Healthcare System Research Paper 2022

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1.0 Introduction
Postoperative nausea is one of the common difficulties that patients undergo after operations.
The treatment of preoperative nausea has also been the concern of most of the physicians since
there exist conflicting theories on the most appropriate intervention. The therapeutic effect of
peppermint oil has been evidenced by several studies owing to its chemical properties. Studies
have shown peppermint oil to be an alternative treatment for dyspepsia (Shams et al., 2015;
Chiarioni et al., 2018), and irritable bowel syndrome (Merat et al., 2010). Multiple antiemetic
drugs have for a long time been used to treat postoperative nausea but have been found to be
ineffective and have severe side effects (Hunt et al., 2013). There are claims that peppermint oil
can be an appropriate option for nausea, but there is no sufficient evidence to back up this
conclusion. The authors conducted experimental research to ascertain the effectiveness of
peppermint oil in the treatment of postoperative nausea through the olfactory pathway. This
paper is a critique of the study.
1.2 Appropriateness of Experimental Design in Determining Causal Effect
The primary aim of most of the research is the determination of causal associations, or showing
that a given independent variable (the cause) impacts the dependent variable of concern (the
effect). An experimental design is the most appropriate approach for establishing the causal
effect. There are five criteria for ascertaining cause and effect but the first three are the major
ones. These include association, time order and nonspuriousness. The other two criteria are used
to further strengthen the already proved causal relations, they include causal mechanism and
context in which the effect takes place (Ruxton and Colegrave, 2011).
1.2.1 Association
The initial stage is establishing causality by showing an association. In other words, determining
if there is an association between the independent variable and the dependent variable. If the two

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variables under study are numeric, then the researcher will examine the correlation between the
two variables to ascertain if they both seem to convey. If there exists no association, then there
cannot be any claim of a causal association (Kirk, 2012). For example, the current study aims at
determining whether peppermint oil is effective in the treatment of postoperative nausea. Other
quarters may also think otherwise; that peppermint is not effective in dealing with postoperative
nausea. There exist studies that have recommended post-operative patients not to take
peppermint such as Dunning (2013). So to test this hypothesis (peppermint oil is effective in the
treatment of postoperative nausea), the researcher will need to compare two groups of subjects;
an experimental group and a control group. In this case, the dependent variable was ‘nausea’
while ‘peppermint’ was the independent variable. First, the subjects must have undergone
operation then the experimental group will be given peppermint through the olfactory pathway
while the control group will not be given any. Then at the end, postoperative nausea will be
measured and compared to determine any improvement changes. Thus, an association will have
been established.
1.2.2 Time Order
The next step after establishing the association is to determine the temporal order of the variables
under study. Association is important in establishing a causal effect, but it isn’t enough. The
researcher must be sure that the changes in the independent variable preceded the changes in the
dependent variable. In other words, it is logical that the cause must precede its supposed effect.
This criterion is known as time order. This aspect of ordering time is critical in experimental
research because the author judiciously controls exposure to the intervention (most likely the
independent variable) and then measures the results (the dependent variable) (Imai, Tingley, and
Yamamoto, 2013). With reference to the current article under consideration, there is a possibility

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of the existence of an association between outside the experimental setting, but that will not
establish time order. May be, postoperative patients, use peppermint outside hospitals and get the
health of nausea. So, there would exist an association, but not the causal association which is of
interest. Therefore, by controlling who receives peppermint, and when, then the researcher
establishes a time to order.
1.2.3 Nonspuriousness
Nonspuriousness is the third principle for causality and is critical because it demands another
option to explain the reasons for the observed association between two variables. Spurious
implies false. A relation between two variables is said to be spurious when it is caused by
changes in a third variable, therefore what seems to be a direct relation is not. In other words, a
relation between two variables can be due to another variable, but what the aim of the researcher
here is nonspuriousness (Mitchell, 2015). That is, there is no other third variable that affects the
observed association between the use of peppermint oil vial the olfactory pathway and
alleviation of postoperative nausea.
1.2.4 Mechanism
A causal mechanism establishes an association between the link between the changes in the
independent variable and dependent variable that it is assumed to cause. For instance,
considering how the specific chemical constituents of peppermint affect oesophageal sphincter to
alleviate postoperative nausea is likely to increase confidence in the conclusion of the existence
of a causal effect (Mitchell, 2015).
1.2.5 Context
Ascertaining the context in which the causal association takes place is not a criterion in and of
itself for an effective conclusion. Moreover, it is not often tried; however, it is important to gain
an insight into the causal relation (Mitchell, 2015).