evidence based practice evidence based practice

evidence

1. Evidence-Based
Nursing practice

2. 2
Under supervison:
prof. Amira Ahmed
prepared by:
Ahmed Gamal
Soad Salem

3. Intended Learning Outcomes
3
Attheendofthislecture,allparticipantswillbe
abletoprovidehigh-qualitycaretotheirpatientsbased
onresearchandknowledgethrough:
•DefinitionofEBP
•ElaboratetheaimofEBPinnursing
•Elaborate the benefits of EBP in nursing.
•Discuss the models of EBP.
•Identify levels of EBP.
•Apply the five steps of EBP process.
•Musculoskeletal system
•Application of EBP on musculoskeletal disorders
•( fracture)

4. Introduction:
-EBNisaprocessfoundedonthecollection,
interpretation,andintegrationofvalid,important,
andapplicablepatient-reported,clinician-observed,
andresearch-derivedevidence.
-EBNmustusethebestresearchevidencewith
clinicalexpertiseandpatientvalues.
4

5. 5
Patient
Values
Clinical
Expertise
Best
Research
evidence
EBNP

6. •Today’nursingpracticeemphasizestheuseofresearch
todeterminebestpractices,ortheinterventionsor
approachestopatientcarethatwillhavethebest
impactonpatientoutcomes.
•Professionalsinthepastusededucationalknowledge,
consultationwithpeersandspecialists,andtheirown
experiencestomakedecisionsaboutpatientcareand
toselectinterventions.
6

7. 7
Themodernclinicianwhousesevidence-basedpractices
integrateshis/herclinicalexperiencewithcurrent
researchtohelpguidepatientcaredecisions.
Nursesarenowcreatingevidence-basedguidelinesusing
theresultsofresearchthatareavailableintheformof
systematicreviews.

8. Definitions
•NursingResearch:
Ascientificprocessthatvalidatesandrefines
existingknowledge andgeneratesnew
knowledge thatdirectlyandindirectly
influencesnursingpractice.
8

9. •EvidenceBasedNursing:
isanapproachtomakehighqualitydecisionsand
providingnursingcarebaseduponpersonalclinical
expertiseincombinationwiththemostcurrent&
relevantresearchavailableonthetopic.
9

10. 10
Itisaproblem-solvingapproachtothedeliveryof
healthcarethatintegratesthebestevidencefrom
studiesandpatientcaredatawithclinicianexpertise
andpatientpreferencesandvalues.
Evidence-based practice (EBP)

11. Aim of EBP
•Providethehighestqualityandmostcost-efficient
nursingcare.
•Advancequalityofcareprovidedbynurses.
•Increasessatisfactionofpatients.
•Focusonnursingpracticeawayfromhabitsand
traditiontoevidenceandresearch
11

12. The Benefits of EBP in Nursing
A-To Patients/Consumers:
•Improve the quality of received care.
•Saves patient rights
•Rapid recovery.
B-To Nurses:
•Keep nurses updated by reading the published literature.
•Improve communication skills.
•Increase confidence to EBP Nurse because they provide care
that is supported by facts rather than habits, and can
•take legal accountability for their practice.
12

13. 13
C-ToHealthCareOrganization:
•Enhancemarketingoforganizations.
•Decreasecost.
•Increaseeffectiveness.
•Toolforeducation.
D-ToCommunity:
•Saveresources
•Limittheamountofdisabilityandsufferingthroughout
thecommunitybyensuringthemostcurrentand
effectivecareisprovided

14. Misconception about EBP
•Evidence-basednursingignorespatientpreferencesand
values.
•Evidence-basednursingistheoretical.
•Evidence-basednursingisonlyaboutquantitativeresearch.
•Evidence-basednursingoveremphasizesrandomized
controlledtrialsandsystematicreviews.
14

15. 15
Models of Evidence-Based Practice
-RosswurmandLarrabee(1999)proposedamodel
forguidingnursesthroughasystematicprocessfor
thechangetoevidence-basedpractice.
-Thismodelrecognizedthattranslationofresearch
intopracticerequiresasolidgroundinginchange
theory,principlesofresearchutilization,anduseof
standardizedterminology

