text: Nurses need an extensive amount of knowledge to address health problems. Their roles demand a wide variety of theoretical and practical knowledge to provide efficient healthcare. Evidence based practice offers nurses with a new perspective of identifying realistic problems and concerns, and then using that to guide their inquiries into current research. This aids them to link the results of research with practical nursing practice.
  Summary
  This essay addresses the procedures for selection of a nursing research topic to help in evidence based practice. The paper provides the stages of selection of a research topic using the PICO question criteria. It provides a rationale for the selection of the questions and how it will contribute to the family nursing profession. I have also detailed the possible key search words that are useful for literature search to answer the research question. The essay details the reasons for the selection of words. The essay also contains a literature review of 5 relevant studies to the PICO question I have selected. It gives a critique of the studies and extracts relevant findings that can inform my research. I have drawn a preliminary conclusion from the findings of the literature I have reviewed. This essay also discusses the process of how the practice identified from my study can be integrated to nursing practice, how other colleagues can learn about it and implements it and how I can convince the critiques to accept.
  My area of interest is family nursing. I endeavor to promote general and preventive family healthcare to ensure a healthy life in the community. I take considerable concentration on issues of enacting preventive measures as the solution to medical problems rather than use of medicine. I am also interested in maternal health and how it can be improved to reduce child mortality.
  The problem I have identified is finding out the role of water in aiding child delivery. Most parents lose their babies during delivery because of poor maternal healthcare. This relates to the fact that a large part of the low-class expectant mothers lack access to high quality maternal healthcare because of high costs. In addition, most midwives are less informed on alternative pain reduction and delivery enhancing methods during child delivery. This leads to wrong decisions that may cause death of expectant mothers or/and the infant. Many expectant mothers now prefer c- section surgery as the efficient method for child delivery.
  Maternal health is a significant issue in the contemporary age where reduction of the rate of child mortality is a top development agenda. This research problem will add value to improvement of maternal healthcare through using cost-effective methods during child delivery. The five research questions that I will use in this study include: what are the challenges of maternal health? What are the methods used to aid child delivery? What is the relationship between water and child delivery? How will water aid in child delivery? How will use of water in child delivery improve maternal healthcare?
  I have analyzed these questions for feasibility to ensure that the research can be able to address them effectively. Not all questions are pliable to research inquiry. For instance, a research cannot be developed from moral questions because there cannot be a yes or no response to them. In making decisions for the choice of these questions, I have ensured that they are not ethical in nature. Since this research will be time-bound, I have ensured that the questions are answerable within the stipulated period of the research. Their scope is within the aspects I can address during the time frame allowed for the research. I have also considered who will be my respondents. I have ensured that the questions target a given population, in this case expectant mothers and that I will be able to access them during my research. I have considered the sensitivity of the questions and the likelihood that the respondents will cooperate and give responses during the study. I have put into consideration the nature, of facilities and equipment I will need in this research, in the formulation of the questions. In addition, I have also considered the costs it will take to undertake the research. Also, for the questions to be more feasible, I have ensured that they are specific in addressing the research problem I want to address, and they can be measured by given parameters. I have checked that they are realistic questions, which the respondents can relate to the everyday challenges in the provision of maternal health.
  My preliminary PICO question arises from the case of Miss Sarah Johnson, an expectant mother who was in the maternity wing of the Chicago County Hospital, Chicago. Though her pregnancy did not have significant complications, Miss Caroline was complacent on using injections to aid her deliver the baby. Her concern about the idea of using a C-section as the method of delivery. However, because they believed in what she termed as a “friendly and natural” way of delivery, she was upbeat to the idea of water immersion as an aid during child labor. The midwives granted Sarah's wish of using water during labor (Santos et al, 2007). However, they had shallow information about the role of water in child labor and the likely implications. Therefore, I decided to research on the question on what is the role of water in child labor. I used a PICO to help focus my clinical research question. I identified the key problem of Miss Sarah, the treatment I was considering, the alternative treatment available and the outcome I wanted to avoid.
  P- Patient / Problem Miss Sarah Johnson: Expectant mother who declines use of injections and C-section as method of delivery.
  I- Intervention Use of water immersion in child labor.
  C- Comparison Epidural analgesia, conventional vaginal delivery and C-section.
  O- Outcome Primary: Use of cost-effective, easy, accessible and natural method in child labor.
