The paper attached examines the relationship between music therapy and stress levels in mechanically ventilated patients in the ICU. By forming an accurate and applicable PICOT question, we were able to streamline our research and gather pertinent data points to formulate our paper. The knowledge gleaned from our Evidence Based Practice course also guided our efforts in piecing together an efficacious research process.
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Evan Carrell
EBP Final Reflection
August 1, 2021
This project was valuable in many ways. Working in a team is always a challenge, as combining multiple writing styles and preferences into one paper requires adjustments. In my future nursing practice, I will inevitably encounter situations where I will need to collaborate with colleagues who I disagree or clash with. Additionally, this foundational experience allowed me to practice finding appropriate research articles that fit well with the group’s PICOT question. The ability to find evidence to back up a research question will certainly be something I’m faced with in the clinical setting. In order to successfully write this paper, I had to pull outcomes from multiple different clinical trials and evaluate them based on their relevance, variables and reproducibility. Being able to pick out the strengths and weaknesses of a clinical trial is a very valuable skill to have, as doing so is vital in the process of eliminating redundancy, while increasing search efficiency.
In the instance of the research into our topic specifically, I learned a lot about the benefits of music therapy. None of the studies we found cited any observable disadvantages or adverse effects associated with this intervention. The results from these studies showed me the benefits of implementing music therapy hospital wide. I can say for certain that in my future practice, I will utilize music therapy in the treatment of my patients.
As far as my individual team contribution, I learned that I work best with structure, and laying out a clear outline of what my work will look like helps me organize my thoughts. Luckily, my teammates operate similarly, and our work came together fairly smoothly
July 25, 2021
After researching our chosen topic (the use of music therapy in mechanically ventilated patients) it became clear to us that this technique, while maybe not widely implemented, is effective and useful in the clinical setting. From the start, just based on a quick overview of our articles, we knew that music therapy was understood to be helpful in creating a healing environment. However, I didn’t realize the extent to which it was useful in shortening hospital stays, preventing agitation, and decreasing the number of days on a ventilator. Additionally, our articles pointed out that music therapy as a treatment is cost-effective, requires minimal resources, and does not require additional training for staff.
That being said, I can confidently say that I will implement music therapy into my future nursing practice. At no point in any of our articles were any adverse effects listed, which is a promising finding. Considering that it does no additional harm, and actually reduces anxiety for patients at no additional cost, I would use it for as many patients as possible.
I think the only point of disagreement my groupmates and I had about the findings was how we might tweak our PICOT question. Some of the research articles we found talked about ICU patients specifically, others talked about conscious versus unconscious patients, and we went back and forth for a bit about how specific our patient population should be.
During the writing process, the only challenge we faced as a group was blending our writing styles in our paper, which worked out nicely once we revised the paper as a group.
- Based on your review of the above individual’s medications, what do you feel are actual or potential safety concerns surrounding medication administration and why
One potential safety concern for this patient is the combination of a few of her medications. For example, taking an antiviral like acyclovir frequently can decrease the effectiveness of her birth control pill. It is an important education point that not many people are made aware of. Furthermore, taking birth control has many specific monitoring instructions to ensure safety. Due to the varying quantity of hormones on different weeks, it is vital that the pills are taken in order, and at the same time every day. This patient has a past medical history significant for IBS and persistent nausea. Both vomiting and diarrhea can decrease the effectiveness of birth control, so it is important to use a second form of birth control at those times. Taking the pill at night can help to mitigate gastrointestinal side effects which is what this patient has chosen to do.
Spironolactone is a diuretic, although it has off-label use for treating hormonal acne. Diuretics, or “water pills” are classically used to eliminate excess water from the body, often for patients with hypertension or heart failure. Therefore, it lowers the blood pressure in high doses. It is important for this patient to monitor her heart rate, especially because spironolactone is a potassium-sparing diuretic, and an increased serum potassium can become life threatening. In the same vein, it is important for this patient to watch her intake of high potassium foods.