16. E B N P is a Five-Steps Process
16

17. •Five A’S in the evidence based practice
•ASK:Informationneedsfrompractice
areconvertedintofocused,structured
questions.
•ACQUIRE:Thefocusedquestionsareusedasa
basisforliteraturesearchinginordertoidentify
relevantexternalevidencefromresearch.
•APPRAISE:Theresearchevidenceiscritically
appraisedforvalidity.
•APPLY:Thebestavailableevidenceisused
alongsideclinicalexpertiseandthepatient's
perspectivetoplancare.
•ASSESS:Performanceisevaluatedthrougha
processofselfreflectionorpeerassessment.
17

18. step 1: Ask
Therearegenerallyfourpartstoquestionbuilding:the
patient/problem,theintervention,thecomparisonandthe
outcome.YoumayhaveheardoftheacronymPICOtorefertothis
questionbuildingprocess.
18
Developing a PICO Question
P=patientpopulationofinterest.Identifyyour
patientsbyage,gender,ethnicity,disease,orhealth
problem.

19. 19
Developing a PICO Question
I=interventionofinterest.Whatistheintervention
youthinkisworthwhiletouseinpractice(e.g.,a
treatment,diagnostictest,prognosticfactor)?
C=Comparisonofinterest.Whatistheusual
standardofcareorcurrentinterventionyouusenow
inpractice?

20. Developing a PICO Question
•O=Outcome.Whatresultdoyouwishtoachieveor
observeasaresultofanintervention(e.g.,change
inpatient’sbehavior,physicalfinding,changein
patient’sperception)?
20

21. 21

22. Step Two: Acquire
Selecting Resources and Search for the Evidence.
22
Inthisstep,thenursewilllocatethehighestquality,
relevantinformationfromthemedicalliteratureto
answerthequestion.
Thenurseneedstoselectthedatabasesandjournals
thatwillusetofindtheanswertoherquestion.

23. 23

24. Somedatabases,suchasPubMed,havea
controlledvocabulary.Forexample,insteadof
classifying"cancer",theyclassify"neoplasm".When
usingtheircontrolledvocabulary,youmayreceive
greateraccuracyintermsorthetopiconwhichyou
aresearching.
24

25. Step 3: Appraise
Critical Appraisal/Evaluation of the Literature
•Inthisstepthenursecriticallyappraisestheevidenceforits
validity,Relevance,andApplicabilityinclinicalpractice.
•Validity(Thetrustfulnessofevidence):Aretheresultsofthestudy
valid?Ontheotherhand,isthequalityofthestudygoodenoughto
produceresultsthatcanbeusedtoinformclinicaldecisions?
•Relevance:Doesevidencedirectlyanswerthequestion?Whatarethe
resultsandwhatdotheymeaninourcontext/forourpatients?
•Applicability:Cantheresultsbeappliedtlocalpopulation?Canwe
applytheminourclinicalsettings?
•Thisstepcanbeoverwhelmingduetothegrowingbodyofknowledge
availabletonurses.Itisimportanttobeginbyfocusingononearticleata
time.Knowtheelementsofanarticle,anduseacarefulapproachwhen
reviewingeachone.
25

26. Evidence-based articles include the
following elements:
•Abstract:Anabstractsummarizesthepurposeofthe
studyorclinicaltopic,themajorthemesorfindings,and
theimplicationsfornursingpractice
•Introduction
•Literaturerevieworbackground
•Manuscriptnarrative:The“middlesection”or
narrativeofmanuscriptdiffersaccordingtothetypeof
evidence-basedarticle,eitherclinicalorresearch.
26

27. A clinicalarticle:
Describesaclinicaltopic,whichoften
includesadescriptionofapatient
population,thenatureofacertain
diseaseorhealthproblem,howit
affectspatients,andtheappropriate
nursingtherapies.Clinicalarticles
oftendescribehowtouseatherapyor
newtechnology.
Aresearcharticle:
Describes the conduct of a
research study, including its
purpose statement, methods
or/how the study was designed,
the results or/conclusions, and
clinical implications
27

