Literature Review on "Imagery Literature Review Guided Imagery and Pain"

Quoted Instructions for "Imagery Literature Review Guided Imagery and Pain" Assignment:

Hello there, this paper is supposed to be a continuation of a project and the first written paper has been attached below.

The first article is an example of a Literature Review, please review the steps

This is part one of the project and the next paper written will be a continuation of this one below, so please carefully follow what*****s on this paper and write a 3 page paper that relates to *****"Guided Imagery and Pain Management.*****"

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Citation Study

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Course Project: Part 2*****Literature Review

This is a continuation of the Course Project presented in Week 2. Before you begin, review theCourse Project Overview document located in the Week 2 Resources area.

The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.

To prepare:

*****¢ Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.

*****¢ Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICO question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library*****s databases.

*****¢ Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week*****s Learning Resources.

*****¢ Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.

To complete:

Write a 3- to 4-page literature review that includes the following:

*****¢ A synthesis of what the studies reveal about the current state of knowledge on the question that you developed

o Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.

*****¢ Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry

*****¢ Your literature review summary table with all references formatted in correct APA style

Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study*****s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.

Public Policy

The Systematic Review of the Literature

A Tool for Evidence-Based Policy

Susan Crocker Houde, PhD, ANP-BC

ABSTRACT

The systematic review of the litera- ture is a valuable tool for geronto- logical nurses to influence policy decisions. There are several organi- zations that provide helpful guide- lines for the conduct of systematic reviews of the literature, including the Cochrane Collaboration, the Joanna Briggs Institute, and the Evi- dence for Policy and Practice Infor- mation Co-Ordinating Centre at the Institute of Education, University of London. Gerontological nurses who have a strong foundation in re- search methodology and the skills to synthesize scientific evidence for the purpose of promoting evidence- based policy have the potential to positively influence health care out- comes for older adults. For nurses to assume a leadership role in syn- thesizing scientific evidence for evi- dence-based policy development

ABOUT THE AUTHOR

and refinement, nursing education will need to assume a more active role in teaching systematic review methodology. This article presents an overview of resources for con- ducting systematic reviews of the literature and discusses the use of the systematic review as a tool for evidence-based policy.

Gerontological nurse practitio- ners, researchers, and educa- tors have been promoting the use of evidence-based practice to improve care of older adults in the commu- nity, long-term care, and acute care hospital settings. This has led to the emergence of conducting systematic reviews of the literature to examine evidence that will assist in determin- ing the best approaches for provid- ing and modifying gerontological nursing practice. There has been less emphasis, however, on the use of systematic reviews of the literature to inform policy makers in the devel- opment and modification of health care policy that can benefit older adults and their family members. The systematic review of the literature can be a valuable tool in the public



Dr. Houde is Professor and Director of MS, DNP, and Graduate Certificate Programs, Department of Nursing, University of Massachusetts Lowell, Lowell, Massachusetts.

The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Susan Crocker Houde, PhD, ANP-BC, Professor and Director of MS, DNP, and Graduate Certificate Programs, Department of Nursing, University of Massachusetts Lowell, 3 Solomont Way, Lowell, MA 01854; e-mail: susan_houde@uml.edu.

Posted: August 21, 2009 doi:10.3928/00989134-20090731-05

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policy arena, to ensure that policies are developed based on a body of evidence that has been systemati- cally synthesized and analyzed. It*****¨is also an important tool to refine policy within specific health care settings and communities, leading to improved health care outcomes for older adults. The purpose of this article is to present resources for conducting systematic reviews of

that has been derived from primary research articles. Many kinds of studies may be included in system- atic reviews that have value in basing policy decisions. These studies may include intervention studies, as

well as studies that examine indi- vidual perspectives toward policies, evaluation studies that examine the effectiveness of policies, and imple- mentation studies.

l It is research that follows stan- dard stages.

l It is accountable, replicable, and able to be updated.

l There is a requirement of user involvement.

Although originally, most of the study designs included in system- atic reviews of the literature were randomized controlled trials, today, many kinds of research design meth- odologies are included in reviews that have policy relevance. There is a growing awareness about the value of including different research designs because randomized controlled trials cannot answer all of the questions needed for evidence in formulating policy and program development (Jackson, Waters, & Guidelines for Systematic Reviews of Health Pro- motion and Public Health Interven- tions Taskforce, 2004). Diverse study designs provide a more compre- hensive view of evidence available but present increased challenges in searching for literature, appraising the quality of studies, and synthesiz- ing evidence into a systematic review for dissemination and utilization (Jackson et al., 2004).