  In the case of Miss Caroline, the clinical question I developed was, “In expectant mothers, does water immersion during child labor, compared to epidural analgesia, conventional vaginal delivery and C-section, aid efficient child delivery?”
  Each of the PICO elements is relevant in the question. The Patient represents a group or an individual with a given health problem. In this case, it is a group of expectant mothers. The Intervention represents the remedy measure to be adopted. It can be preventive, therapeutic, diagnostic, prognostic, administrative or related to economic issues. Control or Comparison implies the standard intervention, or the most common used control. For the outcome, it is the expected result. For the case of my question, the outcome expected is the reduction of child mortality rate (Santos et al, 2007).
  I have selected at least 10 possible key search words that I will use to conduct a literature search for my PICO question. Searching for relevant literature is a fundamental aspect in building information for a research question. I have taken the time to choose key search words, that can aid in finding relevant information, and resources to develop a strong comprehension on my PICO question. The possible key words I have selected include water, labor, immersion, child, role, relationship, maternal, health, effects, and research. The rationale of selecting these possible search key words is because they closely relate to the subject and topic of my study. Therefore, they will be able to provide the most relevant articles during the literature search to enable me build a valid literature to base premises.
  Course Project: Part 2—Literature Review
  Literature Review
  I have selected different studies that relate to my PICO question to help review literature about the subject. First, I have selected Cluett’s study “Immersion in Water During Labor, and Birth.” The study reveals about the rationale of using water immersion as an aid in reducing labor pains during labor. The study also highlights on the disadvantages of water immersion in child labor (Cluett ER, 2009).
  Second, I have selected Mollamahmuto%u011Flu’s study “The Outcome of Immersion in Water During Labor, in Comparison with Conventional Vaginal Delivery and Epidural Analgesia”. The article presents the case for water immersion during pregnancy. It attributes water immersion to maternal relaxation, reduced analgesia requirements, and promotion of a midwifery model of supportive care. It points to the demerits of water immersion in labor as a cause of harm to women and/or babies due to neonatal inhalation of water during labour and maternal/neonatal infections. The article also relates water immersion with epidural analgesia and conventional vaginal delivery and assesses evidences from different case studies in the world. This article will add considerable value in my PICO research question that seeks to draw family nurse practitioners on current affairs of child delivery. It contains a good flow of methodology in finding information. The article proves that the information is of credible use and can be of value in research that seeks to substantiate the source of information and methodology of its development (Mollamahmuto%u011Flu, 2012).
  Thirdly, I have selected Rooks’ study, “Management of Pain in Labor other than Neuraxes: What is the Way Forward?” The study reveals relevant information on using water immersion during labor with a bias on clinical perspective and comparison to neuraxes use. It can be of value for a clinical practitioner who would want the most relevant information and a comparison between managing labor pain with neuraxes or water immersion (Rooks, 2012). Fourth, I have selected the Yinka’s study, “Placental Abruption: Management". The research points to the merits of water use as a remedy to management of labor pains. It also reveals the disadvantages of water use in labor as a cause of harm to women and/or babies due to neonatal inhalation of water, and maternal/neonatal infection. It could be of value to my research question on answering how to manage placental disruption in expectant mothers (Yinka, 2013).
  Finally, I have selected Richard’s study, “Delayed-interval Delivery in Multi Fetal Pregnancy”. The study illustrates the complications of multi fetal pregnancies and the role of water immersion in increasing the chances of fetus survival. The study is valuable in illustrating the importance of water immersion in different emergency cases of pregnancy. This could add value in answering the PICO question in my research (Richard, 2013).
  I have found out that though the previous research on this subject has highlighted on the roles of water during child labor, there are gaps for further questions in the perspectives of how to handle the side effects that may come up during water immersion when in labor. For instance, inhalation of water by the fetus may lead to breathing complication. These studies do not address such element. In addition, the previous literature fails to draw a comprehensive conclusion on the best alternative between use of water and other methods of aiding child delivery such as epidural analgesia, conventional vaginal delivery and C-section.
  The inconsistencies and contradictions evident in the reviewed literature are mainly to do with unclear conclusions. This is because, the studies tend to present the advantages and disadvantages at the same scale. Therefore, it is difficult to make a credible conclusion on whether a case for or against water use in child labor.