28. 28
A work sheet
can be helpful
for evaluating
the evidence.
(Hockenberry et al, 2006)

29. Step 4: Apply
Integrate all evidence :with patient preferences, values and clinical
expertise
Oncethedecisionhasbeenmadetoprovideacertaintreatment,
applicationofthetreatmentisoftenmade.
SuccessfulimplementationofEBPisdependentupon
severalfactorsasshownbelow:
EasyaccesstolibraryandITresources.
Financestosupportnewtreatmentstrategies.
Adequatenumberofnurseswithappropriateskills.
Sufficienttimeforgatheringandappraisingresearch
evidenceandimplementationactivities.
Fullco-operationbetweenpeers,managersandallother
professionals.
29

30. •Beforedecidingtoapplytheresultsofthestudy
manyquestionsthatshouldbeasked
•Isthetreatmentfeasible(achievable)inmyarea?
•Isthepatientsodifferenttothoseinthestudythat
theresultscannotbeapplied?
•Whatalternativesareavailable?
•Willthepotentialbenefitofthetreatmentoverweigh
thepotentialharmformypatient?
30

31. Step 5 Assess
•Afterapplyingwhathasbeenretrievedfromtheliteratureto
clinicalsituation,nursewillneedtoevaluateasfollowing:
•Assesstheeffectivenessandefficiencyoftheevidence-based
process.
•Regardfeedbackfromallstaffandfrompatients.
•Assessifthedesiredoutcomebeingachievedornot.
•Thestrengthsaswellasthedrawbacksofthechangein
practice.
•Commitmentofnursestothechangeinpractice.
•Theconsultationwithothers(especiallywiththenurse
manager).
31

32. Steps of EBNP
32

33. 33

34. Musculoskeletalsystem
Consistsofthebones,muscles,ligaments,
tendons,andcartilagetogetherwiththejoints.
Humanskeletonhas206bones
BonegrowthandmetabolismisaffectedbyvitD,
calciumandphosphorous,calcitonin,growth
hormone,estrogens,testosterone,parathyroid,and
glucocorticoids.

35. Figure41-1Bonesofthe humanskeleton.
Axial Skeleton
Appendicular Skeleton

36. Figure41-2Classificationofbonesbyshape.

37. Functions
1.Supports soft tissue and provides attachment for
skeletal muscles
2.Assists in mov’t, along with skeletal muscles
3.Protects internal organs
4.Stores and releases minerals
5.stores fats
6.produces blood cells

38. Tendons
Connect bone to muscles, and aids movement when muscles
contract.
Ligaments
Connect bone to bone
Provide joint stability and strength
Joints (Articulations)
Area where two or more bones meet
Holds skeleton together while allowing body to move

39. Types of joints
Fibrous -Immovable
Cartilaginous -Slightly movable
Synovial -Freely mobile
Synovial Joints
Found at all limb articulations
Surface covered with cartilage
Joint cavity covered with tough fibrous capsule
Cavity lined with synovial membrane and filled with synovial
fluid.

40. 1.MusculoskeletalDisorder
(Trauma)

41. (Fractures)
Is a break in the continuity of bone when it is
subjected to stress greater than it can absorb.
Causes
•A metabolic bone disease /pathological such as osteoporosis
•An endocrine disorderE.g. Hyperparathyroidism
•Direct force/ trauma or crushing force
•Sudden twisting motion
•Powerful muscle contraction pulls against the bone
•Bone tumors, which weaken the bone structure

42. Whentheboneisbroken,adjacentstructuresarealso
affected,
Resultinginsofttissueedema,hemorrhageintothe
musclesandjoints,jointdislocations,rupturedtendons,
severednerves,anddamagedbloodvessels.

43. TypesofFractures
•Basedoncross-sectionoftheboneinvolved:
1.Completefracture: involvesa breakacrosstheentirecross-
sectionoftheboneandisfrequentlydisplaced(removedfrom
normalposition(
2.Incompletefracture (ge ,kctisneergerutcarf :(ehtkaerb
sruccohguorhtylnotrapfoehtssorc-noticesfoehtenob.
3.Comminutedfracture :isonethatproducesseveralbone
fragments.