Benadryl is the only over the counter medication that this patient is taking. She is also utilizing an off-label application of the drug, as it is classically used to combat allergies. However, since the medication has sedating effects, it can be used for sleep occasionally. Fortunately, she does not take it very often, and only uses it when she works overnight shifts at work. Some studies have indicated an increased risk of Alzheimer’s in people who use Benadryl long-term.
While these four medications do not have dangerous interactions with each other, none of them should be taken with alcohol, as it can either intensify or dampen a medication’s effects. It is also important for this patient to remain hydrated constantly, as it will decrease the chances that she experiences any adverse reactions or side effects.
- Considering concepts of safe medication administration and delivery, how would you approach a teaching plan with this individual to improve the safety of their medication delivery? Consider health care literacy as well as cultural considerations.
I think a very important aspect of successful medication administration and delivery for this patient is hydration. If the patient is unable to stay hydrated, her electrolyte levels may shift and become dangerous, potentially impacting her heart and brain. This has the potential to be very serious considering she also has a history of vomiting and diarrhea, making her more likely to become dehydrated. Dehydration also impacts blood volume, as it causes hypovolemia, which can decrease blood pressure dramatically. Considering that both spironolactone and Benadryl decrease her heart rate, monitoring fluid intake and output is very important for this patient. This patient should be educated about activities and circumstances that can lead to dehydration, such as exercise and increased sweating, and what these symptoms manifest as before they become dangerous.
Other important administration tips include how the patient should be timing her doses of some of her medications. She should understand that spironolactone and her birth control work together to combat hormonal acne and should be taken together for best effects. Additionally, it is best that they be taken at night, as spironolactone can cause drowsiness and birth control can cause stomach upset, which may not be felt during the night.
One larger overarching theme is the fact that with the exception of Benadryl, none of her medications should be taken if she becomes pregnant. It is important that she knows the risks associated with taking these medications while pregnant, and in the case that she does become pregnant, she should contact her providers immediately and discontinue her medications.
I don’t anticipate health literacy as being a problem for this patient, as she does work in a healthcare setting, however, we cannot assume that medical professionals will be perfect patients.
Student Name/Semester: Evan Carrell
Client Name (initials only) AC Date of Review/Interview: 7/15/2021
Allergies: (if stated, list effects/response) NONE
Storage of Medication (How and where does client store medication?): In kitchen cupboard
Keeps medications in original container? Yes or No. If no, please explain:
Access issues (in obtaining meds, trouble opening, reading labels, comprehension, functional issues – i.e. arthritis, hearing deficit, glasses)? Glasses/contacts
How many providers does this client use? 2 providers
Where do they get their medications? Mail Order vs. Pharmacy
List all medications (prescribed, over-the-counter, herbal, supplements) that client takes.
| Drug (generic) | Trade Name | Dose | Where client obtains meds from? | Frequency | Intended Use | Patient Use (if different) | Demonstrates Understanding Yes or No |
| Ex: Ibuprofen | Advil | 200 mg | i.e. Rite Aid, CVS, Mail Order | BID prn (usually 2-3x/week (a) | Pain relief (b) | “arthritis” | Yes (c) |
| Acyclovir | Zovirax | 400mg | Walgreens | 2 tabs TID for 2D PRN (twice a year) | Cold sores | “ | Yes |
| Spironolactone | Aldactone | 50mg | Walgreens | 3 tabs at bedtime | Hormonal acne | “acne” | Yes |
| Norgestimate and ethinyl estradiol | Tri-Lo-Sprintec | 0.18mg/ 0.025mg | Walgreens | 1 tab at bedtime | Contraception | “birth control” | Yes |
| Diphenhydramine | Benadryl | 25mg | Walgreens | 2 tabs at bedtime PRN (once/twice a month) | Sleep | Yes |
References
Lexicomp. (n.d.). Lexicomp. Retrieved July 16, 2021, from https://login.une.idm.oclc.org/login?qurl=https://online.lexi.com%2flco%2faction%2fhome%3fsiteid%3d1%26
I did not have many expectations going into the mental health simulation. I was familiar with the cases, and I have worked with the paid actors before in ISIC, so I suppose I was eager to see how well I could apply therapeutic communication successfully in specific patient cases. I expected the simulation experience to differ from my clinical experiences, but I wasn’t prepared for the unpredictable nature of the hired actors. In my clinical, I never experienced a patient that was aggressive, or had pressured speech, so the mania patient really caught me by surprise. I did not expect the patients to avoid the questions we were asking or resist the process entirely. The mania patient specifically was so acutely manic that he would hardly even acknowledge that we were asking him questions. Additionally, he targeted us personally on our appearances and our clothes, which I wasn’t expecting and felt unprepared for in the moment. On a similar note, the patient in the depression case was very opposed to treatment, and we found it difficult as a group to try to convince him to try a new treatment when countless others had failed. I never got a chance to work with a patient like this at clinical, as most patients either wanted treatment or had a power of attorney making medical decisions for them.
