Presentation of methodology research design created during Introduction to Nursing Research at Truman State University

1. Effect of Acupressure on
Relief of Nausea in
Post-Operative Patients
BY TORI JOHNSON, TSU SN

2. Research Hypothesis
Post-operative patients who receive
acupressure and antiemetic medication will
have lower mean Visual Analogue Scale
(VAS) scores than patients who receive
antiemetic medication only.

3. Experimental Pretest-Posttest
Research Design
 Observation
of variables at two points in time:
before and after treatment
 Experimental group receives standard
intervention with acupressure
 Control group receives standard intervention
only
 Comparison of outcomes of both groups to
research hypothesis

4. Internal Threats to Validity
 Selection
 Testing
 Attrition
 Maturation

5. Sample
• Taken from accessible population, using
convenience sampling

6. Inclusion Criteria
Major elective surgery
 Experiences with nausea
 Post-operative antiemetic medication
 Not pregnant
 Not receiving concurrent chemotherapy
 Must be without loss of bilateral upper extremities,
infection, bruising, or bleeding in hands (Ming et
al.2002)
 Must be 18 years or older
 Must be conscious enough to fill out VAS


7. Sampling Design
• Receive permission from medical center and IRB
 Power analysis to estimate proper sample size
 Discuss potential candidates with healthcare provider
 Lead researcher (LR) discusses study with assigned nurse
 Nurse reports back to LR before research team members or
data collectors are introduced to patient
 LR provides consent form and demographic questionnaire

8. Informed Consent
• Purpose of study
• How long the voluntary participant is involved
• Type of data collected and anticipated procedures
• Potential risks
• Statement of confidentiality
• Research benefits
• Withdraw at any point, continue to receive
standard treatment
• LR contact information

9. Independent Variable Operationalized
Standard Intervention
 Administration of ondansetron (Zofran ®) 8mg PO or 4 mg
IV/IM

By trained member of the nursing staff
Treatment Intervention
 Administration of standard intervention
 Acupressure



Pressure applied to P6 acupooint
Twenty minute session within one-hour post-operative
(Doran & Halm 2010)

10. Dependent Variable Operationalized
• Dependent variable
 Visual
•
•
Analogue Scale (VAS)
Self Report
Ratio level of measurement

11. Validity of VAS
Content validity



Panel of judges
Index for multiple items, at setting of .90
(Polit & Beck 2010)
Concurrent validity


Assess similarity to Rhodes Index of Nausea, Vomiting, and
Retching
(Kim et al. 2007)

12. Reliability of VAS
Evaluated by equivalence

High level of agreement, then measurement errors have been
minimized
Through inter-rater reliability procedures
Index of equivalence: Pearson’s R
(Polit & Beck 2010)

13. Data Collection
Each data collector is trained in use of VAS

Specific assignments for each individual
 Pre test data for control group
 Post test data for control group
 Pre test data for experimental group
 Post test data for experimental group

14. Measures to Control Threats to Internal Validity
 Selection

Random assignment by table of random numbers
 Attrition


Incentive
Limited duration of study
 Testing

VAS administered twice within 12-hour period
 Maturation

Limited time involved in study

15. Data Analysis
 Descriptive statistics for demographic data
(Dibble et al. 2000)
 Pretest data analysis
 Two-tailed independent student’s t-test
 Level of significance: <0.05
 Post-test data analysis
 One-tailed dependent student’s t-test
 Level of significance: <0.05


16. Limitations of Design
 Limitations to Generalizability
Major surgery and general anesthesia
 Previous nausea experiences
 Prescribed PRN antiemetic medication
 Pregnant or chemotherapy patients
 Upper extremities
 Age
 Orientation during post-operative period


17. Relevance to Nursing Practice

If research hypothesis is supported
 New evidenced-based, independent nursing intervention
 Opportunities for more personable care
 (Ming et al. 2002)
 Non-invasive procedure and fewer side effects
 (Doran & Halm 2010)

If null hypothesis is accepted



Continues to receive standard intervention without adjunct therapy
Possibility of negative side effects
Less opportunities for personable care

18. Indications for Future Research
Larger sample size
Use of different acupoints
Use of Sea-Bands
Population including participants younger than
eighteen years old

19. References






Dibble, S., Chapman, J., Mack, K., & Shih, A. (2000). Acupressure for nausea: Results of a pilot study. Oncology
Nursing Forum, 27(1), 41-47. doi: 10.1188/07.ONF.813-820
Doran, K., & Halm, M. (2010). Integrating acupressure to alleviate postoperative nausea and vomiting. American
Journal of Critical Care, 19(6), 553-556. doi:10.4037/ajcc2010900
Kim, T., Choi, B., Chin, J., Lee, M., Kim, D., & Noh, G. (2007). The reliability and validity of the Rhodes index of nausea,
vomiting, and retching in postoperative nausea and vomiting. Korean J Anesthesiol, 52 (6), 59-65. Retrieved from:
http://synapse.koreamed.org/Synapse/Data/PDFData/1011KJAE/kjae-52-S59.pdf
Ming, J., Kuo, B., Lin, J., & Lin, L. (2002). The efficacy of acupressure to prevent nausea and vomiting in post-operative
patients. Journal of Advanced Nursing, 39(4), 343-351. doi:10.1046/j.1365-2648.2002.02295.x
Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising evidence for nursing practice (7 ed.). New
York, NY: Lippincott Williams & Wilkins.
Wilson, B., Shannon, M., & Shields, K. (2011). Pearson nurse's drug guide 2011. Upper Saddle River, NJ: Prentice Hall.

20. Effect of Acupressure on
Relief of Nausea in
Post-Operative Patients
QUESTIONS?