The purpose of the study was to establish whether intra-urethral lubricating gel containing 2% lidocaine results in lower average pain scores when compared with the plain lubricating gel in men undergoing flexible cystoscopy. The problem that prompted the authors to come up with the study was the existing conflicting evidence from previously done randomized trials as well as the lack of definitive practice guidelines regarding the use of intra-urethral anesthesia in men undergoing flexible cystoscopy. The problem was stated concisely and the authors provided a background to the problem, and the works that were done previously were also given.
Statement of the Problem
The problem is narrow and specific enough. It narrowed down from the extensive cystoscopic examination, to specifically the use of the intra-urethral lubricating gel. The scope is also narrow enough in the sense that there is enough information to examine the subject matter in detail. Correspondingly, it creates an interesting and informative project that meets the requirements of the research. The topic can be discussed in depth.
The research is significant in nursing practice because cystoscopy examination is one of the most common practices in Urology. However, it is associated with mild discomfort; the short female urethra, the efficacy of intra-urethral anesthesia by various means of topical application is limited and difficult to standardize. In contrast, men may experience more dis- comfort during cystoscopy due to the longer urethra.
Research Question and Hypothesis
The research question in the study is Does the intra-urethral lubricating gel containing 2% lidocaine results in lower average pain scores com- pared with the plain lubricating gel in men undergoing flexible cystoscopy. The research question provides a narrow scope of exactly what the research is going to look into.
A hypothesis is a proposed explanation that is usually as a starting point for further investigation (Creswell, 2008). Usually, it is written because there is limited evidence. There are two types of hypothesis the null hypothesis and the alternate hypothesis. It is also a guess or anticipation of the results. There were no hypotheses that were listed in the study.
In all scientific experiments, there must be a dependent as well as an independent variable. A dependent variable describes the measurements that are affected during the experiment or scientific study. They are termed dependent variables because they rely on the independent variables (Grove et al. 2015). The dependent variable responds to the independent variable. On the other hand, an independent variable is a variable that stands alone, and it is not affected by the other variables in an experiment. The dependent variable in the study is the pain that the men would feel during the cystoscopy. There are two independent variables in the study. The first one is the intra-urethral lubricating gel containing 2% lidocaine. The second one is the plain lubricating gel.
Review of Literature
A literature review is an important aspect of any research work. It is an evaluative report of other studies found in the literature related to the subject matter (Grove et al. 2015). The literature review is able to offer a description, summary, and clarification of what other scholars have written regarding the subject of study. Furthermore, it provides a theoretical basis for the research and helps in the determination of the nature of research. It also establishes the theoretical framework of the research study as well as provides a definition of the key terms and terminology in the study. In this study, the literature is well organized and previous works have been described well.
The literature review should be current and up to date. The study has a few works that were current as at 2013. An example is the citations that were written in the year 2012 and 2009. However, a large section of the works cited was done even up to ten years before the period of study. Examples include articles from the year 2001 and even 1994. There was a gap in the literature. The authors started doing the work given the conflicting evidence from randomized trials and lack of definitive practice guidelines regarding the use of intra-urethral anesthesia in men undergoing flexible cystoscopy. There was no framework established in the study.
Research Critique Part II
It was a quantitative research. Quantitative methods are used to establish an existing relationship between variables and uses mathematics to do a statistical analysis (Creswell, 2008). This is the type of investigation approach most commonly used in scientific research problems. According to the widely accepted hierarchy of evidence, research evidence from systematic reviews, as well as that from randomized control trials, is usually one of the most reliable one followed by that from cohort studies and control case studies.
It was an experimental as well as a correlational research design. A correlational research design is described as a study explored the relationship between two variables through a correlational analysis. In these study, the variables were the two lubricants and the pain in men undergoing cystoscopy.
Sample and Setting
The target population for the research study was Men undergoing flexible cystoscopy. There are clear descriptions of where there will be obtained from as well as the inclusion and exclusion criterion. All adult males that were above eighteen years and had been scheduled for outpatient flexible cystoscopy were eligible for participation. However, patients using sedatives or regular analgesics and those with the history of hypersensitivity to anesthetic agents, spinal cord injury, or urethral disease were excluded from the study.
Random sampling was used in the study to obtain the respondents. Www.randomization.com generated a randomly assigned list for using either lidocaine gel or lubricant gel. With random sampling, each subject had an equal probability of assignment to either group. The setting is appropriate for the study because the clinic is a major place where respondents can be obtained and also the facilities would be available.
An Institutional Review Board (IRB) is a committee that is typically established for the purpose of reviewing and approving all research work involving human subjects (Grove et al. 2015). The risks to human research subjects are minimized by using procedures that are consistent with sound research design and that do not unnecessarily expose the research participants to risk, and whenever appropriate, by using procedures already being performed on subjects for diagnosis or treatment purposes. The Research Subjects Review Board at the University of Rochester approved this study.
There was an informed consent in the study. However, the major parts have not been discussed. In fact, the informed consent has not been discussed.
Data Collection& Analysis
Interviews were uses to collect the information. All subjects, as well as urologists performing cystoscopy and nurses documenting the pain scores, were blinded to treatment assignment. The tools that were used are clearly described; an example is that they used the 15.5 French Olympus flexible digital cystoscopy to perform the cystoscopy.
Validity is the degree to which results obtained from analysis of the data represents the phenomenon under study (Creswell, 2008). It means the agreement between the value of measurements and its true value. Validity is quantified by comparing measurements with values that are close to the true values as possible. Reliability is the measure of the degree to which a research yields consistent results or data after repeated trials. It is the level of consistency that the research instruments or procedures demonstrate and it is qualified by taking several measurements on the same subjects.
Results, Discussion, Conclusions
The limitations of the study have been given and discussed under the subtopic study limitations. Examples were that the study was limited by race gender, age (most were over 65), and cystoscopic experience of the patients. No recommendation was made for future studies. However, they acknowledged that at the time of the study, definitive recommendations regarding optimal gel volume and timing of installation could not be made. This study was initiated after a discussion among members of our clinic staff regarding the need for the lidocaine gel before cystoscopy. The hospital was faced with a major issue of the cost, considering lidocaine is a medication.
Creswell, J. W., 2008. Research design: Qualitative, quantitative, and mixed methods approaches. 3rd edn. Thousand Oaks, CA: Sage Publications
Grove, S.K., Gray, J, R., and Burns, N. (2015). Understanding nursing research, building
Evidence based practice (6th ed). St. Louise, MO Elsevier Saunders.
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