Analyze and critique a quantitative nursing research article from a nursing research journal published within the past 3 to 5 years. Include 3 scholarly references—the article, the text, and one outside source. Use the University of Phoenix Material: Guidelines for Quantitative Nursing Research Critique to complete the following steps:
1. State the purpose of the study and identify the problem. Demonstrate that more aggressive measures improve the efficacy of analgesic interventions in patients with difficult pain conditions.
Breakthrough pain in patients with chronic cancer and their three categories:
1- Spontaneous pain with no evident precipitating event.
2- Incident pain, with a precipitating cause or event.
3- End-of-dose failure.
2. Analyze the literature review. The articles relevancy is that the use of IV morphine has advantages in specific clinical situations and should be part of daily physicians practice for patients with cancer pain.
No study has assessed the cost-effectiveness of IV morphine.
Majority of reference used were current, between 2000 and 2008, with cero resources from the last five years and eighteen resources from the last ten years.
Morphine iv would not require many days or weeks to reach an effective dose in patients with relevant needs, decreasing suffering for patients with high levels of pain intensity.
Decreasing in the cost of hospital stay, (discharge after dose titration with IV morphine was 4•6 days), and allowing bed availability for other patients.4
3. Analyze the study framework or theoretical perspective. The theoretical framework was implicit within the article, the framework was based on scientific theory: Total drug availability and predictable effects, short onset for opioid titration and breakthrough pain, flexible modalities: boluses, continuous infusion, patient-controlled analgesia, less initial metabolite formation, unlimited volumes, best for patients with oral tract precluded or poor gastrointestinal absorption.
The framework identify, described, and compared the different between patients treated with oral and iv pain medications:
1- Opioid titration (satisfactory pain relief, rapid titration and parenteral routes, and Conversion between IV and oral route).
2- Risk of respiratory depression with parenteral opioids.
3- Potential Interactions of IV medications (Morphine).
4. Identify, describe, and critique for appropriateness any research objectives, questions, or hypothesis. Research process was described in detail, and references were used from Medline, Current Contents, PubMed, and relevant articles using the search terms “intravenous and/or parenteral morphine” and “cancer pain”. Abstracts and reports from meetings were included only when they related directly to previously published work (between January, 1988, and June, 2009), to conclude that the findings were credible and appropriate methods were used, and that the use of IV morphine has advantages in specific clinical setting and should be part of the physicians practice while treating patients with cancer pain.
5. Identify, describe, and critique—conceptually and operationally—the major study variables. During palliative care interventions in patients with difficult pain, is important the outcomes of additional aggressive measures to improve the efficacy of analgesic interventions in patients with difficult pain, IV morphine is a preferred intervention, from a pharmacokinetics point of view, and for achieving rapid pain control. This review provided an overview of the use of IV morphine for management of cancer pain in a secondary-care setting.
Independent Variables of the study: Opioid administration, Effect of their therapeutic use, Interactions.
Dependent Variables of the study: Breakthrough pain, Opioid titration, Satisfactory pain relief, rapid titration and parenteral routes, and Conversion between IV and oral route, Comparison with the subcutaneous route.