| Course | NR 716 Analytic Methods |
|---|---|
| Week | 5 |
| Paper type | Literature matrix |
| Length | About 1,110 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NR 716 Week 5
Literature Matrix: Why Trials of Fascia Iliaca Blocks for Hip Fracture Disagree About Opioid Use, Read Along Six Axes
Student Name
College of Nursing, Chamberlain University
NR 716: Analytic Methods
Instructor Name
Month Day, Year
Literature Matrix: Why Trials of Fascia Iliaca Blocks for Hip Fracture Disagree About Opioid Use, Read Along Six Axes
The Question the Matrix Answers
The appraisal table found that nerve blocks for hip fracture consistently reduce early pain and delirium, but that trials disagree on whether they reduce opioid use. The practice council will ask about opioids, because the department's own figure, 12 mg of intravenous morphine equivalents at the median over the first 12 hours, is one of the outcomes the pilot will track. This matrix lays the studies side by side on the axes along which they differ, to see whether those differences explain the disagreement.
Columns as Axes of Difference
Six axes were chosen because each is a plausible reason two trials of the same block could reach different results: the technique and its guidance, who placed the block and when, the comparison arm, how much pain patients had and what other analgesia they could get, the outcome and its time window, and the result on that outcome. A last column notes what each row contributes to the question. Columns for country, funding and year were left out because they run the same way down most rows and would carry nothing.
The Matrix
Table 1
Studies of Fascia Iliaca and Related Blocks for Hip Fracture, Arranged by Strength of Comparison
| Study | Technique and guidance | Who placed it, and when | Comparison | Starting pain and other analgesia | Outcome and window | Result | Contribution |
|---|---|---|---|---|---|---|---|
| Pasquier et al. (2019), randomized, double-blind | Fascia iliaca, landmark technique | Emergency physicians, in the department | Sham injection of saline | Low pain after morphine in the ambulance | Pain profile at rest, first 45 minutes; morphine to 24 hours | No difference in pain or morphine | Shows little room to gain when pain is already controlled |
| O'Connor et al. (2025), randomized, double-blind | Fascia iliaca, ultrasound-guided, weight-adjusted dose | In the department | Saline of matched volume | Patient-controlled morphine available to all | Morphine demand, first 6 hours | No difference; pain lower at 1 hour; more patients opioid-free | Self-dosing may blunt any opioid difference |
| Morrison et al. (2016), randomized | Femoral, ultrasound-guided, then a fascia iliaca catheter | Emergency physicians on arrival; catheter by anesthesia within 24 hours | Conventional analgesics, no sham | At presentation, before analgesia settled | Pain at 2 hours; function to 6 weeks | Pain 3.5 against 5.3; 33% to 40% fewer morphine equivalents | Largest benefit, with continuous block and unblinded comparison |
| Thompson et al. (2020), randomized | Fascia iliaca, ultrasound-guided | Anesthesiologist, just before surgery | Usual care | Before anesthesia | Opioids after surgery to day 3 | Morphine after surgery: 0.4 mg in the block arm, 19.4 mg in controls | Benefit after surgery, not in the department |
| Di Pietro et al. (2025), randomized | Pericapsular against fascia iliaca, infra-inguinal | In the department | Another block | At least moderate pain | Summed pain relief, first hour; rescue opioid | Pericapsular better for pain; rescue opioid similar | Technique matters for early relief |
| Gawthorne et al. (2021), cohort | Fascia iliaca, ultrasound-guided | Trained nurses against doctors, in the department | Another type of placer | Department arrivals | Pain at 1 and 4 hours, delirium, opioids | No differences between placers | Who places it may not change results |
| Guay and Kopp (2020), review of 49 trials | Several blocks | Varied | No block or sham | Varied | Pain on movement at 30 minutes; delirium | Pain about 2.5 points lower; delirium risk ratio 0.67 | Effect grows with anesthetic concentration |
Note. Note. Rows ordered from the most to the least tightly controlled comparison. Entries are phrased the same way down each column.
Entries Phrased Consistently
Each cell is a phrase in the same form down its column: technique and guidance named the same way, comparison named as what the control arm received, results given as direction and size where the study reported a size. Where a study did not report something on an axis, the cell would say so rather than stay blank; in this set, every study addressed every axis, though at different levels of detail.
