research in the perianesthesia setting: the basics of getting started

Research in the Perianesthesia Setting:The Basics of Getting Started

Gina Myers, MS, RNMichele Kosinski, MS, RN

Research can be defined as a process that systematically investigatesa situation with the objective of expanding the existing knowledge ofa profession. Research asks the question “Does what we do as nurseshelp or hinder?” The purpose of this article is to provide a brief historyof nursing research and to review basic research methods. In addi-tion, examples of potential research projects focused in the perianes-thesia practice arena will be explored. Practical steps will be outlinedto guide novice nurse researchers in their early endeavors.

© 2005 by American Society of PeriAnesthesia Nurses.

Objectives—On completion of this activity, the learner will be able to (1) differentiate betweenquantitative and qualitative research, (2) identify the types of quantitative and qualitative research,
and (3) state the current ASPAN research initiatives.
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NURSING RESEARCH is slowly gathering mo-mentum as bedside practitioners and healthcare leaders look to validate nursing’s impact onpatient outcomes and the health care system asa whole. However, nursing research is not anew concept. Florence Nightingale was revolu-tionary in her observation, interpretation, andinterventions regarding the human response toillness. Nightingale documented her findings inNotes on Nursing1 and was the first to monitorand record the effects of fresh air, hand wash-ing, and adequate nutrition on patient out-comes. These first steps paved the way fornursing practice and research for centuries tocome.

Most nurses want to improve care and maxi-mize outcomes for their patients, particularlythe vulnerable or critically ill. In the perianes-thesia arena, nurses care daily for these patients.Research provides a way to achieve better out-comes. Krenzischek,2 in addressing the visionof ASPAN and research stated, “ It is our com-mitment to educate perianesthesia nurses inmethods of quality patient care and to promotepatient care that is guided by research andresearch methods. Our core values are patient
focused. . ..”
Journal of PeriAnesthesia Nursing, Vol 20, No 1 (February), 2005: pp 35-44

esearch can be defined as a process that sys-ematically investigates a situation with the pur-ose of contributing to the existing knowledgef a profession.3 The goal, to expand the pro-ession’s knowledge base, can be accomplishedhrough either fundamental or applied re-earch. Fundamental research extends the the-ry that is already present within the profes-ion. Applied research investigates a solution ton identified problem.4 Nursing research fo-uses on situations that affect patients and theiramilies. More specifically, it looks at how peo-le respond to health and illness, how nursing

nterventions can be used with both the ill andhe well, how we educate patients and/orurses, and what our role is in disease manage-ent.5 Nursing research can involve any situa-

ion or phenomenon that a nurse encounters inis or her daily practice in any care arena.

Gina Myers, MS, RN, is a nurse at St. Joseph’s Hospitalealth Center, Syracuse, NY; and Michele Kosinski, MS, RN, isnurse at St. Joseph’s Hospital Health Center, Syracuse, NY.Address correspondence to Gina Myers, MS, RN, St. Joseph’sospital Health Center, 301 Prospect Avenue, Syracuse, NY3203; e-mail address: [email protected].© 2005 by American Society of PeriAnesthesia Nurses.1089-9472/05/2001-0008$30.00/0
doi:10.1016/j.jopan.2004.11.003
35

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MYERS AND KOSINSKI36

For many nurses, the idea of doing research canbe intimidating. It seems there are many thingsthat one must know and a certain level ofeducation one must have to conduct research.Although increasing the level of formal educa-tion will assist in the research process, anynurse can become involved in an investigation.Some nurses may think “why would I botherwith research, my questions are not that impor-tant” or “I could never do research.” The pur-pose of this article is to let perianesthesia nursesknow that no matter the location of work, theycan do research. The profession needs perian-esthesia nurses to do research.

Nurses who have been practicing for severalyears are especially valuable. Some recent time-honored practices that have been abolishedthrough research are as follows:

● Maalox, sugar, and heat lamps to treatpressure ulcers.

● Blue dye in tube feeding to monitor foraspiration.

● Discharge of patients from the perianes-thesia care unit regardless of coretemperature.

