NUR 350 Module 5 EBP Final Paper Example

Choice, Comfort and Less Sedation: An Evidence-Based Practice Project on Patient-Directed Music for Mechanically Ventilated Adults

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 350: Professional Nurse Attributes: Accomplished

Instructor Name

Month Day, Year

Choice, Comfort and Less Sedation: An Evidence-Based Practice Project on Patient-Directed Music for Mechanically Ventilated Adults

Introduction

During a junior ICU rotation, I cared for a ventilated man who kept reaching for his tube and was sedated more deeply as the shift went on, while his daughter kept saying that old country songs were the one thing that settled him. That moment became the question I followed through two courses: could nurses ease anxiety on the ventilator with music the patient chooses, and use less sedation as a result? This paper presents the full evidence-based practice project.

PICO(T) Question

In intubated ICU adults who can signal yes or no (P), does a nurse offering self-selected music (I), compared with care as usual (C), lessen anxiety and sedation use (O) across the ventilator days (T)?

Background and Significance

Patients who are awake on a ventilator describe breathlessness, being unable to speak, pain from the tube and feeling powerless (Karlsson et al., 2012). Anxiety often leads to more sedation, yet current guidelines for adult ICU care recommend light sedation for ventilated patients and encourage nonpharmacologic strategies alongside medication (Devlin et al., 2018). A safe, low-cost nursing intervention that reduces anxiety could support both patient comfort and lighter sedation.

Evidence

Read together, the three sources favor music that patients start and stop themselves, offered as ordinary nursing care, with the reasons for its benefit likely including restored choice and connection as well as relaxation.

Intervention

Nurses offer patient-directed music to alert ventilated adults. On the first ventilator day, a family member or volunteer completes a music preference assessment adapted from the trial's tool (Chlan & Heiderscheit, 2009). The patient receives a tablet with single-patient headphones loaded with preferred music and starts and stops it with a button or signal. Nurses record anxiety once per shift on a visual analog scale, and sedative doses are tracked from the record. Music is offered alongside communication boards, explanation and family presence.

Feasibility

A feasibility analysis on a 24-bed medical ICU found low cost, strong leadership and staff support and quick measurement tools. Two barriers had to be solved first: infection control for shared equipment, addressed with single-patient headphones and an approved tablet cleaning method, and nurse time, addressed by asking families or volunteers to complete the preference assessment. About a third of ventilated patients on a given day are alert enough to take part, so the intervention reaches a subgroup.

Implementation and Evaluation

Following the Iowa Model, a four-week pilot on one eight-bed pod comes before any unit-wide adoption (Iowa Model Collaborative, 2017). Champion nurses train staff in brief huddles, and a two-week check-in fixes problems. The pilot counts how often eligible patients are offered music and how long they listen, tracks anxiety and sedation each day, watches nurse workload and any harm from the equipment, and asks patients and families about the experience after extubation.

Illustrative Results

The following figures illustrate how pilot results would be reported and are not data from a real unit: 17 of 21 eligible patients offered music (81%); median use of 25 minutes a day; mean daily anxiety falling from 58 before the pilot to 44 during it; sedative doses per ventilator day falling from 6.1 to 5.2; and 12 of 15 nurses rating the intervention manageable. Results like these would match the direction of the trial but could not prove cause in a small before-and-after pilot, so the recommendation would be to extend the pilot to all pods with continued measurement.

Dissemination

Findings would be shared at a pod huddle, then with the full ICU and its manager, then with the hospital's evidence-based practice council, and finally as a poster at a regional nursing research day, reported according to quality improvement reporting guidelines (Ogrinc et al., 2016).

Changes After Instructor Feedback

Feedback on the summary paper asked me to narrow the population to patients able to signal a preference, which I did throughout. Feedback on the feasibility table asked for local data behind each rating, so I added cost figures and the nurse survey. Feedback on the evaluation paper asked me to label sample results clearly, which this paper does in its own section.

Conclusion

Patient-directed music is a low-cost, low-risk way for nurses to offer ventilated patients comfort, choice and possibly less sedation. The evidence supports it, the unit can carry it out with two barriers addressed, and a measured pilot is the right next step. The project began with one man and a song his daughter named; it ends with a plan that could reach every alert patient on the unit.

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., & Heiderscheit, A. (2009). A tool for music preference assessment in critically ill patients receiving mechanical ventilatory support. Music Therapy Perspectives, 27(1), 42-47. https://doi.org/10.1093/mtp/27.1.42

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

Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

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

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411