Nursing Research
1. Citation:
Best, J., Day, L., Ingram, L., Msugrave, B., Rushing, H., & Schooley, B. (2014).
Comparison of robotic vs. standard surgical procedure on postoperative nursing
care of women undergoing total abdominal hysterectomy. MEDSURG Nursing,
23(6), 414-421.
2. Purpose Statement: This study was conducted to determine if in the postoperative
course there is a difference for women undergoing robotic-assisted total abdominal
hysterectomy when compared to women undergoing traditional (open) total abdominal
hysterectomy.
3. Population of interest: Women undergoing total abdominal hysterectomy
4. Study Variables: Study variables are classified as independent or dependent; the type of
data is also present. Extraneous factors as also listed below.
a. Independent
i. Type of surgery (robotic vs non-robotic/traditional)
● Nominal
b. Dependent
i. Length of surgery
● Interval/Ratio
ii. Total intraoperative intravenous fluid volume
● Interval/Ratio
iii. Estimated blood loss
● Interval/Ratio
iv. Physiological parameters (blood pressure, pulse, oxygen saturation)
● Interval/Ratio
v. Pain intensity
● Interval/Ratio
vi. First ambulation
● Ordinal
vii. Length of stay
● Interval/Ratio
viii. Presence of complications
● Nominal
c. Extraneous Factors
i. Age
● Interval/Ratio
ii. Weight
● Interval/Ratio
5. Inclusion/Exclusion Criteria
a. Inclusion
i. Female gender
ii. Total abdominal hysterectomy procedures
iii. Performed between November 1, 2009 to November 30, 2010
iv. Patients from Novant Health Matthews Medical Center
b. Exclusion
i. No exclusion criteria stated in this study
c. Sample Element: One woman who had a total abdominal hysterectomy at
Novant Health Matthews Medical Center between November 1, 2009 and
November 30, 2010.
6. Operational Population
a. All Women who underwent total abdominal hysterectomy by either robotic
assistance or traditional open procedures from November 1, 2009 to November
30, 2010 at Novant Health Matthews Medical Center.
b. Validity: Six registered nurses were trained in the data collection procedure at
Novant Health Matthews Medical Center. Inter-rater reliability was established by
having several of the trained data collection nurses code each chart.
c. Impact:
The not so good: This study is not generalizable to patients outside of Novant
Health Matthews Medical Center as there could be regional influences that affect
things such as the physician experience or patient length of stay. The timeframe
for the procedure to have taken place can be a drawback as well as a benefit. It
prevents us from being able to see advancements through experience with the
procedures that physicians may have had.
The okay: The time frame for the date of the procedure and specific type of
surgery narrow down the population to yield results more applicable to
gynecologic surgery. Additionally, the timeframe of the procedure also makes the
data more stable, as it gives readers a snapshot of how the lack of education and
experience among hospital staff with gynecologic robotic procedures affected
patient care.
7. Sampling Method
a. Random sampling; Convenience sample of medical records.
i. A limitation to this type of sampling occurred because of the length of
time between the beginning of the project and the completion of chart
reviews. This was partly due to the need to wait for approval from the
hospital’s overseeing institutional review board for chart reviews.
However, a strength to this sampling method was it allowed for a larger
sample size, which produced more accurate results that may be
generalized to this hospital.
8. Study Design
a. Retrospective; Exploratory review of existing medical records.
9. Method
a. The methodology was adequately covered with the exception of inclusion and
exclusion criteria for the data being collected, which was minimal. Data was
obtained from 105 medical records and were recorded on a form created
specifically for this study. Data analysis was done using the statistical SPSS 18
software. Descriptive data was used to analyze demographic data. To determine
significant differences in the length of surgery time, estimated blood loss, total
intraoperative IV fluid volume, and physiological parameters, independent t-tests
were performed on the data. Inter-rater reliability was maintained by have several
of the trained data collection nurses code the same chart.
10. Results
a. Most of the items evaluated were found to have statistical significance between
the two groups. Those items include length of time spent in the PACU (p=0.04),
length of hospital stay (p<0.001), estimated blood loss (p=0.000), and total
intraoperative IV fluids (p=0.000). There was also strong correlation found
between the type of surgery (robotic or traditional) and the total intraoperative IV
fluid administration and estimated blood loss. Numerous areas showed no
statistical significance between the two groups, including age, weight, blood
pressure within the first 24 hours, pulse rate within the first 24 hours, and
complication types or rates. Pain intensity rates were higher among patients who
had the traditional (non-robotic) total abdominal hysterectomies upon admission
to the surgical unit; however, there was no significant difference in intensity of
pain 24 hours after surgery. The researchers concluded that this could be due to
the fact that most robotic assisted surgery patients were discharged before the first
24 hours. Research data was clearly reported through neat tables, but was
minimally analyzed within the text. Extraneous variables were not directly
addressed, nor was there discussion on how they were controlled for. The set p
value was not stated in this study.
