutions that were not a part of the study might facilitate different PSA from the ones described in the research. Therefore, the themes emerging from the study were context dependent and transferability and generalisability of the same was limited (LoBiondo-Wood and Haber 2017). Nevertheless, the value and contribution of the research in the field of nursing is not to be ignored due to the significance of the research topic. References Conway, A., Rolley, J., Page, K. and Fulbrook, P., 2014. Issues and challenges associated with nurse?administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a qualitative study.Journal of clinical nursing,23(3-4), pp.374-384. Deftereos, S., Giannopoulos, G., Raisakis, K., Hahalis, G., Kaoukis, A., Kossyvakis, C., Avramides, D., Pappas, L., Panagopoulou, V., Pyrgakis, V. and Alexopoulos, D., 2013. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study.JACC: Cardiovascular Interventions,6(3), pp.267-273. Godwin, S.A., Burton, J.H., Gerardo, C.J., Hatten, B.W., Mace, S.E., Silvers, S.M. and Fesmire, F.M., 2014. Clinical policy: procedural sedation and analgesia in the emergency department.Annals of emergency medicine,63(2), pp.247-258. Houser, J., 2016.Nursing research: Reading, using and creating evidence. Jones Bartlett Learning. LoBiondo-Wood, G. and Haber, J., 2017.Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Nieswiadomy, R.M. and Bailey, C., 2017.Foundations of nursing research. Pearson. Ward, D.J., Furber, C., Tierney, S. and Swallow, V., 2013. Using framework analysis in nursing research: a worked example.Journal of advanced nursing,69(11), pp.2423-2431.