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Introduction
Chronic pain is a serious nursing practice problem that has numerous negative effects on the quality of life of the impacted population. The available pain management approaches are often associated with adverse health effects, limiting their use. The current paper proposes the introduction of mindfulness-based intervention substantiated by the findings of qualitative and quantitative studies and outlines its potential advantages compared to traditional techniques.
PICOT Statement
In adults suffering from chronic pain (P), is mindfulness meditation combined with administration of Acetaminophen (I) a more effective intervention for pain management (O) than the administration of Acetaminophen without the use of mindfulness component (C) in the period of three months (T)?
Research Critiques
Background
The qualitative article selected for the review is the study by Moore and Martin (2015) dealing with the effects of mindfulness-based cognitive therapy (MBCT) on pain management. The clinical problem identified by the researchers was the lack of clarity pertaining to the specific effects of the intervention. Despite the bulk of research dealing with the overall effectiveness of the intervention, the information is for the most part unsystematic, which prevents its implementation in the evidence-based practice.
The study is significant since according to the authors an estimated 20% of the population is impacted by the chronic pain which constitutes a significant economic challenge as well as a noticeable detriment to the quality of life of the impacted population and can cause suicidality, disruption of social connections, difficulties in employment, and depression. Consequently, the purpose of the study at hand is the conceptualization of the perceived benefits of MBCT by patients suffering from chronic pain. Due to the qualitative nature of the research, the research questions are not specified in the article. Nevertheless, they can be inferred as follows:
- What are the perceived benefits of the MBCT program from the perspective of patients with chronic pain?
- What are the factors that enable or hinder the ongoing mindfulness practice?
- What are the best ways to assist the patients in developing their practice?
Both the research questions and the purpose of the study are related to the identified clinical problem.
Methods
The qualitative approach was likely selected due to the exploratory nature of the research (conceptualization of the benefits rather their measurement) and the need to identify the factors impacting the patients’ participation (achievable through interviews). The inferred specific perspective adopted by the researchers was the positive impact of MBCT on the management of chronic pain. The literature review conducted by the authors revealed the abundance of qualitative studies that provided an overview of the benefits and a relative scarcity of quantitative research with specific and measurable conclusions.
The majority of the sources used for the review were within the ten-year range, which is an acceptable practice for the qualitative studies (de Chesnay, 2015). The literature review was logically structured and supplied with a rationale for the choice of the sources. However, the weaknesses of the previous research were not identified.
The research was conducted within a single public hospital pain unit during the course of two years. The sample consisted of voluntary participants with anxiety, depression, and other stress-related conditions (Moore & Martin, 2015). The interviews were administered within the unit on a one-on-one basis during a five-week period. Seventeen participants who agreed to participate were interviewed.
Results
Several distinct themes that determined the participation of patients were identified once the data was processed. The most common themes included the belief of patients in the effectiveness of the mindfulness-based interventions, the extent of control over the pain management procedure, the lack of resistance in accepting the persistent pain, and the emotional struggle between the conflicting needs and ideas during the practice (Moore & Martin, 2015).
The findings align with the results of the studies included in the literature review. The strongest driving forces stemmed from the belief in the effectiveness of the practice and the expectations to avoid the negative effects of the condition whereas the conflicts of priorities and the inability to accept the recurring nature of pain were the most detrimental to the involvement.
Ethical Considerations
The study was approved by the research ethics committee of the hospital where the study was performed as well as the University Human Research Ethics Committee (HREC) (Moore & Martin, 2015). The consent for the recording of the data was obtained from the participants before the study was started. The data gathered via from the interviews was anonymized through deidentification. The participation was not associated with adverse health effects and allowed for additional pharmaceutical means of relief if necessary (Beck, 2013). The research design did not include a control group. Hence, neither the treatment nor lack thereof could raise ethical concerns.
Implications
The research in question contributes to the current understanding of the issues by identifying the factors responsible for the success of the intervention and its underlying mechanisms. In addition, its results align with those of the previous studies, enhancing their reliability. The findings also present several implications for nursing practitioners. Specifically, they allow for the development of effective and affordable pain management interventions and highlight the most likely barriers to success. They also point to a viable direction of further inquiry, such as pain catastrophizing.
Background
The second reviewed article is the quantitative research by Andersen and Vægter (2016) on the effects of mindfulness-based pain management program in patients with chronic pain. The growth of cases of chronic pain in the modern healthcare setting is not adequately addressed. The suggested intervention is based on the assumption that its low resource requirements, non-pharmaceutical nature, and long-term effects make it preferable for the patients.
The purpose of the study is thus to determine the effectiveness of the cognitive behavioral therapy program with integrated mindfulness meditation (CBTm) in the reduction of the intensity of pain compared to a control group of patients on a waiting list and to establish the relationship between mindfulness and pain reduction (Andersen & Vægter, 2016). The paper does not contain the research questions, but they can be inferred from the hypotheses.
