Assign 03 PPH4805

STUDENT NUMBER

:

46355537

MODULE CODE

:

PPH4805

ASSIGNMENT NUMBER

:

03

UNIQUE NUMBER

:

642926

TITLE: RESEARCH PROTOCAL

TABLE OF CONTENT

PAGES

1. INTRODUCTION………………………………………………………………………………………1 2. THE RESEARCH PROPOSAL FOR THE STUDY OF EFFECTIVENESS OF PAINSCORING SYSTEM…………………….……………………………………………………………..1 2.1 TITLE OF THE PROPOSED STUDY…………………………………………………….1 2.2 INTRODUCTION OF THE STUDY………………………………..…………………….1 2.2.1 Literature review…………………………………………………………………..1 2.2.2 Problem statement……………………………………………………………….3 2.2.3 Purpose and objective of the study……………………………………….4 2.2.4 Specific objective…………………………………………………………………..4 2.3 METHODOLOGY………………………………..…………………………………………..4 2.3.1 Terms……………..…………………………………………………………………..4 2.3.2 Study design………………………………………………………………………..5 2.3.3 Study setting……………………………………………………………………….5 2.3.4 Study population…………………………………………………………………6 2.3.5 Sampling technique…………………………………………………………….6 2.3.6 Exclusive criteria………………………………………………………………….6 2.3.7 Pilot study……………………………………………………………………………6 2.4 DATA COLLECTION…………………………………………………………………………7 2.5 DATA ANALYSIS AND PROCESSING………………………………………………...7 2.6 STUDY LIMITATAIONS………………………………………………………………….…7 2.7 ETHICAL CONSIDERATIONS………………………………………………………….…7 2.8 TIME SCHEDULE……………………………………………………………………………..8 2.9 DISSEMINATION OF RESULTS ………………………………………………………..9 3. CONCLUSION….…………………………………………………………………………………….10

4. LIST OF SOURCES……………………………………………………………………………….11

1 1. INTRODUCTION The research proposal is a formal written document which is prepared prior to the study. It shows the background, the reasons for the study, detailed methodology that will be used and important administrative aspects such as time and financial management. Research proposal is a way of opening communication between the researcher and the stakeholders. It is used for request of support either financial or emotional. It is a dynamic document which keeps on changing in the planning phase. The final copy of a research proposal is submitted to the ethics committee for approval before the study is commenced. 2. THE

RESEARCH

PROPOSAL

FOR

THE

STUDY

OF

EFFECTIVENESS OF PAIN-SCORING SYSTEM 2.1.

TITLE OF THE PROPOSED STUDY

The title clearly describes the purpose of the study (Joubert 2012). Assess the effectiveness of pain-scoring system in children between the age of five and 10 years at Butha-Buthe General Hospital children’s ward. 2.2.

INTRODUCTION OF THE PROPOSED STUDY 2.2.1. Literature review

Literature review is a process that involves finding, reading, understanding and forming conclusion about the published research and theory on a particular topic Brink 2002). The aim is to determine what is already known about the topic.

2 According to international Association for the study of pain (IASP) (2012) pain is defined as an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage. Pain can be classified as either acute/short term or chronic pain/long term pain. In most cases children experience acute pain as a result of injury or medical producers. (Gebhart, 2000) If pain in children is not managed effectively and quickly it may have long term-term physical and psychological effect to the child (American Academy of paediatrics 2004). Long-term effect of pain in children may include anticipatory anxiety during future medical procedures, lowering of pain threshold and sensitisation to future pain reducing effectiveness of analgesics and increasing analgesic requirements (Cunliffe and Roberts 2004). Hauer and Jones (2014) indicate that, pain assessment and management are essential components of paediatric care. However it is a challenge to identify presence and severity of pain in young children. Therefore use of a good pain-scoring tool upon cognitive ability will help in identifying the severity of pain in a child hence appropriate pain management is applied. Orthopaedic procedures are often painful, unexpected for children presenting at the orthopaedic clinic. This situation becomes complicated because children are not able to verbalise their level of pain (Srouji, Ratnapalan, & Schneewiss 2010). However IASP (2012) state that inability to communicate verbally does not negate the possibility that a child is not experiencing pain. This experience has heightened by situational stress and anxiety leading to an overall unpleasant for children admitted in children’s ward.