These customs changed because of research,which is established by using systematic evalu-ation of interventions and patient outcomes.

Historically, there have been several ap-proaches to patient care. One approach is to dothings a certain way, “because that’s the waywe’ve always done it.” Another approach topatient care is based on intuition or experience.For the experienced practitioner, this can be avalid approach; however, caution must be usedto be certain our interventions are based onfacts instead of tradition or comfort level. Thethird approach is evidence based. This is prac-tice grounded in the routine and systematicevaluation of interventions and patient out-comes. Evidence-based research poses the ques-tion “Do specific nursing efforts help or
hinder?” This leads to nursing research. o
articipating in research expands the body ofursing knowledge. Moreover, when nurses arengaged in research, patients receive more ef-ective care, and nurses have better insight intoays of practice. Nursing research validates to

he whole health care community why ournterventions are so important. As nurses, were privileged to know information about pa-ients that other disciplines may not. For exam-le, nurses walk into a room and perceive thathe patient is fearful to undergo anesthesia.nderstanding this, the nurse connects with

he patient and offers words of comfort in justhe right way. How did the nurse instantly grasphis from the patient? How did the nurse knowust the right way to offer comfort? Any experi-nced perianesthesia nurse can answer theseuestions. Our patients depend on the nurse toe the “link” and benefit from our expertise.he real question becomes whether there isesearch data to validate what the nurse per-eived to be true. Thus, without research,urses cannot share their unique knowledgeith those outside of nursing, nor can they pass

t along to novice nurses who are doing theirest to quickly learn what their experiencedolleagues already understand. In addition, aack of supporting data can make it difficult tomplement improvements in the way nurseserform interventions and validate nursingractice. It is often difficult to modify an age-oldrocess without the evidence to support theationales for change.

ther reasons exist to support nursing involve-ent in research. Nursing research attempts to

escribe, explain, predict, and/or control theorld around us. Description focuses on creat-

ng a picture of what is happening in a particu-ar situation. The nurse does not seek to changenything, but rather to obtain a clear under-tanding of the circumstances. Explanation aimso provide possible reasons why something maye happening a certain way or why something

s the way it is. Prediction allows insight into theuture in an attempt to forecast the probability
f an event or situation occurring or not occur-

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RESEARCH IN THE PACU 37

ring. Lastly, control gives nurses the ability tochange how they do things in the pursuit ofimprovement. Potential areas of nursing re-search will fit into one or more of those catego-ries.3

Types of Research

Nursing is both a science and an art, and assuch, is served by both quantitative and qualita-tive research techniques. To comprehend andapply findings, it is important to understand theintent and scope of each type of research.Quantitative research focuses on the traditionalscientific causal relationship between variables.Information is provided numerically. Qualitativeresearch seeks to understand and describe thehuman experience in illness and wellness. Bothtypes of research have a different, yet equallyimportant, role in the holistic approach to pa-tient care and outcomes.5

Quantitative Research

Quantitative research seeks to show causal re-lationships between variables. Quantitative re-search is objective, based on deductive reason-ing, and measures a given response to anintervention. Numbers are used to depict valuesand are also used in analysis. Data collection iscompleted via the use of a valid and reliable toolwhich measures a response to a specified inter-vention. There are four basic types of quantita-tive research: descriptive, correlational, quasi-experimental, and experimental. They are listed

Table 1. Types and Exam

Research Type

Descriptive “A Survey of CuManagement”1

Correlational “Postoperative RLaparoscopic S

Quasi-experimental “AromatherapyEffective in Re

Experimental “Effects of RecliDiagnostic Lap

with examples in Table 1. w

escriptive research is the least rigid method ofuantitative research and seeks to define theharacteristics of a particular situation or group.escriptive research is performed when little isnown about how variables interact. Descrip-ive research determines the frequency ofvents, categorizes information, and organizes itn a logical fashion. One example is thermoreg-lation and hemodynamic stability in the peri-nesthesia patient. Descriptive research showshat hypothermic patients have more bloodressure instability during their first hour in theACU.6

orrelational research investigates the relation-hip between or among variables or things. Thiselationship can be defined as either positive oregative. The goal of correlational research is to

dentify the strength of the relationship be-ween variables. Using the thermoregulation ex-mple, those patients who are hypothermic arelso hypotensive. Thus, the patient’s cold tem-erature has a negative relationship to bloodressure.

