Browsing by Subject "Critical care"

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    Generating Evidence for Perceptions, Knowledge, Beliefs, and Use of Music, Aromatherapy and Guided Imagery in Critical Care Settings
    (2019-05) Meghani, Naheed
    This dissertation begins with two integrative reviews of literature constituting the current evidence on the use of music, aromatherapy and guided imagery for the symptom management of pain, insomnia and anxiety in critically ill patients. The first integrative review of literature examines the use of music therapy for the management of anxiety, pain, and insomnia in critical care. Following this, the dissertation proceeds with an examination of the evidence of aromatherapy and guided imagery in improving the signs and symptoms of anxiety, pain, and insomnia in critical care. The results of these integrative reviews offer evidence-based insights of the use of these three therapies in critical care. The dissertation also includes a brief background of the development of Tracy et al.’s survey from 2003, which was used in a national survey of critical care nurses on the attitudes, knowledge and use of complementary therapies. Since then no other surveys have been conducted in the United States, thus contemporary perceptions, use and knowledge of critical care nurses regarding complementary therapies are virtually unknown in this area. This dissertation concludes with results of a study examining the perceptions, knowledge, beliefs and use of complementary therapies of critical care nurses from multiple intensive care units within a single tertiary care hospital. The survey was administered twice 4-6 weeks apart, generating the consistency of responses data of the survey measures. For the cohesiveness of this dissertation, the results presented focus on the domains of perceptions, knowledge, beliefs, and use related to the three primary therapies of interest: Music therapy, aromatherapy and guided imagery. Further, the consistency of responses data for these three therapies are evaluated pertinent to eight items/measures related to the domains of perceptions, knowledge, beliefs, and use of these three therapies. Finally, the implications of this body of work related to practice, education and research are presented.
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    Patients' recall and evaluation of mechanical ventilation: impact of sedation.
    (2012-05) Guttormson, Jill Lynn
    Purpose: Mechanically ventilated patients routinely receive sedative medications to manage patient symptoms of anxiety and agitation. However, these medications are associated with multiple complications and the effectiveness of sedation for improving symptoms during mechanical ventilation has not been evaluated from the patient’s perspective. The purpose of this study is to examine the relationship between the pattern of sedation and mechanically ventilated patients’ evaluation of critical care and to identify non-pharmacologic interventions patients find effective during mechanical ventilation. Subjects: Sixty-nine mechanically ventilated patients were enrolled from a medical surgical intensive care unit in a Midwestern community hospital of whom 35 completed post ICU interviews. Subjects completing interviews had a mean age of 66 (SD 12.6) and were mechanically ventilated for an average of 4.5 days (SD 6.8). Methods: Level of arousal data utilizing the Motor Activity Assessment Scale and all sedative medication received were abstracted from the medical record. Subject interviews were conducted after ICU transfer and included the ICU Memory Tool and Intensive Care Experience Questionnaire. Latent Class Growth Analysis was used to classify subjects based on patterns of arousal and sedative exposure over the first 5 days of mechanical ventilation. Results: The most common memory of ICU was confusion. Hallucinations, difficult communication, and feelings of loss of control were the most disturbing memories for subjects. Subjects that were minimally arousable over the first five days of mechanical ventilation had more delusional memories of ICU. There was no difference in patient satisfaction, awareness of surroundings, frightening experiences, memories of negative feelings, or factual memories based on level of arousal. Sedative exposure did not impact patients’ memories of ICU. A lower level of arousal and higher sedative exposure were associated with increased time on the ventilator and in the ICU. Subjects reported family presence, receipt of information, and freedom of movement as helpful during mechanical ventilation. Conclusions: Deeply sedating mechanically ventilated patients may not be effective for improving the patient’s experience. Improving communication, frequent provision of information, providing choices to patients, and inclusion of patients’ families are basic interventions that may improve the patients’ experience of mechanical ventilation.