CoChRAne CollABoRATion

There are several well- documented approaches to conduct- ing a systematic review of the litera- ture. The Cochrane Collaboration is a global network that supports the conduct of systematic reviews and publishes and disseminates the re- sults of reviews. Most of the reviews conducted by the Cochrane Col- laboration are based on randomized controlled trials that investigate the effects of interventions in health care. With increasing frequency, however, other kinds of evidence are being included in Cochrane Reviews (Jack- son, n.d.). Not only do Cochrane Reviews provide valuable sources*****¨of evidence for policy decisions, but the Collaboration provides useful guidelines that gerontological nurses could incorporate when conducting their own reviews for the purpose of





A systematic review provides readers with best available evidence that has been derived from primary research articles.



the literature for policy analysis and to discuss the usefulness of sys- tematic reviews as a tool for use in evidence-based policy development and refinement.

BACkgRound

A systematic review of the litera- ture synthesizes evidence found in the literature using a research methodol- ogy that is clearly articulated. The movement to base policy decisions on best available evidence demands that health care providers acquire a foun- dation of knowledge, not only on re- search methodology but also on con- ducting reviews of the literature using a systematic, replicable approach. Systematic reviews are important tools for informing policy makers, eliminat- ing the need for them to collect and analyze available evidence prior to making important policy decisions. A review conducted by a gerontological nurse with a background in research methodology and skill in conduct-*****¨ing systematic reviews will provide a nonbiased perspective on older adult health and health systems issues that can potentially influence health policy decisions, because it is based on sound scientific evidence synthesis.

A systematic review provides readers with best available evidence

There are several considerations for the gerontological nurse when conducting a systematic review*****¨of the literature, whether it is for public policy or nursing practice. In conducting a review, the reviewer should identify and review as much of the available evidence as possible. The evidence should be collected in*****¨a nonbiased manner and should not be limited to reviewing those pieces of evidence that are easiest to identify and obtain. Reviewers must ensure the findings of the systematic review accurately represent the results of the studies examined, and the trust- worthiness of the studies must be presented with a clear analysis of the validity and reliability of the research (Harden & Thomas, 2005). The methodology used by the reviewer should be clear, so the literature search is replicable, and a coher-*****¨ent approach to collecting the data should be maintained (EPPI-Centre, n.d.b). The Evidence for Policy and Practice Information and Co-Or- dinating Centre at the Institute of Education, University of London (EPPI-Centre) (n.d.a) has identified four key elements of a systematic review:

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l

It uses explicit and transparent methods.

making policy or practice decisions in their place of employment or in the wider policy arena.

The Cochrane Public Health Group (http://www.ph.cochrane. org) focuses on conducting system- atic reviews on health promotion and public health interventions that evaluate the effectiveness of inter- ventions at the population level. The reviews focus on environmental factors that affect health and equity issues. Because of the public health focus of these reviews, the strategies used may be helpful to gerontologi- cal nurses who wish to influence health policy decisions.

An advantage of conducting a systematic review of a public health or health promotion intervention*****¨is that the outcomes of the inter- vention can be evaluated among different population groups with varying levels of disadvantage (Armstrong et al., 2007). There is a need to evaluate studies to identify who has benefited from interven- tions, who has not benefited, and who has had an adverse response*****¨to interventions (Jackson et al., 2004). Systematic reviews that in- clude detailed analysis can provide important information about the effects of interventions, policies,*****¨or programs on societal subgroups to help stakeholders develop and modify policies that reduce health disparities. Interventions that as- sist older adults can be evaluated, looking at differences in outcomes according to age, health status, gender, ethnicity, socioeconomic status, functional ability, and place of residence. This evidence helps target interventions and policies that can better address the needs of a diverse older adult population.

According to the Cochrane Pub- lic Health Group, the applicability and transferability of interventions should be evaluated within a policy context (Armstrong et al., 2007). Several of the questions posed by the Group are related to applica- bility of an intervention and have

relevance for gerontological nurses. These involve whether the political environment is conducive to imple- menting the intervention, consider- ation of political barriers, resource availability for the intervention, acceptance of the intervention, and structural barriers to implement- ing the intervention. Questions posed related to transferability of*****¨an intervention or policy include prevalence of the problem locally and characteristics of the target population. Issues such as the politi- cal environment, the structure of the organization, social acceptability, and skills available that would affect the capacity to implement the inter- vention or policy within the local environment are also important to consider (Armstrong et al., 2007).