44. Basedoninvolvementoftheskin:
1.Closed elpmis((erutcarf:seodtonesuacakaerbniehtniks.
2.Open ,dnuopmoc(ro,xelpmoc(erutcarf:ehtniksrosuocum
membranewoundextendstothefracturedbone.
Openfracturesaregradedaccordingtothefollowingcriteria:
A.GradeI:isacleanwoundlessthan1cmlong.
B.GradeII:isalargerwoundwithoutextensivesofttissue
damage.
C.GradeIII:ishighlycontaminated,hasextensivesofttissue
damage,andisthemostsevere.

46. Clinical Manifestations
Pain
loss of function
Deformity
shortening of the extremity
crepitus (a grating sensation palpation)
swelling and discoloration.
False movement
Note: all of these clinical manifestations may not present in
every fracture.

47. EmergencyManagementofFractures
Immediatelyafterinjury,wheneverafractureissuspected,
immobilizethebodypartbeforethepatientismoved.
Splintsareappliedforimmobilization.
Ifaninjuredpatientmustberemovedfromavehiclebefore
splintscanbeapplied,theextremityissupportedaboveand
belowthefracturesitetopreventrotationaswellasangular
motion.
Withanopenfracture,thewoundiscoveredwithaclean
(sterile)dressingtopreventcontaminationofdeepertissues.
Donotattempttoreducethefracture,evenifoneofthebone
fragmentsisprotrudingthroughthewound.

48. MedicalandsurgicalManagement
1.REDUCTION
-Reductionreferstorestorationofthefracturefragmentsto
anatomicalignmentandrotation.
1.ClosedReduction:closedreductionisaccomplishedbybringing
thebonefragmentsintoapposition(ie,placingtheendsin
contact)throughmanipulationandmanualtraction.
2.OpenReduction:Throughasurgicalapproach,thefragmentsare
reduced .lanretnInotiaxfisecivedcillatem(,snip,seriw,swercs
,setalp,slianro)sdoryamebdesuotdlohehtenobstnemgarfni
notiisop.

49. 2. IMMOBILIZATION
Afterthefracturehasbeenreduced,thebonefragmentsmustbe
immobilized,orheldincorrectpositionandalignment,untilunion
occurs.
Immobilizationmaybeaccomplishedbyexternalorinternal
fixation.

50. 3.Maintaining and restoring function
Swellingiscontrolledbyelevatingtheinjuredextremityand
applyingiceasprescribed.
Neurovascularstatus(circulation,movement,sensation)is
monitored,andtheorthopedicsurgeonisnotifiedimmediatelyif
signsofneurovascularcompromiseareidentified.
Isometricandmuscle-settingexercisesareencouragedto
minimizedisuseatrophyandtopromotecirculation.

51. NursingManagement
Instruct the patient regarding the proper methods to control
edema and pain
Teach exercises to maintain the health of unaffected muscles and
how to use assistive devices such as crutches, walkers.
Teach about selfcare, medication information, and monitoring for
potential complications.
In an open fracture, there is a risk for osteomyelitis, tetanus, and
gas gangrene. Intravenous antibiotics are administered
immediately upon the patient’s arrival in the hospital along with
tetanus toxoid if needed.

52. ComplicationsofFracture
Complicationsoffracturesfallintotwocategories
Earlycomplicationsinclude:
Shock
Fatembolism
Compartmentsyndrome
Deepveinthrombosis
Thromboembolism(pulmonaryembolism)
Disseminatedintravascularcoagulopathy(DIC)
Infection.

53. Delayed complications include:
Delayedunionandnonunion,
Avascularnecrosisofbone,
Reactiontointernalfixationdevices,
Complexregionalpainsyndrome(formerlycalled
reflexsympatheticdystrophy).