Rows in a Chosen Order
The rows run from the most tightly controlled comparison to the least: blinded sham or placebo first, then open comparison with usual care, then a comparison of two blocks, then a cohort comparing who placed the block, and finally the pooled review as context. An alphabetical order would have put the New York trial between the Dutch and Swiss trials and the review at the top, and the pattern that matters, that the opioid result changes with the strength of the comparison, would have been hidden in the middle of the table. The order was decided before the cells were filled, so it could not be chosen to produce the pattern.
Reading Down the Columns
Read down the comparison column, the two trials that found no opioid reduction are the two with a blinded sham or placebo. Read down the starting pain column, they are also the two in which pain was already controlled or patients could give themselves morphine on demand. The trials that found reductions compared the block with open conventional care and started measuring before analgesia had settled. Two explanations therefore compete. Either blinding removes an expectation effect that inflates opioid differences in open trials, or blocks reduce opioids mainly when pain is high and analgesia is not yet in place, which describes our department's patients in the first hour. The matrix cannot choose between them, but the second is consistent with the review's finding that the effect grows with the concentration of anesthetic used (Guay & Kopp, 2020), which suggests a real pharmacological effect rather than expectation alone.
Contribution Notes
Each row's last cell says what the study adds, not what it found. The Swiss and Dutch trials add the strongest control and the clearest warning. The New York trial adds the closest match to the department's plan, with the caveat that its patients also had a catheter. The perioperative trial adds little on timing. The head-to-head trial adds a technique question the pathway will face within a year. The Australian cohort adds the only evidence on who can place the block.
What the Matrix Changes in the Project
The pilot should record pain before the block, so that the department can see whether opioid differences appear mainly in patients who arrive in severe pain. Opioid savings should be left out of what the pilot claims to the council. And it should keep the delirium outcome as primary, since that is where the evidence agrees.
References
Di Pietro, S., Maffeis, R., Jannelli, E., Mascia, B., Resta, F., De Silvestri, A., Musella, V., Centurioni, C. E., Regeni, E., Grassi, F. A., Locatelli, A., & Perlini, S. (2025). Comparing the pericapsular nerve group block and fascia iliaca block for acute pain management in patients with hip fracture: A randomised clinical trial. Anaesthesia, 80(12), 1484-1492. https://doi.org/10.1111/anae.16695
Gawthorne, J., Stevens, J., Faux, S. G., Leung, J., McInnes, E., Fasugba, O., Mcelduff, B., & Middleton, S. (2021). Can emergency nurses safely and effectively insert fascia iliaca blocks in patients with a fractured neck of femur? A prospective cohort study in an Australian emergency department. Journal of Clinical Nursing, 30(23-24), 3611-3622. https://doi.org/10.1111/jocn.15883
Guay, J., & Kopp, S. (2020). Peripheral nerve blocks for hip fractures in adults. Cochrane Database of Systematic Reviews, 2020(11), Article CD001159. https://doi.org/10.1002/14651858.CD001159.pub3
Morrison, R. S., Dickman, E., Hwang, U., Akhtar, S., Ferguson, T., Huang, J., Jeng, C. L., Nelson, B. P., Rosenblatt, M. A., Silverstein, J. H., Strayer, R. J., Torrillo, T. M., & Todd, K. H. (2016). Regional nerve blocks improve pain and functional outcomes in hip fracture: A randomized controlled trial. Journal of the American Geriatrics Society, 64(12), 2433-2439. https://doi.org/10.1111/jgs.14386
O'Connor, R. D., Postma, S., Van Kamp, D., Benraad, A. C., Lommen, A., Korver, S., Ten Bosch, J. A., & Reinders, M. K. (2025). Effect of ultrasound-guided fascia iliaca compartment block on pain management in hip fracture patients: A double-blind placebo-controlled randomized clinical trial. Medicine, 104(40), Article e44622. https://doi.org/10.1097/MD.0000000000044622
Pasquier, M., Taffe, P., Hugli, O., Borens, O., Kirkham, K. R., & Albrecht, E. (2019). Fascia iliaca block in the emergency department for hip fracture: A randomized, controlled, double-blind trial. BMC Geriatrics, 19, Article 180. https://doi.org/10.1186/s12877-019-1193-0
Thompson, J., Long, M., Rogers, E., Pesso, R., Galos, D., Dengenis, R. C., & Ruotolo, C. (2020). Fascia iliaca block decreases hip fracture postoperative opioid consumption: A prospective randomized controlled trial. Journal of Orthopaedic Trauma, 34(1), 49-54. https://doi.org/10.1097/BOT.0000000000001634
Reading the NR 716 Week 5 instructions
Choose columns that represent the axes along which your studies genuinely differ, such as intensity, population, comparison, outcome measure and follow-up, because those differences explain why results disagree. Leave out columns that would read the same down every row. Keep entries short and phrase them the same way down each column, so rows can be compared without rereading the papers. Order the rows deliberately, usually by design strength or by the axis the disagreement runs along, and decide the order before filling the cells. Record silence as silence rather than leaving a blank. Add a contribution note for each row saying what the study adds, not what it found. Under the table, read down the columns and state the pattern you see, then say what the matrix changes in your project.
