A1 Quantitative Article:

Background or Introduction This research aims at using numbers to establish a value for health professionals. It performs a quantitative study of pain management in palliative care. According to Unne & Rosengren (2014), pain is a common symptom associate with palliative care. This study is therefore among other various studies that have analyzed the staff's application of evidence-based measurement tools for pain estimation. Providing quality care for patients is vital. Therefore, the health systems should be sustainable economically and be by proper clinical practices and patient consultations. The evidence based care, therefore, depends on three basic approaches, i.e., the staffs' skills and experiences, patient desires and needs and the resent indications based on the present researchers. Efforts should also be put forth to achieve the required quality and safety in health and patient care.

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Review of the Literature Previous researches indicate the importance of searching for more information by using data that measures and monitors the performance of health care processes. The article, therefore, makes use of the visualization of pain and pain management processes through measurements to increase employee performance and participation in understanding work improvements. Various studies indicate the use of the PDSA methodology to increase adherence to evidence-based practice as a way of improving quality care and safety of patients. Moreover, staff motivation for learning is also imperative to ensure continuous advancement in patient care.

Discussion of Methodology The study made use of statistical and quantifiable outcomes to provide a real description of pain management and routines that can be applied to improve pain management. The quantitative methods include systematic collection of empirical and quantifiable data to summarize and provide generalizations on pain management in palliative care.

Data Collection and Analysis The team established nine questions in line with the staff's daily work with the management of pain and palliative care. A 14-day period was provided to answer them. These questions provided a baseline for improving efforts and establishing a status report. They included: 1) Number of patients being asked about their pain and the number that reported the pain; 2)Number of pain ratings basing on the FLACC, ESAS, VRS and NRS; 3) Number of pain assessments; 4) Number of patients that were monitored as a result of pain; 5) the number of adjustments for pain treatments; 6) the number of patients who were taken through the pain management process; 7) the number of patients who scored more than 4 on the ESAS; 8) the number of patients whose pain was discussed during team meetings and the pain ratings discussed at team meetings; 9) the number of patients enrolled in a pain management plan. All the patient visits were also analyzed (165 for the North team and 153 for the South team).

The quantitative approach used involved measurement and quantification of the selected data. Descriptive statistics were used to analyze the nine questions in Microsoft excel. Pain management data was analyzed and documented by reviewing the medical records as shown by the VRS.

Researcher's Conclusion The results of the study indicate significant similarities and differences in the documentation of pain in pain management and palliative care. There were increases in the number of ratings of patient pains between the first, second and third time periods. The medical records attributed the use of direct activities such as drug treatments to the fewer pain assessments. There was an increase in pain relief due to the use of pain assessment instruments, i.e. NRS, VAS, and FLACC. There was adequacy in the quality of goals of the health district, and 80% of pain management should be conducted by validated pain assessment instruments.

Critique whether the evidence presented in the journal article supports the researcher's conclusion.

The evidence presented in each section of the journal article adequately supports the researcher's conclusion. Unne & Risengren (2014) argue that good clinical practices should be provided with proper consultations with the patients to provide the required high-quality care for them. Patient consultation might involve the frequent inquiry on them at the different time intervals to understand the levels of their pain. The methods used in data collection such as the questionnaires provide vital details in line with the pain assessments, treatment adjustments and pain ratings that are in line with the findings of the research.

Protection of human subjects and cultural considerations.

The article protects the human subjects and conforms to the cultural considerations in the nursing profession. It aims at protecting the human subjects by providing an analysis of pain in patients as a common symptom in palliative care. It tries to control the problem by providing high-quality care for the patients. Moreover, the study conforms to the cultural considerations of the profession by ensuring that the devised methods of study and health systems are economically sustainable and by proper clinical practices and patient involvement. It ensures that the methods and solutions suggested are in line with the values, standards, and policies of the nursing profession.

Strengths and limitations of the study

Strengths

The study achieved its objective of identifying the differences with regards to the method of estimating pain within palliative care in north-eastern Sweden. The documentation of the research data was easy to find and relate to the medical records and showcased a clear and systematic way of documenting the pain ratings.

Limitations

The limitation of the study is the small sample size applied, i.e. only two teams on one health care district were included in the research. Moreover, it encourages a mix of data that contributes to generalization from the questions set by the staff, patient reviews, death surveys, and medical records.