54. StagesofBoneHealing
•Hematomaformationwithin48to72hr.afterinjury
•Hematomatogranulationtissue
•CallusformationandOsteoblasticproliferation
•Boneremodeling
•Bonehealingcompletedwithinabout6weeks;up
to6monthsintheolderperson

56. Contusions,Strains,andSprains
Contusions
•Is a soft tissue injury produced by blunt force, such as a blow, kick,
or fall.
•Many small blood vessels rupture and bleed into soft tissues
ecchymosis, or bruising.
•A hematoma develops when the bleeding is sufficient to cause an
appreciable collection of blood.
•Local symptoms includes pain, swelling, and discoloration
•Most contusions resolve in 1 to 2 weeks.

57. Strains
•Isa“musclepull”causedbyoveruse,overstretching,orexcessive
stress.
•Strainsaremicroscopic,incompletemuscletearswithsome
bleedingintothetissue.
•Thepatientexperiencessorenessorsuddenpain,withlocal
tendernessonmuscleuse.

58. Sprains
•Is an injury to the ligaments surrounding a joint that is caused by a
wrenching or twisting motion.
•The function of a ligament is to maintain stability while permitting
mobility. A torn ligament loses its stabilizing ability.
•Blood vessels rupture and edema occurs; the joint is tender, and
movement of the joint becomes painful.

59. •Thedegreeofdisabilityandpainincreasesduringthefirst2
to3hoursaftertheinjurybecauseoftheassociatedswelling
andbleeding.
•Anx-rayshouldbeobtainedtoruleoutboneinjury.
•Avulsionfracture(inwhichabonefragmentedispulled
awaybyaligamentortendon)maybeassociatedwitha
sprain.

60. JointDislocations
•Adislocationofajointisaconditioninwhichthearticular
surfacesofthebonesformingthejointarenolongerin
anatomiccontact.
•Thebonesareliterally“outofjoint.”
•Asubluxationisapartialdislocationofthearticulating
surfaces.
•Dislocationsmaybecongenital,spontaneousorpathologicor
traumatic.

61. •Traumaticdislocationsareorthopedicemergenciesbecausethe
associatedjointstructures,bloodsupply,andnervesare
distortedandseverelystressed.
•Ifthedislocationisnottreatedpromptly,avascularnecrosis
(AVN)(tissuedeathduetoanoxiaanddiminishedblood
supply)andnervepalsymayoccur.

62. 2.MusculoskeletalDisorder
(Metabolic disorders )

63. Osteoporosis“porousbones”
Isametabolicbonedisordercharacterizedbylossofbonemass,and
anincreasedriskoffractures.
Pathophysiology
•Thereducedbonemassiscausedbyanimbalanceofbone
resorptionandboneformation.
•Thetotalbonemassanddensityisreduced,resultinginbones
thatbecomeprogressivelyporous,brittle,andfragile.

64. •Althoughosteoporosismayresultfromanendocrinedisorderor
malignancy,itismostoftenassociatedwithaging.
•Withaginglevelofcalcitoninandestrogendecreasesbutlevelsof
parathyroidhormoneincreases.
•Estrogendeficiency,whichoccursatmenopause,isconsideredthe
leadingfactorinosteoporosisamongagingwomen.
•Osteoporosiscanbeprimaryorsecondary.

65. •Primaryosteoporosisoccursinwomenaftermenopauseandin
menduetofailuretodevelopoptimalpeakbonemassduring
childhood,adolescence,andyoungadulthood.
•Secondaryosteoporosisistheresultofmedicationsanddiseases
thataffectbonemetabolism.
•Prolongeduseofmedicationsthatincreasecalciumexcretion,such
asaluminum-containingantacidsandanticonvulsants,increasethe
riskofdevelopingosteoporosis.
•Corticosteroids

66. OSTEOMALACIA
•Oftenreferredtoasadultrickets,ischaracterizedbyinadequate
ordelayedmineralizationofbonematrix,resultinginsoftening
ofbones.
•Markeddeformitiesofweightbearingboneandpathologic
fracturesoccur.
•Thetwomaincausesofosteomalaciaare
•Insufficient calcium absorption in the intestine due to a lack of
calcium intake or vitamin D deficiency,
•Increased losses of phosphorus through the urine

67. Paget’sDisease
•An imbalance of increased osteoblast and osteoclast cells;
thickening and hypertrophy.
•Results in bone deposits that are weak, enlarged, and
disorganized
•Bone pain most common symptom; bony enlargement and
deformities of long bone usually bilateral, kyphosis,.

