Breanna Hetland

The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review

Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning.

Factors Influencing Active Family Engagement in Care Among Critical Care Nurses

ABSTRACT Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work‐flow partially mediated the relationships between the intensive care unit environment and nurses’ attitudes and between patient acuity and nurses’ attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.

End-of-Life Decision Support in the ICU: Where Are We Now?

Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies. Few studies demonstrated significant improvements in the primary outcomes. In conclusion, there is limited evidence on the effectiveness of end-of-life decision support for critically ill patients and their surrogate decision makers. Additional research is needed to develop and evaluate innovative decision support interventions for end-of-life decision making in the intensive care unit.

Safety and Acceptability of Patient-Administered Sedatives During Mechanical Ventilation

Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self‐administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dexmedetomidine and 20 to usual care. Dexmedetomidine was administered via standard pumps for patient‐controlled analgesia, with a basal infusion (0.1–0.7 &mgr;g/kg per hour) titrated by the number of patient‐triggered doses (0.25 &mgr;g/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients’ self‐reported satisfaction and ability to administer the sedative. A 100‐mm visual analog scale was used daily to assess patients’ anxiety. Results The sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short‐term treatment. Nurses’ adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (&bgr;day = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self‐administer medication. Conclusions For select patients, self‐administration of dexmedetomidine is safe and acceptable.

Letting the Patient Decide: A Case Report of Self-Administered Sedation During Mechanical Ventilation

&NA; It is common for critical care nurses to administer sedative medications to patients receiving mechanical ventilation. Although patient‐controlled analgesia is frequently used in practice to promote effective selfmanagement of pain by patients, it is not known if patient‐controlled sedation can be used to promote effective self‐management of distressing symptoms associated with mechanical ventilation. A randomized pilot trial was conducted to evaluate whether patient self‐administered sedation with dexmedetomidine is safe and acceptable for self‐management of anxiety during ventilator support. This case report details the experiences of one patient enrolled in the pilot trial who was randomly assigned to the experimental dexmedetomidine intervention, completed the study protocol, and provided feedback. In a poststudy survey, the patient responded positively to the use of self‐administered sedation with dexmedetomidine during ventilator support.

Construct Validity and Reliability of the Questionnaire on the Quality of Physician-Patient Interaction in Adults With Hypertension

Background and Purpose: There are limited reliable and valid measures of the patient‐provider interaction among adults with hypertension. Therefore, the purpose of this report is to describe the construct validity and reliability of the Questionnaire on the Quality of Physician‐Patient Interaction (QQPPI), in community‐dwelling adults with hypertension. Methods: A convenience sample of 109 participants with hypertension was recruited and administered the QQPPI at baseline and 8 weeks later. Results: The exploratory factor analysis established a 12‐item, 2‐factor structure for the QQPPI was valid in this sample. The modified QQPPI proved to have sufficient internal consistency and test‐retest reliability. Conclusions: The modified QQPPI is a valid and reliable measure of the provider‐patient interaction, a construct posited to impact self‐management, in adults with hypertension.

Animal-Assisted Interactions to Alleviate Psychological Symptoms in Patients Receiving Mechanical Ventilation

Mechanical ventilation is a common life-support intervention for critically ill patients that can cause stressful psychological symptoms. Animal-assisted interactions have been used in a variety of inpatient settings to reduce symptom burden and promote overall well-being. Because of the severity of illness associated with critical care, use of highly technological equipment, and heightened concern for infection control and patient safety, animal-assisted interaction has not been widely adopted in the intensive care unit. This case study of the therapeutic interaction between a canine and a mechanically ventilated patient provides support for the promotion of animal-assisted interactions as an innovative symptom management strategy in the intensive care unit.