uasi-experimental research is performed toxamine causality in situations where completeontrol is neither possible nor desired. In mostealth care research, a specific type of patientr situation is studied. In the study of hypother-ic patients, any patient who was admitted to

he PACU with a defined low core temperatureeg, �96.8°F) would be included in the study.hus, those with a defined normal temperature

f Quantitative Research

Example of Research

Perianesthesia Nursing Practice for Pain and Comfort

ry at Home After Ambulatory Gynecologic”12

eppermint, Isopropyl Alcohol, or Placebo is EquallyPostoperative Nausea”13

air Versus Traditional Hospital Bed on Postsurgicalpic Recovery Time”14

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make patients hypothermic so that blood pres-sure can be monitored. They use the populationalready in place who meets that definition. Qua-si-experimental research helps explain why cer-tain events occur in specific patient popula-tions.

The last type of quantitative research is experi-mental, and is the most rigid of the quantitativegenre. Three requisite factors for experimentalresearch are control, manipulation, and ran-domization. A controlled investigation is per-formed for the purpose of predicting or explain-ing certain events. This type of researchmandates that certain patients will receive anexperimental intervention or treatment,whereas others will receive usual care. All pa-tients have an equal chance of receiving theexperimental intervention. By returning to thethermoregulation example, a perianesthesianurse researcher may want to evaluate a newpatient-warming device. One group of patientswould use the new device, and the other groupwould be warmed with traditional therapies.This study could evaluate which therapy wasmore effective in returning patients to a normaltemperature.

Many believe that quantitative investigations arethe only “valid” type of research because theycan be definitively measured. However, peopleand their responses to illness, wellness, andinterventions cannot be fully captured with fi-nite tools and numbers. For this reason, the roleand significance of qualitative research are sub-

Table 2. Types and Exam

Research Type

Phenomenological “Telephone Follow-uExperiences”15

Grounded-theory “Chronically Ill ChildPerceptions and Sug

Ethnographic “Nurses’ Advocacy inHistorical “Plato, Nightingale, a

stantiated. T

ualitative Research

ualitative research seeks to understand humanxperience. Insight is gained through descrip-ion and interpretation of the person’s perspec-ive on a chosen encounter. Although there areany types of qualitative research, all shareost of the same characteristics.4

nterviews and observation are the principalays of collecting data in qualitative research.

deally, the researcher spends time in the natu-al setting where the subject experiences his orer daily life. The primary tool of the researcheror data collection is words, pictures, or some-imes artwork. On the basis of interviews witheople involved within the phenomenon, theesearcher attempts to tap into the perspectivef the person who has experienced a situation.he researcher then searches for meaning inommon themes among the interviews of theeople involved.7

ualitative research is often referred to as asoft science” with a broad and holistic focus.ecause of the subjective nature, the actualxperiences of people form the basis of re-earch. The goal of qualitative research is toruly grasp what a person goes through given aarticular situation. The knowledge gained isften used to develop and build nursing theory.our types of qualitative research are brieflyeviewed. These include phenomenologic,rounded-theory, ethnographic, and historicalesearch, which are listed, with examples, in

of Qualitative Research

Example of Research

ay Surgery Patients: Patient Perceptions and Nurses’

oping with Repeated Hospitalizations: TheirInterventions”16

ustralian Operating Department”17

ntemporary Nursing”18

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Phenomenologic research describes the livedexperiences of a group of individuals who sharesimilar circumstances. The researcher hopes togain a better understanding of what it is like tohave the experience under investigation. Thegoal of grounded-theory research is theory gen-eration or discovery. Grounded-theory researchconcentrates on how people interact, whatthey do, and how they become involved inresponse to the phenomenon. Ethnography isused to describe and interpret how a cultural orsocial group behaves, what their customs are,and what their way of life is. It involves obser-vation of the group in which the researcher hasto become immersed in the daily lives of thegroup members over a period of time.7 Histor-ical research entails looking critically at pastevents and investigating how they occurred andunder what circumstances. This type of re-search examines how past trends or eventsshaped the present.4