68. 3.MusculoskeletalDisorder
(Infection )

69. OSTEOMYELITIS
Is an infection of the bone.
Staph. aureus is the most common infecting organism.
Classified as:
•Contiguous-focus osteomyelitis, from contamination from bone
surgery, open fracture, or traumatic injury (eg, gunshot wound)
•Hematogenous osteomyelitis
•Osteomyelitis with vascular insufficiency eg. DM and peripheral
vascular disease

70. •Afterentry,bacterialodgeandmultiplyinthebone,resultingin
theinflammatoryandimmunesystemresponse.
•Iftheinfectionreachestheoutermarginofthebone,itraises
theperiosteumofthebone,spreadingalongthesurface.
•Liftingoftheperiosteumfromthecortexdisruptsthebloodvessels
thatenterthebone,compromisingthevascularsupplyandleading
toischemiaandeventualnecrosisofthebone.
•Newbonecellsaredepositedontheperiosteumwhilethe
underlyingbonebecomesnecrotic.

71. Thepocketofnecroticbone(sequestrum)mayremainsequesteredfor
yearsoreventuallydrainbyformingasinustractthroughtothe
skin;whichleadstochronicosteomyelitis.
Complicationsofosteomyelitisinclude:
•Septicemia
•Thrombophlebitis
•Musclecontractures
•Pathologicfracturesand
•Nonunionoffractures

72. SEPTIC (INFECTIOUS)ARTHRITIS
•Jointscanbeinfectedthroughhematogenousspreadordirectly
throughtraumaorsurgicalinstrumentation.
•Infectionofthejointleadstosynovitis,jointeffusionandabscesses
formation;canleadtodestructionoftheaffectedjoint.
•Asinglejoint,oftentheknee,isusuallyaffected.

73. 4.MusculoskeletalDisorder
(Joint and connective tissues )

74. OSTEOARTHRITIS (OA)
Degenerative Joint Disease (DJD)
Themostcommonformofarthritis.
degenerationandwearingawayofthearticularcartilage
exposingbone
Typicallyaffectstheweight-bearingjointsandthosethatarerepeatedlyusedfor
work.
UnlikeRA,DJDhasnoremissionsandnosystemicsymptoms,suchasmalaise
andfever.

75. Rheumatoidarthritis
•Systemicautoimmuneinflammatorydisorderofconnective
tissue/jointscharacterizedbychronicity,remissions,and
exacerbations.
•Female-to-maleratiois2-4:1
•Itscauseisunknown
•Particularlyaffectsmalljointsofthehandsandfeet,
•canalsoaffectlargejoints
•Chronicinflammationbeginsinthesynovialmembrane

76. GOUT
•Ageneticdefectofpurinemetabolismresultingin
hyperuricemia,usuallyaffectsthefeet(especiallythegreattoe),
hands,elbows,ankles,andknees.
•Oversecretionofuricacidorarenaldefectresultingin
decreasedexcretionofuricacid,oracombinationofboth,
occurs.
•Itoccursmorecommonlyinmalesthanfemales

77. 77
Contents
1.Introduction
2.Aimoftheresearch
3.Stepstheevidencebasedonpractice:
Ask
Acquire
Appraise
Apply
Assess

78. Application
A60yearoldman,avidgolferslipandfallathome.doesnot
takeanymedication.Hehasseverpain,swelling,and
ecchymosisofRt.dominantshoulderandarmwithnormalneuro-
vascularexam.Radiographs:fractureoftheproximalhumorous
andneedsurgicalintervention.

79. 79
Introduction:
In recent years fractures, particularly those occurring in
osteoporotic bone, have become a major health issue. They are
relatively common and treatment has become increasingly
expensive and complicated.
Incidence
The overall incidence was 1,229 fractures per 100,000 individuals
per year. This gives a person-yearly fracture incidence rate of
1.2%.
Fracture incidence increased with age in both sexes, but age-
adjusted rates were 49% greater among the women.