  A possible explanation for the inconsistent explanations may be that the methodologies of the studies are so broad and generalized rather than being specific to addressing the main research question. The research design of the studies fails to address the objectives and purposes of the study effectively, so the research question lacks credibility leaving room for contradictory explanations. This has led to contradiction in some of the research findings, in the studies.
  I have made a preliminary conclusion that the studies provide strong evidence to suggest the need for a change in practice on the use of water in child labor. The studies reveal that water immersion can contribute to maternal relaxation, reduced analgesia requirements, and promotion of a midwifery model of supportive care. However, it is clear that there are challenges that the studies reveal in use of water, in child labor. Therefore, adequate research should be focused on addressing how to minimize the negative effects of water use in child labor such as neonatal inhalation.
  Course Project Part 3 – Translating Evidence into Practice
  My PICO question was about, “In expectant mothers, does water immersion during child labor, compared to epidural analgesia, conventional vaginal delivery and C-section, aid efficient child delivery?” This question has fundamental significance to family nurse practitioners because they indulge in roles revolving around the provision of general and preventive healthcare for patients. The topic relates to midwifery roles that are there to ensure efficient healthcare for pregnant mothers. Therefore, it can provide information on how to promote healthcare for expectant mothers.
  There are nursing practices that have the support of evidence from studies in my literature review. The research studies I have reviewed indicate that water can increase the chances of fetus survival in complicated multi fetal pregnancies. It is also evident that water is integral in labor pain management. It can contribute to maternal relaxation, reduced analgesia requirements, and promotion of a midwifery model of supportive care. However, the findings also indicate that water can lead to harm to women and/or babies due to neonatal inhalation of water and maternal/neonatal infection. One nursing practice that has the support of the articles is the use of water immersion in reducing labor pains. Mollamahmuto%u011Flu’s study reveals that water immersion can help maternal relaxation and analgesia requirements which are supportive of this nursing practice. In addition, Richard’s study also supports the use of water in management of complicated multi fetal pregnancies.
  The practice will contribute in reducing the cost of child labor through the use of water as a method to aid delivery, unlike other expensive techniques. This water immersion practice produces better outcomes by increasing access to quality maternal healthcare to many low class expectant mothers and reduces mortality rates. Water immersion practice also reduces pressure on the abdomen of the mother. This increases buoyancy and promotes efficient uterine contractions and better blood circulation, leading to better oxygen flow of the muscles in the uterine, reduces pain for the mother, and there is more oxygenation for the fetus. In addition, Water arouses the temperature of the nerve fibers in the skin. It prevents impulses in the pain fibers, identified as the Gate Theory of Pain. This effectively reduces labor pains.
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  However, the possible result of failing to implement the evidence based practice I have identified is that maternal mortality rate will continue to increase especially in areas that cannot afford high quality and expensive maternal care. This practice provides an alternative model of cheap, natural and efficient method in child labor instead of using epidural analgesia, conventional vaginal delivery and C-section which could be accompanied with side-effects. Failure of adoption of this practice will also lead to persistent rise in complications arising from the use of epidural analgesia, vaginal delivery and C-sections (Davis, 2011).
  I would disseminate information about this evidence-based practice throughout my practice setting by sharing with my colleagues about it in work and passing a memo around my organization. I will also display my research findings for them to review and understand the information. I will also upload the information to family nursing practitioners’ databases for people to access. Family nurse practitioners should be in touch with relevant and evidence based information for purposes of providing efficient healthcare to patients. For instance, from my experience as a family nurse practitioner, I have noted that it is essential to have evidence based information so that can I can make informed decisions (Cluett, 2006).
  I would communicate the importance of the practice through sensitization campaigns in various maternity wings and to health practitioners. This will then raise their awareness to enhance the adoption of practice and help to improve the provision of healthcare. I would implement the practice in my organization by training my fellow colleagues based on the findings of my study. They will then have the knowledge on how to undertake the practice so as to make use of it in various maternity wings. I would address challenges and opposition to the adoption of the practice by providing concrete evidence on the rationale of its implementation to convince those who may be against it.
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  In conclusion, development of a topic for research in evidence-based practices is a systematic process. The relevant clinical question should be developed using the PICO criteria and then a strong research methodology developed to support searching of information. The right key words have to be selected to the literature search. This next step is the reviewing of preceding studies to reveal information on the subject and findings that can form a preliminary conclusion. This forms the basis on which information can be translated from evidence based to practice.