Scientific underpinnings for evidence based practice

Full Answer Section

1. Asking a focused and answerable clinical question: Identifying a specific problem or area for improvement in patient care.
2. Searching for the best evidence: Systematically locating relevant and rigorous 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 and patient population.
4. Integrating the appraised evidence with clinical expertise and patient values: Synthesizing the research findings with the clinician's knowledge and experience, while also considering the patient's unique needs, preferences, and values.
5. Evaluating the outcomes of the practice change: Assessing the impact of the implemented intervention on patient outcomes and making adjustments as needed.

Applying EBP to Reduce PONV in the Medical-Surgical Unit

1. Asking a Focused and Answerable Clinical Question:

The clinical problem identified in our medical-surgical unit is the persistent and significant incidence of PONV despite the administration of standard antiemetic medications. 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 aromatherapy with peppermint oil (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 electronic databases PubMed and CINAHL. The search terms used included "postoperative nausea vomiting," "PONV," "aromatherapy," "peppermint oil," and "nursing." The search was limited to articles published within the last five years to ensure the evidence is current and relevant.

Two relevant research articles were identified:

• Article 1: Anderson, L. A., & Gross, J. B. (2019). Aromatherapy with peppermint oil for postoperative nausea and vomiting: A systematic review and meta-analysis. Journal of PeriAnesthesia Nursing, 34(5), 913-921.
• Article 2: Tayebi, N., Asili, J., Beyranvand, F., & Alavi, M. (2020). The effect of peppermint oil inhalation on postoperative nausea and vomiting in patients undergoing cesarean section: A randomized clinical trial. Complementary Therapies in Clinical Practice, 40, 101199.

3. Critically Appraising the Evidence:

• Article 1 (Systematic Review and Meta-Analysis): This study rigorously synthesized the findings from multiple randomized controlled trials (RCTs) that investigated the effectiveness of inhaled peppermint oil for the prevention and treatment of PONV in adult surgical patients. Systematic reviews and meta-analyses provide a high level of evidence due to their comprehensive and unbiased approach to summarizing existing research. The authors concluded that inhaled peppermint oil is a safe and potentially effective intervention for reducing the incidence and severity of PONV, as well as the need for rescue antiemetics. The large sample size, pooled from several studies, enhances the statistical power and generalizability of the findings to our adult postoperative population.  
• Article 2 (Randomized Clinical Trial): This RCT specifically examined the effect of peppermint oil inhalation on PONV in patients undergoing cesarean section. The study design (randomized and controlled) minimizes bias and strengthens the causal inference. The results demonstrated a statistically significant reduction in the severity and duration of nausea in the peppermint oil inhalation group compared to the control group. While the surgical population is specific (cesarean section), the underlying physiological mechanisms of PONV can be similar across different surgical procedures, suggesting potential relevance to our broader medical-surgical patient population experiencing PONV. The moderate sample size (n=100) provides reasonable statistical power for the specific outcome measured.

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

The evidence from both the systematic review and the RCT supports the use of inhaled peppermint oil as a complementary intervention for PONV. My clinical experience confirms that PONV remains a significant concern for many postoperative patients, impacting their comfort, recovery, and length of stay. Aromatherapy is a non-pharmacological, relatively inexpensive, and easily administered intervention with minimal reported side effects. Many patients appreciate non-pharmacological approaches to symptom management. Offering peppermint oil inhalation aligns with patient values of seeking natural and less invasive options for managing their postoperative discomfort.

5. Proposed Intervention:

Based on the available evidence and considering our clinical context, I propose the following intervention for our medical-surgical unit:

• Implement the use of aromatherapy with inhaled peppermint oil 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 prescribed antiemetics, nurses will offer the patient a cotton ball or commercially prepared aromatherapy inhaler containing a few drops of peppermint essential oil. The patient will be instructed to hold the inhaler or cotton ball near their nose and inhale gently as needed for up to 2-3 minutes, repeated every 2-4 hours or as needed for persistent symptoms.  
• Education: Nursing staff will be educated on the evidence supporting the use of peppermint oil for PONV, proper administration techniques, safety considerations (e.g., avoiding direct skin contact with undiluted oil), and documentation procedures. Patient education materials will be developed to explain this option as a safe and potentially effective way to manage their postoperative nausea and vomiting.

Sample Answer

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

Evidence-Based Practice (EBP) is a conscientious and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research (Sackett et al., 1996). The core principles of EBP include:  

1. Asking a focused and answerable clinical question: Identifying a specific problem or area for improvement in patient care.
2. Searching for the best evidence: Systematically locating relevant and rigorous research studies that address the clinical question.