NUR 315 Module 2 EBP Paper 1: Introduction, Clinical Significance and Literature Search Example

Anxiety on the Ventilator: Clinical Significance and a Literature Search on Music for Mechanically Ventilated Adults

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 315: Nursing Research and Application to Practice

Instructor Name

Month Day, Year

Anxiety on the Ventilator: Clinical Significance and a Literature Search on Music for Mechanically Ventilated Adults

Introduction

Being awake on a ventilator is frightening. Patients cannot speak, they may feel short of breath even when well ventilated, and they are surrounded by alarms and strangers. Nurses often respond to visible distress with sedation, which can calm a patient but also delay recovery. My approved question asks whether ICU adults on ventilators who choose and control their own music, rather than receiving standard care alone, end up less anxious and less sedated while intubated. It explains the clinical significance of the problem and describes the literature search used to find evidence.

Clinical Significance

Anxiety is common among ventilated patients, and its causes are easy to understand from their own accounts. Adults interviewed after being conscious on a ventilator described voicelessness as the worst part of the experience after breathlessness, along with pain from the tube and a sense of helplessness (Karlsson et al., 2012). These feelings can lead to agitation, attempts to pull at tubes and lines and requests for more sedation.

Sedation has costs. National guidelines for pain, agitation and sedation in adult ICU patients recommend using light rather than deep sedation for ventilated adults, because lighter sedation is associated with shorter ventilation and ICU stays, and they encourage nonpharmacologic approaches alongside medications (Devlin et al., 2018). A nursing intervention that reduces anxiety and the need for sedatives would support that goal.

Music is inexpensive, safe and easy for nurses to offer. A Cochrane review of 14 trials found that music listening lowered anxiety in ventilated patients by over a full standard deviation relative to usual care, a large effect, though the trials were small and most had a high risk of bias (Bradt & Dileo, 2014). If music helps, it could be part of everyday ICU care rather than a special program.

Literature Search

I searched two databases through the ASU Library: CINAHL Complete, which indexes nursing journals, and PubMed, which covers the wider medical literature.

I chose the 2010 limit to focus on current research but kept the 2014 Cochrane review because it is the most complete summary of trials. For the qualitative article I ran a separate CINAHL search pairing ventilator terms with words for patient experience and interview methods, which returned 37 results; after screening, five described the patient's own experience of ventilation.

Selecting the Two Articles

From the quantitative results, I chose the trial by Chlan et al. (2013), which randomized 373 ventilated adults in 12 ICUs to patient-directed music, noise-canceling headphones or usual care and measured both anxiety and sedative exposure. Each part of my question appears in it, and random assignment gives it the most weight for a question about whether an action works. From the qualitative results, I chose the study by Karlsson et al. (2012), which interviewed 12 adults who had been conscious during ventilation, because it describes the experience that the music intervention tries to ease. Studies of family members' experiences and of music during weaning were excluded because they did not match my population or outcome.

Conclusion

Anxiety during mechanical ventilation is common, distressing and often treated with sedation that guidelines urge nurses to minimize. Music listening is a promising, low-cost alternative with review-level support. The two articles selected here, a multisite randomized trial and a phenomenological interview study, will be appraised in the next two papers to judge whether the evidence supports changing practice.

References

Bradt, J., & Dileo, C. (2014). Music interventions for mechanically ventilated patients. Cochrane Database of Systematic Reviews, (12), Article CD006902. https://doi.org/10.1002/14651858.CD006902.pub3

Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skaar, D. J., Guttormson, J. L., & Savik, K. (2013). Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: A randomized clinical trial. JAMA, 309(22), 2335-2344. https://doi.org/10.1001/jama.2013.5670

Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., ... Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299

Karlsson, V., Bergbom, I., & Forsberg, A. (2012). The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study. Intensive and Critical Care Nursing, 28(1), 6-15. https://doi.org/10.1016/j.iccn.2011.11.002