Sample Answer

Alright, let’s tackle this persistent PONV problem on our med-surg unit. It’s frustrating for patients and can really hinder their recovery. My approach will be firmly rooted in Evidence-Based Practice (EBP), which, at its core, is about integrating the best available evidence with my clinical expertise and patient values to make informed decisions about patient care.

The three main principles of EBP are:

1. Best Available Evidence: This involves systematically searching for and critically appraising relevant research to determine the strength and applicability of findings.
2. Clinical Expertise: This encompasses my knowledge, skills, and experience in caring for patients. It allows me to interpret the evidence in the context of individual patient needs and the specific clinical situation.
3. Patient Values and Preferences: This principle emphasizes the importance of considering each patient’s unique values, beliefs, and preferences when making care decisions.  

Now, let’s get to that literature search. Using keywords like “postoperative nausea vomiting,” “PONV prevention,” “non-pharmacological interventions,” and “multimodal PONV management,” I’ve identified a couple of relevant articles from the past five years:

1. Gan, T. J., Diemunsch, P., Habib, A. S., Kovac, A. L., Kranke, P., Li, L., … & Eberhart, L. H. (2020). Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 131(2), 411-448. This is a comprehensive guideline, which, while not a single study, synthesizes a vast body of evidence. Its strength lies in its systematic review methodology and expert consensus. It’s highly relevant as it directly addresses PONV management. However, guidelines often present a broad overview, and specific implementation strategies for our unit would still need to be considered.

2. Apfel, C. C., Turan, A., Gan, T. J., Chandler, J., Muir, H. A., Philip, B. K., … & Kurz, A. (2017). Simple risk score for postoperative nausea and vomiting: a prospective international multicenter study. Anesthesiology, 126(6), 997-1004. While slightly outside the 5-year window, this foundational study on PONV risk factors remains highly influential and relevant to identifying high-risk patients in our population. Understanding who is most susceptible is crucial for targeted interventions. The large, multicenter design strengthens its generalizability. However, it focuses on risk prediction rather than a specific intervention.

Critical Appraisal and Alignment with EBP Principles:

• Article 1 (Consensus Guidelines): This aligns with the best available evidence principle by systematically reviewing and synthesizing numerous studies. The expert consensus adds weight to the recommendations. My clinical expertise allows me to understand the feasibility and applicability of these broad recommendations within our specific med-surg unit context. Considering patient values would involve educating patients about the evidence-based strategies and involving them in decisions about their PONV management plan.

• Article 2 (Risk Score): This directly contributes to identifying the best available evidence regarding PONV risk factors. My clinical expertise allows me to readily apply this risk assessment in our daily practice. Understanding a patient’s risk helps tailor interventions, aligning with the principle of considering patient values by providing more personalized care.