Inside the NR 716 Week 5 example
The sample states the disagreement on opioid use and explains why the council will ask about it. It names six axes, explains why country, funding and year were left out and presents seven rows from the Swiss sham trial to the Cochrane review. A section on row order explains that blinded comparisons come first and that alphabetical order would have hidden the pattern. Entries use the same phrasing down each column. The reading paragraph notes that the two trials finding no opioid benefit were blinded and started with pain controlled, sets out two competing explanations and links the second to the review's dose finding. Contribution notes say what each study adds, and the closing section asks the pilot to record pain before the block and to keep delirium primary.
NR 716 Week 5 rubric: what full points look like
The costliest defect is a matrix nobody can read down: cells of very different lengths, some in the authors' words and some in yours, units shifting between rows. Next is the alphabetical matrix, which hides the pattern the assignment exists to expose. Marks also go for template columns that run identical down the page and carry nothing, for blanks where a study was silent and for a contribution column that repeats the finding. Graders look for a reading paragraph that states the pattern down the columns and names rival explanations rather than averaging results. Matrices score well when the columns were chosen for the question, when the row order was fixed before the cells were filled and when the matrix changes something in the project.
NR 716 Week 5 help from the desk
Most matrices are built from a template and end up describing studies side by side without comparing them. Tell us the disagreement or question your matrix has to answer and send your appraised sources, and we can help you choose the axes the studies really differ on, phrase entries the same way down each column, fix the row order before filling the cells and write the paragraph that reads down the columns. We can also help you decide what the pattern changes in your project. The sources and conclusions remain yours throughout.
Get a NR 716 Week 5 example written to your instructions
Send the Week 5 instructions, your matrix template and the appraised studies you are working with, and a custom example is built into your own columns and returned inside 24 to 48 hours. The first one is free. What stays in the set remains your decision.
More NR 716 papers and DNP samples
- NR 716 Week 1: Model Placement Post
- NR 716 Week 2: PICOT Question Write-Up
- NR 716 Week 3: Search Strategy Write-Up
- NR 716 Week 4: Evidence Appraisal Table
- NR 716 Week 6: Critical Appraisal Write-up
- NR 716 Week 7: Evidence Synthesis Paper
- NR 716 Week 8: Practice Recommendation Presentation
- NR 715 Week 5: Conceptual Model Write-Up
- NR 714 Week 5: Data Analysis Plan
- NR 709A Week 5: Handover Packet Outline
- NR 702A Week 5: Aim Statement Draft
NR 716 Week 5 questions, answered
How is this different from the matrix in the theory course?
The instrument looks alike and the purpose is opposite. A theory matrix compares explanations, so its columns hold constructs and propositions, and it ends by choosing a framework. This one grades study quality toward a practice change, so its columns hold designs, doses and measured outcomes, and it ends pointed at a recommendation. The social work criteria matrix is a third instrument again; everything here stays inside a nursing practice question.
How many studies belong in the matrix?
Whatever the instructions set, and the count matters less than the spread. A set sharing one design cannot show a pattern, while a smaller one spanning two or three designs usually can. If your search returned very little, that is a result to record and carry into the synthesis rather than a gap to plug with loosely related papers.
Do qualitative studies belong in the same matrix?
They can, provided the columns hold. Sample and setting transfer directly, findings become themes, and a dose column simply reads not applicable. Where that part of the set is large, many sections prefer a second matrix so its columns can be picked for that kind of evidence, which keeps both readable. Say which your section wants when you send the instructions.
Where can I find a free NR 716 Week 5 sample paper?
A full matrix of seven nerve block studies, arranged to explain why the trials disagree on opioid use, can be read on this page.
What pattern does the NR 716 Week 5 matrix reveal?
The trials finding no opioid savings were the blinded ones, which also began with pain already controlled or patients dosing their own morphine.