I found it valuable that we got to interact with these clients in an outpatient setting. Prior to simulation, I was more comfortable with inpatient mental health cases. The clients on P6 have concurrent medical problems that can be life-threatening and are far more reliant on healthcare professionals.
I learned about how to interact and converse with patients that are resistant to care and aren’t admitted to a unit. I got to practice my therapeutic communication techniques as well as learn new methods from my colleagues. The experience as a whole was very valuable and memorable.
After coming up with our original PICOT question, and finding reliable resources, my group was able to narrow down our topic a bit more. Originally, our question was “What is the relationship between music and patient outcomes in the ICU?”, which was a good start, but it was still a bit vague. Researching the original question helped us to more narrowly define “patient outcomes” and we decided to focus on anxiety levels in ventilated patients. Our revised question is “What is the relationship between music and anxiety levels in critically ill ventilated patients in the ICU?” This was a difficult process, as our searches came up with multiple potential outcome topics. However, it seemed like the majority of the primary resources we found discussed playing music for ventilated ICU patients and monitoring more self-reported measures like pain and anxiety. We were quickly able to agree on this change, given the number of pertinent journal articles we found. I think what was helpful for our process as a group was our collective ability to connect to this subject, and share personal stories relating to our question. We are all very devoted to and excited about our chosen topic!
I anticipate this group project going smoothly. I have worked with my teammates during group work before, and I know that we all trust each other’s ability to do good work. Our communication plan so far is to talk over text, email and zoom to work out details and assign tasks. We will set deadlines for ourselves and hold each other accountable for the work we agree to do. In the case of a conflict, we will have honest conversations and reorganize, reassigning tasks and making edits as needed. Respectful, timely communication is key to successful group projects. I don’t foresee many barriers to completing this project, however, everyone tends to do work and write papers a little bit differently, so that is good to keep in mind preemptively. We each have different levels of clinical experience as well, and that is an important factor as we prepare to write a paper involving hospital policies and different interventions in the care process. This same idea will be useful in future nursing practice, as every individual brings a completely different set of experiences to the table, which can be an advantage as well as a disadvantage at times.
1. Many people have preconceived ideas about what mental illness means and what it looks like. I think the fear and stigma surrounding it comes mostly from a lack of understanding and the idea that having a mental illness is a “deviation” from what is considered “normal”. In many ways, this stigma is societal and is “taught”. In that sense, those that experience mental illness may suffer from their own self-stigmas. Mental health alone is treated as a delicate subject and getting help or seeing a professional can be seen by some as “weakness”.
2. Different cultures approach healthcare in myriad ways, and the same goes for mental healthcare. Religion and spirituality may help some patients be more in touch with their minds and bodies, while others may feel excluded and misunderstood. Certain cultures may influence the way people view wellness, or what is considered “normal”. Mental illness may be understood as a punishment by a higher power or a gift!