JoAnnA BRiggS inSTiTuTe

The Joanna Briggs Institute (JBI) is an international collaboration of centers and entities that is a leader in conducting reviews of economic, qualitative, and policy research. They use an approach that is broad and inclusive when conducting systematic reviews (JBI, 2008b). The JBI promotes the inclusion of quali- tative studies in systematic reviews because of the ability to *****analyze cultural and sociological phenom- ena***** (JBI, 2008b, p. 75). Policy decisions based on the analysis of research evidence that addresses*****¨the clinical effectiveness, rigor of research design, economic evidence, and sociological and cultural per- spectives provide a sound founda- tion for making health policy deci-

ReSouRCeS foR ConduCTing SySTemATiC liTeRATuRe ReviewS

Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions, Version 2. http://www.ph.cochrane.org/Files/Website%20Documents/Guidelines%20HP_ PH%20reviews.pdf

These guidelines are a supplement to the handbook and provide useful information on planning the scope of a review, forming advisory groups, including studies in a review, ensuring intervention integrity, searching for literature, and integrating qualitative and quantitative studies.

Handbook: Systematic Reviews of Health Promotion and Public Health Interventions http://www.ph.cochrane.org/Files/Website%20Documents/HPPH_systematic_ review_handbook.pdf

Important guide for conducting systematic reviews of the literature with a public health or health promotion focus. Includes tools to assist in evaluating quality of studies. Focuses on both quantitative and qualitative studies.

The JBI (Joanna Briggs Institute) Approach to Evidence-Based Practice

http://joannabriggs.edu.au/pdf/about/Approach.pdf

This document provides a clear overview of the JBI Model of Evidence-Based Health Care; the JBI levels of evidence, including the FAME (Feasibility, Appropri- ateness, Meaningfulness, and Effectiveness) scale; and grading of evidence.

The Joanna Briggs Institute Reviewers***** Manual: 2008 edition

http://www.joannabriggs.edu.au/pdf/JBIReviewManual_CiP11449.pdf

This manual provides an overview of strategies to conduct systematic reviews of the literature, including evaluation of evidence related to the feasibility, appro- priateness, meaningfulness, effectiveness, and economic evidence supported by the research design.

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sions. The JBI has recognized the importance of evaluating economic evidence for the purpose of health policy and evidence-based practice decision making (JBI, 2008b). In response to the number of published economic an*****s and the need to analyze economic evidence to more effectively allocate scarce resources, the JBI provides guidelines for the evaluation of economic evidence that may be helpful to the geronto- logical nurse conducting a review with policy relevance.

The critical appraisal of research studies in a systematic review has two major purposes. The first is to evalu- ate the quality of a study by examin- ing for the possibility of bias. The goal is to include only studies of high quality in the review. The reviewer also examines studies to determine whether the researcher has indicated with clarity *****the population, inter- vention, and outcomes of interest***** (JBI, 2008b, p. 48), which is necessary to synthesize the results of multiple studies for the purpose of proposing recommendations for evidence-based policy or practice. A number of dif- ferent checklists and tools are avail- able to extract data from articles and assist in appraising the quality and level of evidence presented in studies.

The JBI (2008b) promotes the development of a search strategy*****¨to address the topic to be explored that includes international evidence. The search strategy should be based on clear and specific objectives that include a population focus, a stated intervention if there is an interven- tion focus, and the specific outcomes of interest. Clarity of the purpose of the systematic review provides an important foundation for the review and serves as a guide throughout the search, analysis, synthesis, and con- clusion process. Reviewers should include the following in their search strategy: databases to be explored, search terms, time frame, research methods to be included, and a review of reference lists of studies to search for other relevant articles (JBI,

2008b). A methodological approach to the systematic review is needed to ensure that recommendations pro- posed by the gerontological nurse are based on sound scientific evidence.

The JBI Model of Evidence- Based Health Care includes the evaluation of evidence related to the feasibility, appropriateness, mean- ingfulness, and effectiveness of the activity (FAME scale) (JBI, 2008a, 2008b). Feasibility is defined as whether the intervention or activity is *****physically, culturally, or finan- cially practical or possible within a given context***** (JBI, 2008b, p. 11). Appropriateness is whether the activity *****fits with or is apt in a situa- tion***** (2008b, p. 11). Meaningfulness is related to the perspectives associ- ated with the activity, and effective- ness is whether the intended effect was achieved. A 4-point rating scale for levels of evidence is proposed*****¨to rate the feasibility, appropriate- ness, meaningfulness, effectiveness, and economic evidence of research articles. A system for grading of rec- ommendations is also presented by JBI. Details about the system may be found in JBI (2008a).

