OBJECTIVES OF THE STUDY

For consistency, the objectives of study, which are repeated, were to:

• Develop a clinical guideline for comprehensive management of acute pain in adult patients admitted to the CT-ICU post cardiothoracic surgery.

• Pilot test the clinical guideline developed for the comprehensive management of acute pain in the CT-ICU.

The intervention was assessed in terms of a primary outcome of patients’ comfort and secondary outcomes of patients’ satisfaction with pain management, length of stay of patients in the CT-ICU and cost of CT-ICU care.

The research design and method used to achieve the objectives of the study will now be discussed into details.

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2.3 RESEARCH DESIGN

A research design refers to the procedures of enquiry (Creswell, 2014) and is the overall plan for answering research questions. In quantitative studies, the design indicates whether there is an intervention, the nature of any comparisons, the methods used to control confounding variables, whether there will be blinding, and the timing and location of data collection. (Polit & Beck, 2010: 254). The authors earlier described it as “the overall plan for obtaining answers to the research questions being studied and for handling some of the difficulties encountered during the research process” (Polit & Beck, 2008:66). A research design is a “blueprint for the conduct of a study that maximises control over factors that could interfere with the studies desired outcomes” (Burns & Grove, 2011: 49). Simply put, it is how a researcher intends to conduct a study.

The overall plan for this intervention study was to employ both the qualitative and quantitative designs, and use a pre-and post-intervention method to answer the research questions and achieve the objectives of the study.

Qualitative and quantitative paradigms have different and unique epistemological and ontological assumptions, world views and perspectives. While the qualitative approach is interested in studying naturally occurring phenomenon such as pain, the quantitative paradigm focuses on numbers, statistics, is highly structured and controlled and aimed at generalisability. Both paradigms were found appropriate to answer the research questions and meet the objectives of the study.

2.3.1 Intervention Study

Intervention research is a term sometimes used to refer to a distinctive process of planning, developing, implementing, testing, and disseminating interventions (Polit and Beck (2004:240). Intervention studies examine the effect of an independent or intervention on a dependent variable or outcome (Grove, Gray & Burns, 2015: 38). A clinical guideline for the comprehensive management of acute pain was developed based on findings from a systematic literature review and interviews with CT-ICU nurse experts, CT-ICU doctors, patient who were treated in the CT-ICU and their relatives. The intervention study method

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was used to implement the clinical guideline in the CT-ICU in Ghana using a pre-and post- intervention method and outcomes of the guideline implementation assessed.

2.3.2 Pre-and Post-Intervention Method

Pre- and post-intervention method involves administering an experimental treatment (or intervention) to some subjects while withholding it from others. It involves the observation of the dependent variable at two points in time before and after the treatment (Polit & Beck, 2010:226). The pre- and post-intervention tests, which included assessing patients’ level of comfort and satisfaction with pain management in the CT-ICU, their length of stay and cost of CT-ICU care, was done before and after the intervention to improve pain management in the CT-ICU. The pre-and post-intervention method was chosen for this educational intervention as the intention of the researcher was to educate all nurses and doctors who practice in the CTI-CU and determine the effect of the intervention on patients’ pain. A randomised control trial was not chosen as this will mean that some of the healthcare professionals will not be given the education and this was not the aim of the researcher.

2.3.3 Qualitative

Qualitative research is an approach for exploring and understanding the meaning individuals or groups ascribe to a social or human problem (Creswell, 2014:4); a form of social enquiry, focusing on the way people make sense of experiences and the world in which they live (Holloway & Galvin, 2017:3).

The descriptive qualitative research design was used to understand the views and experiences of Intensive Care nurse experts, doctors, patients and their relatives, their opinions about pain assessment and management, and the improvements they think could be made in the ICUs in Ghana. This informed the clinical guideline and put it into the Ghanaian context.

Descriptive qualitative research is an approach used to gain more information about characteristics within a particular field, and to provide a picture of a situation as it naturally occurs. It explores new areas of research and describes situations, as they exist in the world

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(Burns & Grove 2011:21). The descriptive qualitative approach leads to a summary in everyday, factual language that facilitates understanding of a selected phenomenon (Colorafi & Evans, 2016). The qualitative part of the study was descriptive, as it provided an in-depth description of the study participants’ experiences of pain and its management in the CT-ICU. In descriptive qualitative studies, researchers tend not to penetrate their data in any interpretive depth. These studies present comprehensive summaries of a phenomenon or of events in everyday language. Descriptive qualitative designs tend to be eclectic, with their basis on the general premises of naturalistic enquiry (Polit & Beck, 2010:273).

The study had three phases and the qualitative approach was used for the first part of the first phase of the study, thus the exploratory phase. Qualitative interviews were conducted with CT-ICU nurse experts, CT-ICU doctors, patients who were treated in the CT-ICU and their relatives. The way the qualitative method was employed in the study is discussed in detail under the phases of the study. Knowledge that is generated from qualitative research will provide meaning and understanding of specific emotions, values and life experiences (Burns & Grove, 2011:21).

2.3.4 Quantitative

Quantitative research is an approach for testing objective theories by examining the relationship among variables (Creswell, 2014:4). According to Grove, Gray and Burns (2015:32), quantitative design is a formal, objective, systematic process for generating numerical information about the world. It is conducted to describe new situations, events or concepts, to examine relationships among variables and determine the effectiveness of treatments or interventions on selected health outcomes throughout the world.

The quantitative research method was used to determine if studies met the cut off score to be included in the systematic review. It was also used to validate the clinical guideline before it was pilot tested and to assess the effectiveness of the intervention. This was done by asking patients who were treated in the CT-ICU to assess their level of comfort and satisfaction and assess the length and cost of CT-ICU stay before and after the intervention and to examine the relationship between the intervention and the outcomes. The quantitative research approach was thus used for the second and third phases of the study, thus the

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development and pilot testing phases. The way the quantitative method was used in the study is also discussed under the phases of the study.