3 Because of the advance in technology and availability of wide range analgesia to manage pain in children, there is improvement in management of pain in child (Fein, Zimpsky & Cravero 2012). However there is a gap in assessing the intensity of pain in children due to challenges such as, children cannot verbalise the pain and presence of many tools for scoring pain in child which nurses have little knowledge on. 2.2.2. Problem statement Research problem is a situation in need of solution, improvement, or alteration, or discrepancy between the way things are and the way they ought to be (Brink 2002). There are several barriers that challenging adequate pain control in children at the orthopaedic clinics these includes; difficulty in assessing pain in children, unfamiliarity with new products and technology, fear of medication adverse side-effects, staff limitations and the constraints (American academy for children 2012). In most of cases children’s pain is underestimated because of the underuse of appropriate assessment tools and the failure to account for the wide range of children’s developmental stages. Moreover nurses are not familiar with the available tool for assessing level of pain in children. Fein et el (2012) indicates that, although few physicians still believe that children do not feel pain the same way adults do and the pain has no adverse consequences, there is a growing recognition of how even minor painful procedure like needle prick can affect a child’s long-term emotional well- being and the process of hearing.

4 It is important to note that pain assessment plays an important part in pain management in children (Wong, Lau, Palozzi, and Campbell 2001). Every patient has a right to the assessment and optimal management of pain. However optimal management of pain requires thorough understanding of pain assessment tools and the pain management strategies. 2.2.3. Purpose and objectives of the study The research objectives are clear, concise, declarative statements that are expressed in the present tense. An objective focuses on one or two variables and indicates whether the variables are to be identified or described. (Brink 2002). There is still scarce data on how effective is the pain scoring system in children between the ages of five and ten years. Therefore the aim of this study is to assess the effectiveness of the tool used in assessing the level of pain at Butha Buthe general hospital. 2.2.4. Specific objectives To assess the level of pain to children (5-10 years) admitted in children’s ward one hour after receiving standard pain management, following pain assessment done the in the two comparable groups. 2.3.

METHODOLOGY 2.3.1. Terms

Pain- Unpleasant feeling occurring as a result of injury Scoring system- classification according to amount Children- ages between 5 and 10 years

5 2.3.2. Study Design A study design is a set of logical steps taken by the researcher to answer the research question. It forms a blueprint and determines the methods used to obtain subjects, collection and analysis of data, and interpretation of results. The study design for this study will be prospective cross-sectional Randomised Controlled Trial (RCT). Children with orthopaedic problems will be randomised into two arms. One arm will be assessed their levels of pain using the new pain-scoring system and the other arm will be assessed the level of pain using other methods currently used in the children’s ward. All children will receive the standard pain management depending on the level of their pain. Then after one hour we measure the presence of pain in all the children and the outcome will be classified as pain or no pain. This design allows the casual association between the intervention and the outcome. Again the selection of participants into each arm and the controlled way in which the trial is carried out means that all factors other than the intervention are considered equal. The study ability to make causal inference means that it provides the strongest empirical evidence and it is tailored to answer specific questions. 2.3.3. Study setting The study will be conducted at BBGH children’s ward in Butha Buthe one of the 10 districts of Lesotho.

6 2.3.4. Study population The study population is the entire group of persons or subjects that is of interest to the researcher. In our case the study population will be all orthopaedic children (male and female) with the age between 5 and 10 years, admitted in the children’s wards in the hospital where a new pain-scoring system has been introduced. 2.3.5. Sampling technique Sampling technique for this study will be simple random sampling technique, The Admission register will be reviewed and all children with orthopaedic problems will be identified and be put in one list then we use flip coin to allocate these names into two groups. (If coin comes up “head” the participant uses new pain-scoring system and if it comes “tail’ the participant uses the standard system). 2.3.6. Exclusive criteria 1. Child without the caretaker who is above 18years. 2. Children under sedation 2.3.7. Pilot study The pilot study is a mini-study which test parts of the study before the main study. It is intended to check the method for example instruments and logistics and need for field training to data collectors. The pilot study will be carried out to check the practicability of the tools and if the data collectors understands the questions to be asked.

7 2.4.

Data collection

Data will be collected using a structured self-report instrument. The nurse will fill the questioner one hour after the child receives pain management. The questionnaire will be composed of open and closed questions to allow the respondent to explain in their own words. 2.5.

Data analysis and processing

The data will be coded and entered in the computer using Statistical package for the social sciences (SPSS) software. After data cleaning, resolving missing data problems and completing data transformation then data analysis will be done. The data will be organised in a table shells and analysis will be done thereafter. 2.6.