SummARy

There are several models of systematic review methodology available for gerontological nurses to consult when conducting a systematic review of the literature. The EPPI-Centre, the Cochrane Collaboration, JBI, and the Camp- bell Collaboration (http://www. campbellcollaboration.org) provide useful information for geronto- logical nurses who are conducting systematic reviews with policy relevance. For nurses to assume a leadership role in synthesizing sci- entific evidence for evidence-based policy development and refinement, nursing education programs will need to assume a more active role in teaching systematic review method- ology. This educational foundation, coupled with a strong foundation in research methodology, will prepare

nurses to synthesize and disseminate the evidence necessary to gener-*****¨ate future policy that will improve the health care outcomes of older adults in a society with limited fiscal resources. Gerontological nurses who have sensitivity to the needs

of the older adult population and who are aware of the strengths and weaknesses of the health care system have the potential to influence the quality of care provided to older adults. Increasing knowledge and skill in synthesizing and dissemi- nating research evidence will assist gerontological nurses in becoming a powerful influence in the future ag- ing and long-term care policy arena.

RefeRenCeS

Armstrong, R., Waters, E., Jackson, N., Oli- ver, S., Popay, J., Shepherd, J., et al. (2007). Guidelines for systematic reviews of health promotion and public health interven- tions. Version 2. Retrieved December 1, 2008, from the Cochrane Public Health Group Web site: http://www.ph.cochrane. org/Files/Website%20Documents/ Guidelines%20HP_PH%20reviews.pdf

EPPI-Centre. (n.d.a). What is a systematic re- view? Retrieved December 1, 2008, from http://eppi.ioe.ac.uk/cms/Default.aspx? tabid=67&language=en-US

EPPI-Centre. (n.d.b). Why is it important to be systematic? Retrieved December 1, 2008, from http://eppi.ioe.ac.uk/cms/ Default.aspx?tabid=69&language=en-US

Harden, A., & Thomas, J. (2005). Method- ological issues in combining diverse study types in systematic reviews. International Journal of Social Research Methodology, 8, 257-271.

Jackson, N. (n.d.). Handbook: Systematic re- views of health promotion and public health interventions. Retrieved December 1, 2008, from the Cochrane Public Health Group Web site: http://www.ph.cochrane.org/ Files/Website%20Documents/HPPH_ systematic_review_handbook.pdf

Jackson, N., Waters, E., & Guidelines for Sys- tematic Reviews of Health Promotion and Public Health Interventions Taskforce. (2004). The challenges of systematically reviewing public health interventions. Jour- nal of Public Health, 26, 303-307.

Joanna Briggs Institute. (2008a). The JBI ap- proach to evidence-based practice. Retrieved January 12, 2009, from http://joannabriggs. edu.au/pdf/about/Approach.pdf

Joanna Briggs Institute. (2008b). The Joanna Briggs Institute reviewers***** manual: 2008 edition. Retrieved January 12, 2009, from http://www.joannabriggs.edu.au/pdf/ JBIReviewManual_CiP11449.pdf

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Guided Imagery and Pain Management

Everyone experiences pain at some point. From the patient in the most dire circumstances in urgent care to the little kid with a sprained ankle. Pain is universal. Yet, it continues to plague individuals all over the world.

Pain Management and the post-surgery healing processes are a difficult area to study based on the personal nature of how each individual patient deals with and visualizes their own pain and recovery. Still, nursing researchers and practitioners are constantly looking for methods to improve or augment current pain management practices within contemporary nursing practice. In more contemporary pain management strategies, there is often a tendency to over rely on pharmaceutical medications. Pain is experienced by patients of all sorts. Anything from injuries to degenerative diseases can cause chronic pain that continues to plague the patient in question (Bresler, 2012). Using guided imagery can possibly help increase individual pain tolerances, and thus it is a better solution for pain management rather than trying to combat all the causes for the plethora of pain that is witnessed in clinical practice on a daily basis. Increasing pain tolerance and the ability for the individual to manage pain during treatment and recovery can transcend differences to why the pain is even an issue at all. Thus, it becomes a more universal method for helping individuals deal with pains of all sorts.