- Would CBTm program reduce pain intensity and psychological distress compared to the control condition (Andersen & Vægter, 2016)?
- Would the CBTm program increase the level of mindfulness and acceptance (Andersen & Vægter, 2016)?
- Would the change in the level of mindfulness be associated with a reduction in pain intensity and psychological distress (Andersen & Vægter, 2016)?
The questions are aligned with the problem statement since both are aimed at pain reduction.
Methods
Neither the risks nor the benefits of the study are stated in the paper but can be inferred. The offered benefits include improved methods of chronic pain reduction. The risks involve the relative inefficiency of the intervention in the control group. Participation in the study was voluntary. The written consent was obtained from the participants. The protocol of the research was approved by the review board of the University of Southern Denmark where the study was conducted.
The study utilized a single independent variable – the level of mindfulness produced by the CBTm program. The dependent variables included pain catastrophizing, pain intensity, awareness, attention, and acceptance. Only the dependent variables were specified by the authors. The data was collected via a questionnaire within a single multidisciplinary pain center in Denmark in the course of 13 weeks. Two sets of data were obtained before and after the intervention.
The rationale for the research design was not provided. The participants were invited via mail and underwent the questionnaire. Next, the 13-week program was introduced by professional psychologists, followed by the second questionnaire. Chi-square test was used for the analysis of the baseline data and a sample t-test for continuous data. Several verification procedures were applied to assure rigor, including the Norman-Kleus post-hoc test and an expectation-maximization algorithm. The ANOVA statistical platform was used for data analysis. The measures to eliminate the effects of researcher bias were not specified.
Results
The results revealed the reduction of pain catastrophizing, anxiety, and depression in the treatment group (Andersen & Vægter, 2016). The choice of tools, sampling methods, and the demonstration of scientific rigor allow us to conclude that the results accurately represent reality. The limitations of the study include the sample size which is insufficient for a quantitative study (Charan & Biswas, 2013). Second, the non-randomized convenience sample was used. Third, a significant proportion of the participants dropped out of the study. Fourth, some confounding variables were likely present in the study. Despite the identified limitations, the results were presented with clarity and inappropriate manner.
Ethical Considerations
The study was approved by the review board of the University of Southern Denmark. No information is available on the protection of the participants’ privacy. All patients were subject to established pain management interventions, and mindfulness-based interventions do not produce adverse health effects (Gu, Strauss, Bond, & Cavanagh, 2015).Therefore, no ethical considerations regarding the treatment or lack thereof are detected.
Implications
The current research adds to the existing knowledge on the effectiveness of mindfulness-based interventions for pain management and provides a viable example for measurement of the clinical outcomes associated with the practice. The nursing practitioners can incorporate the findings by adjusting their care delivery methods, improving patients’ outcomes, and increasing patient satisfaction rates.
The research can also be utilized by nursing administrators by modifying the guidelines for pain management for organizations and healthcare networks. However, the results should first be replicated using better controls and more appropriate sampling techniques. Finally, the researchers can obtain directions for further inquiry by addressing the gaps in the association between the variables. In their current form, the results provide an overview of the direction for nursing discipline development.
Proposed Evidence-Based Practice Change
The research articles reviewed in the previous section deal with the same nursing practice problem: the occurrence of chronic pain insignificant proportion of the population. Due to its persistent nature, the phenomenon impacts multiple areas of the suffering individuals’ lives, including economic, psychological, and social well-being. Despite the significant improvements in the pharmaceutical means of pain management, their overall effectiveness is compromised by the adverse side effects.
On the other hand, the use of mindfulness-based interventions, such as mindfulness meditation, yield consistently positive results, enhance patients’ self-management skills, and can be adopted for application in other settings that influence the quality of life on the social and emotional level (Andersen & Vægter, 2016; Moore & Martin, 2015). Therefore, it is suggested to change evidence-based practice by including the techniques which would familiarize the patients with the concept of mindfulness while at the same time equip them with the efficient approaches to pain management.
References
Andersen, T. E., & Vægter, H. B. (2016). A 13-weeks mindfulness based pain management program improves psychological distress in patients with chronic pain compared with waiting list controls. Clinical Practice and Epidemiology in Mental Health, 12, 49-58.
Beck, C. T. (Ed.). (2013). Routledge international handbook of qualitative nursing research. New York, NY: Routledge.
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 35(2), 121-126.
de Chesnay, M. (Ed.). (2015). Nursing research using data analysis: Qualitative designs and methods in nursing. New York, NY: Springer.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1-12.
Moore, K. M., & Martin, M. E. (2015). Using MBCT in a chronic pain setting: A qualitative analysis of participants’ experiences. Mindfulness, 6(5), 1129-1136.
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