An Alcohol Pad for Nausea? Building a PICOT Question and a Documented Literature Search From an Emergency Department Problem
Student Name
RN to BSN Program, Aspen University
N494: Essentials of Nursing Research
Instructor Name
Month Day, Year
An Alcohol Pad for Nausea? Building a PICOT Question and a Documented Literature Search From an Emergency Department Problem
Evidence-based practice begins with a question that comes from practice. This paper describes a problem observed in a composite emergency department fast-track area, converts it into a searchable question in PICOT format, documents a search of three databases, and summarizes the evidence retrieved and its level. The aim is not yet to change practice but to show that the question is answerable and that credible evidence exists to answer it.
The Clinical Problem
In the fast-track area of a busy composite emergency department, many adults present with nausea from gastroenteritis, migraine, or medication side effects. Standard practice is to wait for a provider evaluation, then place an intravenous line and give intravenous ondansetron, or give an oral dose if vomiting is mild. On busy evenings, patients may wait an hour or more before receiving anything for nausea, and placing an intravenous line only for an antiemetic adds cost, discomfort, and time. Several nurses on the unit have heard that sniffing an isopropyl alcohol prep pad can relieve nausea within minutes. The pads are cheap, already stocked, and could be offered at triage under a protocol. Before the unit considers such a change, it needs to know whether the claim is supported by evidence.
The PICOT Question
The question was structured using the PICOT format, which names the population, intervention, comparison, outcome, and time frame so that each element can become a search term (Melnyk & Fineout-Overholt, 2023). Population: adults presenting to the emergency department with nausea. Intervention: inhaled isopropyl alcohol. Comparison: oral ondansetron or placebo. Outcome: reduction in nausea severity. Time: within 30 minutes.
The full question reads: In adults presenting to the emergency department with nausea (P), how does inhaled isopropyl alcohol (I) compared with oral ondansetron or placebo (C) affect nausea severity (O) within 30 minutes of treatment (T)? This is an intervention question, so the best answer would come from a review that pooled several randomized trials, and the next best from well-conducted single trials.
The question also matters for nursing specifically. Nausea is assessed and treated first by triage nurses, and an intervention that nurses could offer under a standing protocol at the moment of triage would shift the first response to nausea from the provider's order to the nurse's assessment. If the evidence supports it, the change would reduce the time patients spend nauseated, could avoid some intravenous lines placed only for antiemetics, and would give nurses a low-cost tool they already have in every room. If the evidence does not support it, the unit avoids adopting a popular remedy on the strength of anecdote, which is its own form of good practice.
Search Strategy
Three databases were searched: CINAHL Complete, because it indexes nursing literature; PubMed, for broad biomedical coverage; and the Cochrane Library, for systematic reviews. Each PICOT element was translated into keywords and, where available, controlled vocabulary. In PubMed, Medical Subject Headings included Nausea, 2-Propanol, Aromatherapy, Ondansetron, and Emergency Service, Hospital. Keywords added synonyms such as isopropyl alcohol, IPA, alcohol pad, alcohol swab, and emergency department.
Terms within each concept were joined with OR, and concepts were joined with AND. The core PubMed string was: (nausea OR vomiting) AND ("isopropyl alcohol" OR 2-propanol OR "alcohol pad" OR aromatherapy) AND ("emergency department" OR "emergency service"). A second search removed the emergency department concept to capture perioperative studies, which are relevant to the mechanism even if the setting differs. Limits were English language, adults, publication from 2012 onward, and study designs limited to randomized trials and reviews that pooled them. Reference lists of retrieved reviews were also checked. Because database totals change as new records are added, the search log below records the strategy and the studies kept rather than raw hit counts.
| Database | Main terms | Limits | Studies kept |
|---|---|---|---|
| PubMed | MeSH plus keywords for nausea, isopropyl alcohol, emergency department | Adults, English, 2012 to present, RCT or systematic review | Beadle et al. (2016); April et al. (2018); Lee and Tamale (2023) |
| CINAHL Complete | CINAHL headings Nausea and Aromatherapy plus keywords | Same | Erdogan-Ongel et al. (2023) |
| Cochrane Library | aromatherapy AND nausea | Reviews | Hines et al. (2018) |
Evidence Retrieved
Five sources were retained. The first is a double-blind trial that randomized 80 emergency department patients to alcohol or saline inhalation, which found a median nausea score at 10 minutes of 3 on an 11-point scale with inhaled isopropyl alcohol, compared with 6 with saline placebo, along with higher patient satisfaction (Beadle et al., 2016). The second is a three-arm randomized trial of 122 emergency department patients that compared inhaled isopropyl alcohol with oral ondansetron; patients receiving isopropyl alcohol, with or without ondansetron, had larger reductions in nausea at 30 minutes than those receiving ondansetron with a saline placebo (April et al., 2018).