Understanding how to better manage pain can help individuals suffering from a wide variety of injuries and conditions. Further research on alternative methods for pain reduction and management techniques may be able to give some much needed relief to a mass of individuals, not just a handful of patients (Bresler, 2012). Pain can not only harm individuals with the injury, it can cause harm to everyone around them (Bresler, 2012).No one wants to see their loved ones suffer. Also, patients themselves may damage their own personal relationships because of the extremity of pain and how it can isolate an individual (Bresler, 2012).

To best understand how to structure an investigation into how to combat pain, one should look to use a PICO format. The concept of PICO revolves around the elements of patient/population, intervention/issue, comparison, and outcome (Davies, 2011). First, the patient and problems regard pain management in individuals having to experience traumatic injuries and surgeries. As they have to endure serious pain during their recovery, there are issues as to how to best manage pain in individuals who are trying to recover with serious trauma to their bodies. The main intervention here is guided imagery, which is *****the practice of concentrating on a mental picture to promote healing and relaxation or other positive outcomes***** (Cornelius, 2010). It is the alternative method of coaching, where medical staff ask patients to picture particular health outcomes, like the movement of blood out of an area that is about to undergo surgery (Bresler, 2012). Studies have explored how it can be a helpful preparation tool for individuals undergoing invasive surgeries. Essentially, *****guided imagery could be used to raise pain tolerance, facilitate restful sleep, elevate mood, increase motivation, reduce dependence, and promote self management***** (Bresler, 2012). Still, the concept of guided imagery tends to stray far from traditional methods of pain management. Pharmaceuticals have long been a major method of treatment for pain, but have resulted in major backlashes in regards to

patients becoming addicted, especially in long-term and chronic cases of pain. If guided imagery could be a successful method, it may reduce pain or increase pain tolerance, without the threat of chemical dependence.

There are a number of benefits which are seen in the ongoing discourse today. As such, the expected improvements include things like drops in blood high blood pressure, lower heart rates, and reduction of chronic pain symptoms, lessoning of headache pain, and increasing overall pain tolerance (Cornelius, 2010). In situations were patients going into a major surgery were coached with guided imagery, it was *****shown to decrease stress and anxiety before and after surgery,***** thus helping reduce additional pain issues during the crucial stages of recovery directly after an invasive surgery (Cornelius, 2010). It is a natural and holistic way to approach pain management. It eventually aims *****to increase the ability to self-manage pain, and decrease dependence upon medications and medical care***** (Bresler, 2012). This may mean increasing an individual*****s pain tolerance in order to increase their quality of life as they recover.

The previous discussion highlights a clear problem that could possibly be addressed with the proposed method of guided imagery within clinical practice. However, if there is a relationship between the variables here, it will be difficult to discern based on the abstract nature of the data that would be needed. As such, the research questions that drive this research must be well tailored in order to secure a more directed path for the overall research process. The questions for this current research are as follows:

*****¢ How can guided imagery help direct pain management strategies?

*****¢ Does guided imagery help increase pain tolerance?

*****¢ Can guided imagery before surgery help prevent pain from increasing to intolerable levels?

*****¢ How can guided practice be implemented into clinical practice more often today?

*****¢ How can strategies utilizing guided imagery be evaluated in terms of how successful they are for managing pain?

These questions can help drive a more thorough investigation into the environment and related factors that contribute to unmanageable levels of pain. Next is a much-needed search through the literature in order to better answer such questions. The following search terms will help focus that literature review most appropriately:

*****¢ Pain Management

*****¢ Alternative Pain Management

*****¢ Guided Imagery

*****¢ Holistic Pain Management

*****¢ Increasing Pain Tolerance

*****¢ Pain and Guided Imagery

*****¢ Pain Management After Surgery

*****¢ Pharmaceutical Medications and Pain Management

*****¢ Preparing Patients for Invasive Surgery

*****¢ Surgery and Pain

*****¢ Pain and Nursing

References

Bresler, ***** E. (2012). Raising pain tolerance using guided imagery. Practical Pain Management. Web. http://www.practicalpainmanagement.com/treatments/psychological/raising-pain-tolerance-using-guided-imagery

Cornelius, Debra. (2010). Guided imagery improves treatment options for various conditions. Health. Web. http://voices.yahoo.com/guided-imagery-improves-treatment-options-various-6299902.html

Davies, Karen Sue. (2011). formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Informative Practice, 6(2), 75-81.

*****