Impacts of the findings of the study on the nursing practice.

This evidence impacts highly to the nursing practice. It would help to establish a systematic pain management routine in health care centers to help the staff to improve palliative care and improve their visualization and awareness of pain management. The findings of the study would also develop the nursing practice by enhancing the team's awareness in understanding the clinical practices, increasing their understanding of the importance of policies, items and evidence-based guidelines via double-loop learning to enhance staff participation. This would enhance a positive working environment and encourage a sense of coherence, comprehensibility, meaningfulness, and manageability among the nurses.

Qualitative research (Factors influencing orthopedic nurse's pain management: A focused ethnography)

B1 Qualitative Article:

Background or Introduction Nurses are the best positioned personnel among health care providers within a hospital setting to assess pain and establish effective pain management plans that meet the needs of their clients/patients. However, various barriers to pain management have been highlighted. These include the beliefs and attitudes of the nurses towards pain, time management, formal pain assessment skills, attitude towards analgesics, patient's anxiety, competing demands and feelings of helplessness among the patients (Denness et al., 2017).

Review of the Literature The literature review reveals the cultural practice settings that are prominent and highly influential in the management of pain by nurses. Short-acting opioid analgesics provide a proper prescription for patients with acute pain on a pro re nata (PRB) basis, and nurses are left with the solemn role of deciding whether to administer the PRN opioid or not. The emergence of fast-track surgery programs has enhanced the complexities of tasks involved with nursing as well as increased the number of patients that undergo TKA. The result is a potential impact on the culture of the nursing environment. Therefore, it's vital to look into the effect of this culture on the nursing practices of pain management.

Discussion of Methodology The methodology involved the use of semi-structured interviews that focused on ethnographies to educate the researchers on the meanings that they assign to a particular phenomenon.

Data Analysis Interviews were transcribed verbatim. The data analysis provides a thematic analysis that has a constant comparison and is consistent with the works of other focused ethnographers. The four basic steps involved in the thematic analysis of the ethnographic data included sorting, coding, memoing and generalizing.

Researcher's Conclusion An understanding of complex factors that influence nurse's post-operative pain management processes provides clinical nurses and nursing leaders with proper directions for future research and education. It guides the goal of continued improvement in the management of pain and the challenging settings of fast-track surgeries.

Critique whether the evidence presented in the journal article supports the researcher's conclusion.

The evidence presented in each section of the journal article supports the researcher's conclusions. Clinical nurses and nursing leaders should be equipped with directions for future education and research. The background analyses several barriers to effective pain processes and how they can be reinforced or assuaged by the nursing culture and the context of occurrence of pain management. It also summarizes the essential roles played by nurses in managing acute pain. The factors under consideration include the unit culture, the nurses' self-concept and their perception of pain assessment, all of which provide credible insights for future education and research.

Protection of human subjects and cultural considerations.

The protection of human subjects and cultural considerations are themes that are well-highlighted in the journal article. The study addresses the pain felt by patients that undergo surgeries. According to Denness et al (2017), most patients experience significant post-operative pain. It establishes improvements in pain management for patients that have been in a TKA or associated with early ambulation with the aim of lowering the risk of postoperative complications as well as reducing their length of stay. It also looks into the cultural considerations of the nursing profession. It checks on the nursing culture and physical space that influences the nurse's assessment of pain as well as their decision to treat pain with PRN opioids.

Strengths and limitations of the study

Strengths

The paper analyzes the various factors that contribute to pain management, i.e. the unit culture, the nurses' self-concept and their perception of the pain assessment. The nursing unit culture is described as taking a high priority on pain management to achieve appropriate pain outcomes. It explains the self-concept in nursing and explains the beliefs and information that nurses have concerning their values, roles, and behaviors. It improves the nurses and patient's expressions of pain, develops a perception of their subjective experiences of pain and how they may differ from the patient's perceptions.

Weaknesses

The scope of the study was limited to one specific unit to examine how the unit's exclusive cultural and contextual factors affect pain management. The complexities of acute pain management establish broad theories that might be cumbersome to apply in practice.

The study primarily focuses on the use of interviews as a method of collecting data. Moreover, the behaviors recorded in intervie...