Research in the PerianesthesiaSetting

The perianesthesia setting is filled with oppor-tunities to conduct research. Across the coun-try, perianesthesia colleagues have investigatedtopics addressing hypothermia, postoperativenausea and vomiting, hypoxia, and patient edu-cation.8 Other potential topics have been sug-gested by ASPAN.9 Pain management, tempera-ture regulation, hemodynamic stability, andNPO status are just a few of the identifiedresearch priorities. Table 3 provides the keytopic areas identified by perianesthesia nursingexperts. Promoting research in these areas willbroaden the evidence base, which supports allinterventions.

How to Get Started

The first step for the perianesthesia nurse to getstarted is to write down the questions asked inevery day practice. It is important that the re-searcher keeps paper handy to record flashes ofinsight as they occur; otherwise, thoughts maynot seem as clear or memory may fail. Next, a
decision is made to actually do the research. t
his is often easier said than done. Most nurseesearchers have at least a dozen researchroject ideas just waiting to be started.

f this is the first time doing research, the re-earcher may want to take a course or readeferences on research to aid in understandingf the basic concepts. Partnering with othersho are interested in pursing a research project

s critical. Research is not a solitary journey. Oneay to help bridge the education practice gap is

hrough forming relationships with nurse edu-ators who are often very skilled in conductingesearch. Sources of support include peers inhe perianesthesia units and other practice set-ings. Interdisciplinary research with physi-ians, respiratory therapists, physical therapists,utritionists, and so on, opens many possibili-ies for collaborative research. In the perianes-hesia setting, the research team may includeerioperative nurses, critical care nurses, clini-al nurse specialists, surgical technicians, anes-hesiologists, nurse anesthetists, physical thera-ists, or respiratory therapists. Working withthers who have different abilities and perspec-ives will enrich the project by bringing differ-nt ideas and viewpoints together. It is this kindf partnership that our profession needs. Last,nd most important, is for the nurse researcher

Table 3. ASPAN Research Priorities forPerianesthesia Nursing9

. Discharge criteria and scoring systems (allphases)

. Postoperative nausea and vomiting

. Patient satisfaction issues

. Oxygen theraphy in the PACU

. Validation of perianesthesia standards

. NPO status

. Impact of nursing care on quality and outcomesissues

. Pain management

. Preoperative/preadmission testing0. Thermoregulation1. Documentation issues2. Effects of ICU overflow

o find a mentor who is experienced with re-

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search and who will guide the researcherthrough the process, helping to avoid manystumbling blocks along the way. Your mentorwill serve as the one who encourages, givesconstructive criticism, and helps see the projectto its completion.

Before closing, a word needs to be said aboutreplication of research. Replication is a methodfor determining whether results from an earlierstudy can be repeated when a new set of sub-jects and/or a different setting is used. Thisapproach strengthens our rationale for usingcertain methodologies or innovations in prac-tice.5 To strengthen existing research and addto the evidence base of perianethesia nursingpractice, research findings need to be validatedthrough the replication process. With replica-tion, the researcher seeks to take another’sstudy and repeat it in an attempt to find thesame results. Many practices are built on theresults of 1 or 2 studies. Replicated studies helpto document reliability and validity of researchfindings. In an article by Fahs, Lake-Morgan, andKalman,10 the benefits and barriers to replica-tion were described. They emphasized the needto replicate research, but they clearly statedthere is a lack of enthusiasm for replication dueto a lack of available resources and support.However, they urge nurses to overcome thosechallenges and partake in this type of scholarlyactivity. Furthermore, replication in research isan excellent place for the new researcher to
begin learning about the research process.10
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opefully, this introduction to nursing researchill spur recognition that nursing research is a

aluable and necessary tool for our professionalractice. Understanding and using provenethods of best practice improves patient out-

omes, patient satisfaction, validates our profes-ional practice, and improves professional satis-action. Krenzischek2 further noted, “Patientafety is paramount and should be a main fo-us. . .. We must monitor the impact, value theessons learned from what we see, hear, andxperience and enhance our decisions.” Theuthors would like to further challenge theeaders by saying that the extent to which ones committed to research indicates a commit-

ent to practice.