Three reviews complete the set. A Cochrane review of aromatherapy for postoperative nausea found that isopropyl alcohol shortened the time to a 50 percent reduction in nausea and reduced the need for rescue antiemetics compared with standard treatment, with moderate-quality evidence (Hines et al., 2018). A systematic review of 13 randomized trials in several settings found that most reported isopropyl alcohol to be effective, with high satisfaction and no reported adverse effects (Erdogan-Ongel et al., 2023). A meta-analysis limited to adult emergency department patients pooled two placebo-controlled trials and found a mean reduction in nausea of about 2.2 points on a 10-point scale, above the prespecified minimum clinically important difference (Lee & Tamale, 2023).
Using a common hierarchy, the three reviews represent Level I evidence and the two randomized trials represent Level II evidence (Melnyk & Fineout-Overholt, 2023). The question is answerable, the evidence is recent and directly relevant to the setting, and it is strong enough to justify formal appraisal in the modules that follow.
Conclusion
A problem familiar to many emergency nurses, long waits for nausea relief, produced a focused PICOT question about a simple and inexpensive intervention. A documented search of three databases retrieved two randomized trials and three systematic reviews that address the question directly. The next step is critical appraisal of these studies to judge whether their results are valid and applicable to this department before any change to triage protocols is proposed.
References
April, M. D., Oliver, J. J., Davis, W. T., Ong, D., Simon, E. M., Ng, P. C., & Hunter, C. J. (2018). Aromatherapy versus oral ondansetron for antiemetic therapy among adult emergency department patients: A randomized controlled trial. Annals of Emergency Medicine, 72(2), 184-193. https://doi.org/10.1016/j.annemergmed.2018.01.016
Beadle, K. L., Helbling, A. R., Love, S. L., April, M. D., & Hunter, C. J. (2016). Isopropyl alcohol nasal inhalation for nausea in the emergency department: A randomized controlled trial. Annals of Emergency Medicine, 68(1), 1-9. https://doi.org/10.1016/j.annemergmed.2015.09.031
Erdogan-Ongel, E., Heung, Y., Rozman de Moraes, A., Geng, Y., & Bruera, E. (2023). Inhalation of isopropyl alcohol for the management of nausea and vomiting: A systematic review. Journal of Palliative Medicine, 26(1), 94-100. https://doi.org/10.1089/jpm.2022.0332
Hines, S., Steels, E., Chang, A., & Gibbons, K. (2018). Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database of Systematic Reviews, (3), Article CD007598. https://doi.org/10.1002/14651858.CD007598.pub3
Lee, S. Y., & Tamale, J. R. (2023). Isopropyl alcohol inhalation for the treatment of nausea in adult emergency department patients: A systematic review and meta-analysis. Emergency Medicine Journal, 40(9), 660-665. https://doi.org/10.1136/emermed-2022-212871
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
How this N 494 Module 1 example is structured
N494 Module 1 typically asks you to identify a clinical question from your own work environment, write it in PICOT format and carry out a literature search on it, in an APA paper of about 1,000 to 1,500 words with several sources. Aspen revises courses, so follow your classroom's prompt. This example describes the problem in operational terms, builds the PICOT element by element, documents the search so it could be repeated, summarizes what was found with levels of evidence and stops short of recommending a change, which belongs to later modules.
N494 Module 1 questions, answered
What does N494 Module 1 usually ask for?
Commonly a paper that identifies a clinical question from your work environment, writes it in PICOT format and documents a literature search on it, with the sources found, in about 1,000 to 1,500 words in APA format. The module's discussion often asks about national nursing research priorities.
How detailed should the search documentation be?
Detailed enough that someone else could repeat it: the databases and why, the keywords and subject headings, how terms were combined with AND and OR, the limits applied and the studies kept. The sample includes a search log table and explains why it lists studies kept rather than hit counts, which change over time.
Which level of evidence answers an intervention question?
The strongest evidence for an intervention question is a systematic review or meta-analysis of randomized controlled trials, followed by individual randomized trials. The sample classifies its three reviews as Level I and its two trials as Level II using a common EBP hierarchy.
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