80. 80
Pain Management in Patients with Fractures
after Surgical Intervention, Using Music
Therapy as a Non Pharmacological Method
•Aimofthestudy:
•AimofthisstudyistodeterminePainManagementin
PatientswithFracturesafterSurgicalIntervention,Using
MusicTherapyasaNonPharmacologicalMethod
•ResearchQuestion
•DoseuseofMusicTherapyasaNonPharmacological
Methodwillmanagementofpain.

81. 81
Formulating patient questions: (Ask)
Evidence based nursing begins and ends with
the patient defining a clinical question in terms
of the specific patient problem: aiding in leading
to clinically relevant evidence(according to
PICO).

82. 82
PopulationInterventionCompariso
n
Outcome
Patients
with
fracture
Useofmusic
therapy
Pharmacol
ogical
treatment
withoutnon
pharmacol
ogical
method(
music
therapy)
Musictherapyhaslong
beenusedtoshift
attentionawayfrompain
andgenerateastateof
relaxationandwell-
being.Musicdecreases
painintensityaswellas
narcoticdosesfollowing
surgery(avoidsideeffect
ofmedication).

83. 83
B-Setting:
This study will conducted in the orthopedic
department at suez canal university hospitals

84. 84
Acquire: identify all the relevant evidence. Terms
for the search will identified by isolating the
components of the clinical question and breaking
them down into facets, including population,
intervention, comparison, and outcome. The facet
analysis identified terms that described the
components which will then translated into a search
strategy.

85. 85
Adopting a comprehensive search strategy obviously identified a lot
of irrelevant material but did ensure that relevant studies not
missed.
The following data bases will search:
Cochrane library.
Medline.
Literature (CINAHL).
The search strategy avoided long multicomponent terms and
phrases, as this would have further complicated the search.
https://www.researchgate.net/publication/378427259_Pain_Management_i
n_Patients_with_Fractures_after_Surgical_Intervention_Using_Music_Thera
py_as_a_Non_Pharmacological_Method

86. 86
Evidence is accumulating on the positive effect of
using non pharmacological intervention for reducing
pain of fracture after surgery.
There are published cases and cohort studies and
controlled clinical trails using non pharmacological
intervention for reducing pain of fracture after surgery.

87. 87
Appraise:
Assess for : Validity (The trustfulness of evidence): Are the
results of the study valid? On the other hand, is the quality of
the study good enough to produce results that can be used to
inform clinical decisions?
Relevance: Does evidence directly answer the question? What
are the results and what do they mean in the context/ for the
patients?
Applicability: Can the results be applied to local population?
Can we apply them in the clinical settings?

88. 88
The VAS requires the ability to differentiate minute differences
in pain intensity and might even be
difficult for some people to complete. The Verbal Descriptor
Scale (VRS) is an instrument that has
already been expressly certified for use with people (0 = little if
any pain, 4 = incredibly painful
suffering

89. 89
Apply:
Procedure:permissiontoconductthestudywillobtained
fromthehospitaldirectorsandheadofdepartment,informed
patientconsentswillobtained,datacollectingafterexplanationof
thepurposeandnatureofthestudytothem.Atthebeginningof
thestudydemographicdatawillcollectedbyinterviewing
subjects.
Aftercompletionofdatacollectionvariablesincludedin
eachdataassessmentwillcodedandscoredpriortocomputerize.
Descriptivestatistics(frequency,percentagewillperformedfor
qualitativeandquantitativevariables.

90. 90
Allpatientsaftersurgery,Thepainwillassesseddailyto
decreaseusingofpharmacologicalintervention.
Astheobjectiveofmeasurementofpain.The
subsequentscoreandactionswillalsodocumented.The
painwillalsoobservedinthefollowingconditions:
Whendressingremovedfornewone.
Withanyprocedure.

91. 91
Presentationandanalysisofdata:
Thesefindingofthestudywillpresented
in2parts:
1.Reviewsofsociodemographiccharacteristic
ofthestudygroup.
2.Assessmentofpain.

92. 92
Assess(Outcome)
Usingnonpharmacologicalinterventionsuchasmusic
therapyhasabeneficialactionondecreasingpainaftersurgery.