Study limitations

The study will be carried out to all children 5-10 year with orthopaedic problems. The duration for hospitalisation will not be considered which can affect their perception of pain to children. 2.7.

Ethical considerations

The protocol will be submitted to the Lesotho Ethics committee in the ministry of health for ethical approval. Participation of the respondents will be voluntary and they will be free to agree or refuse to participate without effect to the quality health care management. Prior to the inclusion the caregiver of the child will be informed about the objectives and aim of the study and they will be required to give a written and signed consent if they agree for their child to participate in

8 the

study.

Patient

will

be

allocated

numbers

to

maintain

confidentiality. All the signed consent forms and questionnaires will be filed and stored safely in the medical records store for 2 years.

2.8.

Time schedule 2015

ACTIVITY

JUL

Proposal writing

Proposal

submission

to Ethics committee Training

Nurses

on

pain scoring tool at children’s ward Recruit data collectors

Pilot study

AUG

SEPT

OCT

NOV

DEC

9 2016 ACTIVITYS

JAN

FEB

MAR

APR

Data collection

Data

analysis

and

report

writing Presentation of report

2.9.

Dissemination of the results

The research findings will be presented to the hospital staff in the hospital hall. The results will be discussed with be discussed with hospital quality assurance team to facilitate the implementation of the recommendations.

10 2.10. Budget ITEMS

UNIT COST

TOTAL COST

Personnel 

1 Doctor

@ R1000/day×3days

R3000



2 Nurses

@ R500/day×3days

R1500



1 Data clerk

@R400/day×5days

R2000



1 Consultant

@R1000/hour×10hrs R10,000

Supplies @R1/copy×200

R200



Questionnaires



Stationery & photocopying

R1000



Telephone & internet

R2000

Travel 

Lease car for 5days

@R700/day×5

R3500

General cost 

Cost of reprints

R200



Trainings

R1000



Report dissemination

R5000

TOTAL COST

3.

R 29,400

CONCLUSION

Research proposal provides details of the planned study; it outlines the entire research process that gives the reader the summary of the information discussed in the study. It is also dynamic document that keep on changing during the process of planning.

11

4.

LIST OF SOURCES

American Academy of paediatrics. 2012. AAP recommends steps to control pain, stress in paediatrics emergency care. Available from: https://www.aap.org/en-us/about-the-aap/aap-pressroom/pages/AAP- (Accessed on 26.7.15). Brink, H. 2002. Fundamentals of Research methodology for health care professionals. Cape Town : Creda Communications: Cunliffe M and Robert SA. 2004. Pain management in children: Current Anaesthesia. From: https://podbed.wordpress.com/.../pain-management. (Accessed on 24.7.15) Fein JA, Zempsky. WT, Cravero JP. 2012. Relief of pain and Axiety in pediatric patient in emergency medical system. AAP. Available from: http://pediatrics.aappublications.org/content/130/5/e1391. (Accessed on 27.7.15). Gerbhart, GF. 2000.Scientific issues of pain distress. NCBI. Available From: http://www.ncbi.nlm.nih.gov/books/NBK99533/. (Accessed on 24.7.15). Hauer, J and Jones, BL. 2014. Evaluation and management of pain in children.

Available

from:

http://www.uptodate.com/contents/evaluation-and-management-ofpain-in-children (accessed on 24.07.15)

12

12 International Association for study of pain. 2012. IASP Taxonomy. From: http://www.iasp-pain.org/Taxonomy. (Accessed on 24.7.15) Joubert, G & Ehrlich, R. 2012. Epidemiology: a research manual for South Africa. Cape Town: Oxford University press. Noel M, McMurtry CM, Chamber CT, McGrath PJ. 2009. Childrens memeory for pain procedure: The relationship of pain intensity, axiety, and

adult

behaviour

to

subsequent

recall.

Available

http://jpepsy.oxfordjournals.org/content/35/6/626

from:

(Accessed

on

28.7.15) Srouji R, Ratnapalan S, and Schneewelas S. 2010. Pain in children: Assessment and Nonpharmacological management. Available from: http://www.hindawi.com/journals/ijpedi/2010/474838/.

(Accessed

on

22.7.15) Wong C, Lau E, Palozze L, and Campbell. 2001. Pain management in children: part1- pain assessment tools and a brief review of nonpharmacological and pharmacological treatment options.

NCBI.

Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567578 (Accessed on 24.7.15)