11. Discussion
a. The discussion section of this research focused on the literature review portion.
To a lesser degree, they discussed the findings of this study and what they mean.
The researchers had appropriate suggestions for future research studies regarding
analgesic type used postoperatively in robotic assisted surgeries. Restatement of
the study purpose was clear and helpful in reorienting the discussion section to the
purpose of the research. There was also discussion about the need for
perioperative education development as the staff education program implemented
as a result of this study was both successful and beneficial. Discussion of the
limitations of this research were adequate and included lack of consistent
documentation which led to a lack of analysis of certain variables. Another
limitation discussed in this research was the length of time between the project’s
initiation and the completion of chart review, which could have skewed the
accuracy of the findings because of increased time for surgeons to gain experience
in the robotic surgery style. Both positive and negative findings were addressed in
the discussion section during the discussion of limitations. Power was not
discussed in this study. Overall the discussion section was well organized and
appropriately oriented to the research topic.
12. Summary
a. Author’s conclusion: The authors concluded that this comparison research study
adds to the evidence of potential complications and benefits of robotic assisted
gynecologic surgery, aiding to bridge the gap of the knowledge deficit among
perioperative nurses. However, the researchers recommend further studies be
performed regarding the care and outcomes of patient undergoing other robotic
surgery.
b. My opinion on conclusion: Overall this research was well organized. The major
fall back was the lack of discussion of this research study and the focus being
mostly on the review of the literature. Since this was a retrospective study, I
would recommend that more prospective studies be performed regarding the
effects of length of surgery and surgical position on postoperative plan of care. I
would also recommend further retrospective studies which have a more
generalizable operational population be conducted. I would not recommend
changing nursing practice and patient care until further studies are done.
However, I do feel that this study was a helpful stepping stone for further research
as well as eliciting further questions on this area in interest. I agree with the
researchers when they said that this research “adds to the evidence regarding
potential benefits and complications of robotic-assisted gynecologic surgery”
(Best, Day, Ingram, Msugrave, Rushing, & Schooley, 2014).
c. Research summary:
“Comparison of robotic vs. standard surgical procedure on postoperative nursing
care of women undergoing total abdominal hysterectomy” is an exploratory study
which utilized retrospective chart review of women who underwent total abdominal
hysterectomy procedures at Novant Health Matthews Medical Center. This research
added to the current evidence of complications and benefits of robotic assisted
gynecologic surgery. A need was assessed for this research based on the observation
of an increase in robotic assisted surgical procedures with little nursing literature
available regarding care needs of these patients. The researchers compared the
documented postoperative care for women who underwent both robotic assisted total
abdominal hysterectomy and traditional total abdominal hysterectomy between
November 1, 2009 and November 30, 2010. Six trained nurses evaluated charted
material regarding length of surgery time, estimated blood loss, total intraoperative
IV fluid volume, and physiological parameters.
Extraneous factors were age and weight, which were evaluated briefly but found
to have no significant difference between the robotic and non-robotic group. There
was favorable statistical difference between the groups in regard to length of time
spent in the PACU (p=0.04), length of hospital stay (p<0.001), estimated blood loss
(p=0.000), and total intraoperative IV fluids (p=0.000), and reported pain intensity
rates within the first 24 hours. Conclusion: this comparison research study adds to the
evidence of potential complications and benefits of robotic assisted gynecologic
surgery, aiding to bridge the gap of the knowledge deficit among perioperative
nurses. Further studies are recommended regarding the care and outcomes of patient
undergoing other types of robotic surgery.
Write the reference citation for the article using APA style – Formatting of reference MUST be
appropriate for APA Style /5 pts
Identify the Purpose Statement /5 pts
Identify the Population of Interest /5 pts
Identify the Study Variables /5 pts
Classify study variables as Correlational, Independent, Dependent, or Extraneous; Classify
level of measurement of study variables /15 pts
Identify the Inclusion and Exclusion Criteria and the resulting sample element (subject) /10 pts
Identify the operationalized population of interest and critique validity. /10 pts
Describe the sampling method used and classify it. (ex. convenience, random or nonrandom, etc)
Discuss the appropriateness and limitations of the sampling method
/10 pts
Identify the study design and time perspective /10 pts
Analyze the usefulness/completeness/clarity of the methods section. (Do you understand what
was done in the study? Are there problems with it?)
/10 pts
Summarize and analyze the results including basic statistics. (How were the study findings
reported? Were summary statistics reported appropriately and extraneous variables addressed
and “controlled”? How clear was the reporting?)
/20 pts
Analyze the discussion. Was it in keeping with the reporting of the finding? Were positive and
negative findings discussed? Was power discussed? Was it appropriate?
/10 pts
Summarize the author’s conclusion. What they think, not what you think. /10 pts
Give your informed and reasoned opinion about the conclusion of the research. Would you
recommend any changes in patient care or nursing practice as a result of this study?
/10 pts
Summarize the Research /15 pts
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