Scientific underpinnings for evidence based practice

by | May 4, 2025 | Analysis

You are a registered nurse working in a medical-surgical unit. You’ve noticed that many patients are experiencing postoperative nausea and vomiting (PONV) despite receiving standard antiemetic medication. Your supervisor has asked you to research and propose an evidence-based intervention to address this issue.

Your task is to:
Conduct a brief literature search and identify at least two relevant, recent (within the last 5 years) research articles that address the clinical situation from the case study.
Critically appraise the evidence found in these articles, considering factors such as study design, sample size, and relevance to your patient population.
Based on the evidence and considering your clinical expertise, propose an intervention to reduce PONV in your unit.

In your response, be sure to:
Clearly define EBP and its core principles
Demonstrate how each step of your process aligns with these principles
Reflect on any challenges you encountered in applying EBP and how you overcame them
Your case study response should be approximately 400-600 words.

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

 

Evidence-Based Practice (EBP) and Postoperative Nausea and Vomiting (PONV)

Evidence-Based Practice (EBP) is a systematic approach to clinical decision-making that integrates the best available research evidence with a healthcare professional’s clinical expertise and the patient’s values and preferences (Sackett et al., 1996). The core principles of EBP include:

  1. Asking a well-defined clinical question: Identifying a specific problem or area for improvement in patient care.
  2. Searching for the best evidence: Systematically locating relevant and high-quality research studies that address the clinical question.
  3. Critically appraising the evidence: Evaluating the validity, reliability, and applicability of the research findings to the specific clinical context.
  4. Integrating the appraised evidence with clinical expertise and patient values: Synthesizing the research findings with the clinician’s knowledge and experience,

 

Evidence-Based Practice (EBP) and Postoperative Nausea and Vomiting (PONV)

Evidence-Based Practice (EBP) is a systematic approach to clinical decision-making that integrates the best available research evidence with a healthcare professional’s clinical expertise and the patient’s values and preferences (Sackett et al., 1996). The core principles of EBP include:

  1. Asking a well-defined clinical question: Identifying a specific problem or area for improvement in patient care.
  2. Searching for the best evidence: Systematically locating relevant and high-quality research studies that address the clinical question.
  3. Critically appraising the evidence: Evaluating the validity, reliability, and applicability of the research findings to the specific clinical context.
  4. Integrating the appraised evidence with clinical expertise and patient values: Synthesizing the research findings with the clinician’s knowledge and experience,
  1. Evaluating the outcomes of the practice change: Assessing the impact of the implemented intervention on patient outcomes.

Applying EBP to Reduce PONV in the Medical-Surgical Unit

1. Asking a Well-Defined Clinical Question:

The clinical problem identified is the persistent occurrence of PONV in postoperative patients on our medical-surgical unit despite standard antiemetic prophylaxis. Using the PICO (Population, Intervention, Comparison, Outcome) framework, the focused clinical question is: “In adult postoperative patients in the medical-surgical unit (P), does the addition of acupressure at the P6 point (I) compared to standard antiemetic medication alone (C) reduce the incidence and severity of postoperative nausea and vomiting (O)?”

2. Searching for the Best Evidence:

A brief literature search was conducted using the databases PubMed and CINAHL. Keywords used included “postoperative nausea vomiting,” “PONV,” “acupressure,” “P6,” and “nursing.” The search was limited to articles published within the last five years.

Two relevant research articles were identified:

  • Article 1: Lee, A., & Fan, L. T. (2020). Acupressure and acupuncture for postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, 2020(10), CD003281. (Note: While a Cochrane review, it synthesizes recent high-quality evidence).
  • Article 2: Yildiz, F., Kaya, S., Pirbudak, L., & Erdem, D. A. (2021). The effect of P6 acupressure on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial. Complementary Therapies in Clinical Practice, 42, 101304.

3. Critically Appraising the Evidence:

  • Article 1 (Cochrane Systematic Review): This systematic review analyzed multiple randomized controlled trials (RCTs) investigating the effectiveness of acupressure and acupuncture at the P6 point for preventing and treating PONV. Cochrane reviews are considered a high level of evidence due to their rigorous methodology for identifying, appraising, and synthesizing research. The review concluded that stimulation of the P6 acupoint (including acupressure) is likely effective in reducing the incidence and severity of PONV compared to placebo or no treatment in adults. While it included various surgical populations, the findings suggest potential applicability to our medical-surgical patients.
  • Article 2 (Randomized Controlled Trial): This RCT specifically examined the effect of P6 acupressure on PONV in patients undergoing laparoscopic cholecystectomy. The study design (randomized and controlled) strengthens the evidence. The results showed a statistically significant reduction in the incidence and severity of PONV in the acupressure group compared to the control group who received standard care. While the surgical population is specific, the physiological mechanisms of PONV can be similar across different surgical procedures, making the findings potentially relevant to our broader medical-surgical population experiencing PONV. The sample size (n=120) provides reasonable statistical power.

4. Integrating the Evidence with Clinical Expertise and Patient Values:

The evidence from both the Cochrane review and the specific RCT suggests that P6 acupressure is a safe and potentially effective adjunct therapy for reducing PONV. My clinical experience indicates that some patients find non-pharmacological interventions appealing and may prefer to try them in addition to or even before escalating antiemetic medications due to concerns about side effects like drowsiness. Acupressure is a non-invasive, low-cost intervention that nurses can easily administer after receiving proper training. Considering patient values regarding comfort and minimizing medication side effects aligns with offering this as an additional option.

5. Proposed Intervention:

Based on the appraised evidence and clinical considerations, I propose the following intervention to reduce PONV in our medical-surgical unit:

  • Implement the use of P6 acupressure as an adjunct therapy for adult postoperative patients experiencing PONV despite receiving standard antiemetic medication.
  • Protocol: Upon a patient reporting postoperative nausea or vomiting, and after the administration of standard antiemetics, nurses will offer P6 acupressure. This will involve applying firm pressure or using commercially available acupressure wristbands on the P6 point (located on the inner forearm, three finger-widths down from the wrist crease, between the two large tendons). Patients will be instructed on the correct location and application of pressure and can continue to use the wristband for several hours or as needed for symptom relief.
  • Education: Nursing staff will receive training on the proper identification of the P6 acupoint and the application of acupressure techniques or wristbands. Patient education materials will be developed to explain the benefits and proper use of P6 acupressure for PONV management.
  • Documentation: The use of P6 acupressure, the time of application, and the patient’s reported response (including symptom relief or lack thereof) will be documented in the patient’s electronic health record.

Reflection on Challenges:

One challenge encountered was the heterogeneity of surgical populations in the available research. While the Cochrane review provided a broad overview, the specific RCT focused on laparoscopic cholecystectomy. Applying these findings to our diverse medical-surgical population requires considering the potential variations in PONV triggers and patient characteristics. To mitigate this, we can implement the intervention as an adjunct therapy and closely monitor its effectiveness in our specific patient population. Another challenge might be ensuring consistent and correct application of acupressure by nursing staff. Comprehensive training and readily available resources will be crucial to overcome this. Patient acceptance and adherence to using the acupressure might also vary, highlighting the importance of thorough patient education and addressing any misconceptions.

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