Purpose: Comment the Discussion (Class 504 Unit 7 Comment 1) Jennifer

Thing to Remember:

Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

1 References, find resources that are 5 years or less

No errors with APA format 6 Edition

To Comment:

According to our text Melnyk and Overholt-Fineout (2015) “evidence based practice is the integration of patient preferences and values, clinical expertise, and rigorous research” that answers a clinical question to improve outcomes (p. 171). Patient preferences and values is patient centered care or aiming to meet the patient’s needs and answer the patient’s questions (Melnyk & Overholt-Fineout, 2015). Clinical expertise is to improve patient care though utilization of clinical interventions and outcomes using external and internal evidence (Melnyk & Overholt-Fineout, 2015). Rigorous research is done through critical appraisal of literature searches containing information of the subject matter (Melnyk & Overholt-Fineout, 2015). Melnyk and Overholt-Fineout (2015) point out that evidence research in nursing is not only aimed at quantitative randomized controlled trials but also studies with a range of methodologies.

My clinical question is: In In carpal tunnel patients, is open carpal tunnel release compared to endoscopic carpal tunnel release more effective surgical intervention over six months? I began my rigorous research using Kaplan’s online library utilizing Medline, CINAHL, and Cochrane databases narrowing my results to evidence based peer reviewed results from the last 10 years. Keywords utilized to locate related articles were carpal tunnel release, surgical intervention, treatment of, decompression of, and outcomes. I critically appraised the results narrowing down to level one and level two evidence systemic reviews and randomized controlled to trials (Hain & Kearn, 2015). Clinical expertise was derived from internal evidence obtained through my knowledge that all endoscopic carpal tunnel releases performed in the past 12 months have required open revision to ongoing subjective complaints as well as positive electrodiagnostic studies 3 months post-operative. Although most of the high level evidence identified were directed towards quantitative results one of my chosen articles, a randomized controlled trial performed by Kang, Koh, Lee, and Choi (2013) did look at patient satisfaction as one of its criteria in determining which surgical intervention was superior. Kang, Koh, Lee, and Choi (2013) did find that patients preferred endoscopic release over open release due to scar and pillar pain.

References:

Hain, D. J., & Kear, T. M. (2015). Using Evidence-Based Practice to Move Beyond Doing

Things the Way We Have Always Done Them. Nephrology Nursing Journal,

42(1), 11-21.

Kang, H. J., Koh, I. H., Lee, T. J., & Choi, Y. R. (2013). Endoscopic carpal tunnel release is

preferred over mini-open despite similar outcome: a randomized trial. Clinical Orthopaedics And Related Research, 471(5), 1548-1554. doi:10.1007/s11999-012-2666-z

Melnyk, B.M., Fineout-Overholt, E. (2015). Evidence based practice in nursing &

healthcare. Philadelphia, PA: Wolters Kluwer Health/LippencottWilliams & Wilkins.