NR 505 Week 3 Discussion – Quantitative Research – Collaboration Cafe
Since working in a pediatric emergency room, we see on a daily basis “difficulty breathing” and “wheezing,” per the parents. During the fall and winter months, we see children with asthma have an acute exacerbation; however, this spring has been pretty rough. I remembered five years ago, we were giving a dose of oral Prednisolone at the time of treatment and then sending the patients home with a prescription for another three to five days. In hopes, they would finish the prescribed course of treatment. Over the last one to two years, the physicians have been ordering a one-time dose of Dexamethasone in the department and then sending the patient home with a dose to take in 24 or 48 hours from the initial dose. The pharmacy provides the Dexamethasone upon discharge, making it easier for the family. Thus increasing the likeliness that the patient will receive their second dose at the appropriate time. In hopes the patient can then follow up with their primary care provider and already have all the steroids on board. Keeping the patient out of the emergency room and from admission. Below is my PICO (T) question that I have formulated for the pediatric population with asthma exacerbation.
In pediatric patients with asthma exacerbation presenting to the emergency department, how effective is a multi-dose of Prednisolone or a single dose of Dexamethasone administration in decreasing the symptoms and relapse rates back to the emergency department, rather than a follow-up with a primary care provider in 48-72 hours?
P- Pediatric patients with asthma exacerbation I-Multi dose prednisolone
C- Single dose dexamethasone
O- Decreases symptoms and relapse rates to emergency departments T- 48-72 hour follow-up with primary care provider
The qualitative research design that I chose was Ethnography. Melnyk & Fineout-Overholt state, “Ethnography involves the study of a social group’s culture through the time spent combining participant observation, in-depth interviews, and the collection of artifacts in the informants’ natural setting” (2011, p.143). Ultimately, you want to be able to allow yourself to be immersed in the participants’ culture, challenges, and motivations. This allows you to see how they are able to live their lives or see what challenges arise. I have found that parents are more likely to give their child the second dose of Dexamethasone 24-48 hours from the initial dose if it is given to them prior to discharge (since they do not need to have the prescription filled at the pharmacy). Unfortunately, I had parents tell me that they did not give all of the Prednisolone doses prescribed because they were unable to fill the medication or they skipped numerous doses.
The article I found relevant to my PICO(T) question regarding pediatric asthma exacerbation and corticosteroids was written by Andrews & Simpson. This article discusses the need for systemic steroids when it comes to the treatment of children with acute asthma exacerbation in the emergency room setting. Studies have shown that using a shorter course of Dexamethasone is comparable to using a longer course of Prednisolone. Studies also have shown that Dexamethasone tastes better to children, there are cost savings due to compliance, and there have been improved clinical outcomes. Andrews & Simpson (2014) state, “Dexamethasone is an attractive alternative to prednisone and prednisolone because of its longer duration of metabolic effect and subsequent shorter treatment duration.” The article is an evidence-based systematic review and meta-analysis. The limitations are described within the article. Therefore, this article is trustworthy.
NR 505 Week 3 Discussion – Quantitative Research – Collaboration Cafe
Chamberlain College of Nursing (CCN) refers to reliability as “the extent to which research instruments or questionnaires gather consistent information related to a variable” (2017). Having a reliable instrument makes it accurate. CCN states, “Validity is the degree to which the results of a study are accurate” (2017). In order for validity, all aspects of a concept need to be covered. A thorough review of the literature and questionnaires needs to be conducted for accuracy. In order to determine if a qualitative study is trustworthy, researchers must determine if all the information they are receiving from interviews or other forms of experiences is credible, dependable, confirmable, transferable, and authentic (CCN, 2017).
Much research has been done regarding the treatment of Dexamethasone versus Prednisolone when it comes to pediatric acute asthma exacerbation and the recurrence of emergency room visits. I have seen first-hand how effective taking Dexamethasone versus Prednisolone has had better outcomes for our patients and fewer readmissions to the hospital, thus allowing the pediatrician to follow up with care.
References:
Andrews, A. L., & Simpson, A. N. (2014). Dexamethasone may be a viable alternative to prednisone/Prednisolone for the treatment of acute asthma exacerbation in the pediatric emergency department. Evidence-Based Medicine, 19(5), 175. doi:10.1136/eb-2014-110006
Chamberlain College of Nursing. (2017). NR 505- Week 3. Critiquing and Reviewing the Literature. [Online lesson]. Downers Grove, IL: DeVry Education Group
Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams, & Wilkins.
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Question 
NR 505 Week 3 Discussion – Quantitative Research – Collaboration Cafe
Write a qualitative research question using the PICO(T) model using the P (population), I (abstract concept), O (outcome), and T (time) from the PICO(T) model about an issue from your practice setting. Conduct a search of the literature for a qualitative research article that would answer your qualitative research question. What qualitative research design (Phenomenology, Grounded Theory, Ethnography) did you select and why? Provide a summary of the study. How will you make sure that the information you obtain is trustworthy? How is trustworthiness in qualitative research similar and different from reliability and validity?