onclusion

his article was written to motivate readersrofessionally and expand their horizonshrough an improved understanding of theypes of research that can be performed. Hope-ully, the article will stimulate perianesthesiaurses to think of ways to improve practice andhe experiences of patients. This article iserely a brief overview of the types and role ofursing research. Future articles will includeore in-depth research concepts such as the

esearch process, evaluation, and use.

cknowledgment

e thank Maureen Iacono, BSN, RN, CPAN, Manager for the PACUt St. Joseph’s Hospital Health Center in Syracuse, New York, andonna S. Blum, RN, MS, CCRN, Clinical Nurse Specialist for Medical/urgical patients at Cortland Memorial Hospital in Cortland, New
ork, who reviewed and gave insight to the article.
ces
1. Nightingale F: Notes on Nursing. Philadelphia, PA, Lippin-
cott, 19922. Krenzischek DA: Guest editorial: ASPAN’s research vi-

sion. J Perianesth Nurs 16:149-150, 20013. Burns N, Grove, SK: The Practice of Nursing Research:

Conduct, Critique, and Utilization (ed 4). Philadelphia, PA,Saunders, 2001

4. Powers BA, Knapp TR: A Dictionary of Nursing Theoryand Research (ed 2). Thousand Oaks, CA, Sage, 1995

5. Polit DF, Tatano-Beck C, Hungler BP: Essential of NursingResearch: Methods, Appraisal, and Utilization (ed 5). Philadel-phia, PA, Lippincott, 2001

6. Holtzclaw BJ: Thermal balance. In: Kinney MR, Dunbar,B, Brooks-Brunn J, et al, eds. AACN’s Clinical Reference forritical Care Nursing. St. Louis, MO, Mosby, 99-111,9987. Creswell JW: Qualitative Inquiry and Research Design:

hoosing Among Five Traditions. Thousand Oaks, CA, Sage,9988. Summers S: Editorial opinion: Research. J Perianesth Nurs

6:147-148, 20019. American Society of PeriAnesthesia Nurses. ASPAN re-

earch priorities for perianesthesia nursing. Available at http://ww.aspan.org/ResearchInfo.htm Accessed October 2003

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10. Fahs P, Lake-Morgan L, Kalman M: A call for replication.J Nurs Scholarsh 35:67-71, 2003

11. Krenzischek DA, Windle P, Mamaril M: A survey ofcurrent perianesthesia nursing practice for pain and comfortmanagement. J Perianesth Nurs 19:138-149, 2004

12. Horvath KJ: Postoperative recovery at home after ambu-latory gynecologic laparoscopic surgery. J Perianesth Nurs18:324-334, 2003

13. Anderson LA, Gross JB: Aromatherapy with peppermint,isopropyl alcohol, or placebo is equally effective in relievingpostoperative nausea. J Perianesth Nurs 19:29-35, 2004

14. Agodoa SE, Holder MA, Fowler SM: Effects of recliner-chair i

ersus traditional hospital bed on postsurgical diagnostic laparo-copic recovery time. J Perianesth Nurs 17:318-324, 2002

15. Dewar A, Scott J, Muir J: Telephone follow-up for dayurgery patients: Patient perceptions and nurses’ experiences.Perianesth Nurs 19:234-241, 200316. Boyd JR, Hunsberger M: Chronically ill children copingith repeated hospitalizations: Their perceptions and sug-

ested interventions. J Pediatr Nurs 13:330-342, 199817. Bull R, FitzGerald M: Nurses’ advocacy in an Australian

perating department. AORN J 79:1265-1274, 200418. LeVasseur J: Plato, Nightingale, and contemporary nurs-

ng. J Nurs Scholarsh 30:281-285, 1998


Research in the Perianesthesia Care Unit: The Basics of Getting Started1.4 Contact Hours