After the first semester of nursing school, I can tentatively say that I am interested in critical/intensive care nursing. My previous experiences as both a phlebotomist at Maine Med and a nursing student at Mercy have lead me to consider units like NICU, SCU, CTICU, and CICU. I am someone who likes a more intense, involved, high acuity environment. I am also attracted to the unpredictable nature of intensive care, as well as the more intimate patient-to-nurse ratio. Additionally, I have a solid background in pharmacy, which would most likely come in handy, as intensive care patients are often on a lot of life-sustaining medications. I would like to learn more about the specific responsibilities nurses have in the clinical care setting, and how those differ from what I’ve seen in my clinical rotations on the medical/surgical floors.
At this point, my assumptions about EBP are that it is a system that works toward implementing the best methods of patient care based on observed outcomes. Last semester, we learned about the importance of paying close attention to outcomes, or how patients respond to treatments and interventions. I think this class will help inform us about the best methods for identifying a need for improvement, as well as the best ways to communicate that need to our coworkers. I’m sure that as we learn more about different nursing interventions and therapies in other classes, we will be able to apply what we learn in EBP. In the clinical setting, we can more directly see how evidence-based improvements are implemented in the field, and we will have the ability to ask our instructors more about how research is done at a specific site. While this knowledge be useful in communication with fellow nurses, it is also vital that we use EBP interprofessionally, as healthcare is a co-dependent system that relies on all levels of staff keeping each other in check. I would guess that it helps to get an outsider’s perspective, as an unbiased eye may see room for improvement where others can’t. Additionally, research done by one department may identify a need for adjustment in another department.
NurseLogic 3: Knowledge and Judgement
The Knowledge and Judgement module discussed the breakdown of nursing knowledge, which includes education, skills, and attitude. We can use this knowledge to promote the health of our patients, prevent disease, and empower others. Nurses are able to do these tasks as a result of education and acquired skills, and we can use this knowledge to help keep patients healthy and safe. This large umbrella of ‘knowledge’ involves a multitude of subjects including physiology, pathophysiology, nutrition, math, legal and ethical issues, communication, and more specialized knowledge. These subjects can be used individually or in combination to effectively and efficiently assess and treat patients. It is important to mention that every nurse has a unique set of knowledge and skills that aid in their ability to do their jobs well. While we are all required to receive education regarding the subjects listed above, we also come to clinical settings with extensive personal experiences and our own specialized skill sets that we can contribute to patient care.
NurseLogic 4: Priority Setting
Priority setting as a nurse means using nursing judgment to make decisions about the order of nursing actions. There are seven frameworks that can be used to aid in the priority setting process. These help nurses decide the “now” versus “later” as far as priority of care. The first method is Maslow’s Hierarchy of Needs, which is a pyramid diagram that shows us how the highest priority needs are necessary for survival. The two most important needs are physiological as well as safety and security. Secondly, the nursing process can come in handy when making decisions about nursing actions. The ATI module lists these steps as assessment, analysis, planning, implementation, and evaluation. This differs slightly from the pneumonic we learned in class, which is ADPIE (assessment, diagnosis, plan, implementation, evaluation). Nurses can also use the ABCs (airway, breathing, circulation) to determine the order of care in emergency situations, as well as recognizing early signs of complications in a patient’s status. Safety and risk reduction also play important roles in priority setting. This framework can help nurses assign priority to the factor(s) posing the greatest risk to the patient’s status. The greatest risk is the highest priority. For the least restrictive/ least invasive framework, the module discussed how promoting safety can be done without the use of restraints, and also how invasive procedures can introduce more organisms into the body. A patient’s survival potential is also important to assess. In an emergency situation, we have to look at the chance of survival and the appropriate use of resources. It would not make sense to use up valuable resources on a patient that has a very small chance of survival. Lastly, nurses should assess if a patient’s situation is acute/chronic, urgent/nonurgent, or stable/unstable. This determination aids in the priority setting process as well.