Directions: The multiple-choice examination below is designed to test your understanding ofResearch in the Perianesthesia Care Unit: The Basics of Getting Started according to the objectiveslisted. To earn contact hours from the American Society of PeriAnesthesia Nurses (ASPAN) Continu-ing Education Provider Program: (1) read the article; (2) complete the posttest by indicating theanswers in the test grid provided; (3) tear out the page (or photocopy) and submit postmarked beforeFebruary 28, 2007, with check payable to ASPAN (ASPAN member, $12.00 per test; nonmember,$15.00 per test); and return to ASPAN, 10 Melrose Ave, Suite 110, Cherry Hill, NJ 08003-3696.Notification of contact hours awarded will be sent to you in 4 to 6 weeks.

Posttest Questions

1. Which is the most rigid type of quantitative research?a. Descriptiveb. Correlationalc. Quasi-experimentald. Experimental

2. Ethnography is the study ofa. cause and effectb. how a culture or like group of people behavec. a type of quantitative researchd. an analysis of historical events

3. Holistic nursing practice incorporates both qualitative and quantitative researcha. Trueb. False

4. When first doing research, what is one of the most important keys to a successful endeavor?a. Taking a formal research classb. Having a Bachelor’s degreec. Finding a mentor to work withd. Doing a replication study

5. Why does the profession need you to do research?a. To broaden the knowledge base of our professionb. To help an organization meet the standards required for Magnet designationc. To validate our practiced. All of the above

6. Which of the following is NOT an ASPAN research initiative?a. Postoperative nausea and vomitingb. NPO statusc. Pain managementd. Use of new graduates in the perianesthesia care arena

7. Which of the following is a sample of quantitative research?a. The effects of epidural pain control on hemodynamic status
b. The lived experience of unbearable pain after surgery


c. Vietnamese women and their experiences with pain after surgeryd. A historical review of the evolution of pain control in the perianesthesia care unit

8. Which of the following is a sample of qualitative research?a. The effects of Zofran on postoperative nauseab. The impact on hypothermia on postoperative nauseac. The lived experience of unstoppable nausea after abdominal surgeryd. Factors increasing nausea after surgery

9. In descriptive research, the goal is to:a. find a cause and effect relationshipb. apply an intervention to a group of patientsc. gather information about a situation when little is known about how variables interactd. none of the above

10. To capture the lived experience in qualitative research, which medium is not used by theresearcher?a. Artb. Poetryc. Wordsd. Questionnaire


ANSWERSSystem W010207/2. Please circle the correct answer1. a. 2. a. 3. a. 4. a. 5. a.

b. b. b. b. b.c. c. c. c.d. d. d. d.

6. a. 7. a. 8. a. 9. a. 10. a.b. b. b. b. b.c. c. c. c. c.d. d. d. d. d.

Please PrintName Nursing License No/State

Address

City State Zip

ASPAN Member #

EVALUATION: Research in the Perianesthesia Care Unit: The Basics of Getting Started

(SD, strongly disagree; D, disagree; ?, uncertain; A, agree; SA, strongly agree) SD D ? A SA

1. To what degree did the content meet the objectives? 1 2 3 4 5a. Objective # 1 was met. 1 2 3 4 5b. Objective # 2 was met. 1 2 3 4 5c. Objective # 3 was met. 1 2 3 4 5

2. The program content was pertinent, comprehensive, and useful to me. 1 2 3 4 53. The program content was relevant to my nursing practice. 1 2 3 4 54. Self-study/home study was an appropriate format for the content. 1 2 3 4 55. Identify the amount of time required to read the article and take the test.

25 min 50 min 75 min 100 min 125 min

Test answers must be submitted before February 28, 2007 to receive contact hours.

research in the perianesthesia setting: the basics of getting started

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