Beruflich Dokumente
Kultur Dokumente
Significance
Use of Sensory
Stimulation in Sedated
ICU Patients
PICOT Question
How can nurses integrate sensory stimulation in intubated
adult ICU patients, in order to promote lower levels of
agitation as evidenced by changes in the patients RASS
(Richmond agitation-sedation scale) during their stay at the
ICU?
Literature Findings
Nine articles were found through CINAHL and Pubmed
search engines for the purpose of this evidence-based
protocol.
Four randomized clinical trials
One interventional study
One double-blind randomized clinical trial
One pilot study
One randomized- controlled crossover trial
One study case-control trial
12/1/15
Strengths of Research
Randomized study, adequate sample, size, approval from
University of Minnesotas Institutional Review Board.
(Chan, Weinert, Heiderscheit, Tracy, Skarr, Guttormson, & Savik, 2013).
The study was randomized and there was a large study size of 137
patients (Han, Li, Sit, Chung, Jiao, & Ma, 2008)
Limitations of Research
Unable to control for bias (Chlan, Weinert, Heiderscheit, Tracy, Skarr,
Guttormson, & Savik, 2013)
Limitations Continued
Small sample size, broad age range may be a threat to generalisability of
findings to other settings (Saadatmand, Rejeh, Heravi-Karimooi, Tadrisi,
Zayeri, Vaismoradi, & Jasper, 2013)
Small sample size; convenience sample (Dijkstra, Gamel, van der Bijl,
Limitations Continued
Participants were asked to select from the researchers collection instead
of having the freedom to choose from their own favorite music (Han, Li,
Sit, Chung, Jiao & Ma, 2008)
12/1/15
12/1/15
Application/Implementation to Nursing
Practice
Design Process
Team Development
Define Goals
Changes that can be/need to be made
Application/Implementation to Nursing
Practice
Develop Strategies for establishing new protocol, staff
training, and data collection.
Initiate Plan
Expected timeline of total implementation is 6 months to 1 year.
Cost Analysis
Cost to train the Nurses:
Average yearly salary for ICU nurses in Arizona
$76,000
Hourly Rate: $40.60
(Salary By State, 2013).
12/1/15
Savings
Propofol:
Safe Dose
0.3 mg/kg/hr for five minutes, then titrate
in 0.3-0.6 mg/kg/hr increments to
desired level of sedation
Cost of 100 ml bag of propofol (10 mg/ml
concentration): $39.85
Risk
Over stimulation
Can trigger negative emotional associations
Can cause more anxiety if the chosen stimuli is
agitating to the patient.
Evaluation
By the end of the nurses shift, the patient will show a
decrease in agitation, as measured by RASS, after the
introduction of music therapy
The patient will show a decrease in agitation, as
measured by RASS, after the introduction of therapeutic
touch, by the end of the nurses shift.
Evaluation Continued
By the end of the nurses shift, the patient will show a
decrease in agitation, as measured by RASS, after the
family visits and speaks to the patient in a comforting
tone.
12/1/15
Summary
Summary, continued
Introduction
Description of issue
Nurses can improve patient agitation and anxiety through the use of non
pharmacological methods though sensory stimulation such as touch, music
therapy.
Supportive studies
The studies support the use of non pharmacological methods, such as music
and touch, in order to decrease overall agitation and anxiety
Summary, continued
Summary, cont.
Best Practice
Initiate use of music therapy, touch, and voices of family.
Cost Analysis
By implementing this protocol, reduced anxiety in turn leads to less use of
sedative medications, thereby resulting in shorter length of stay. Shorter
length of stay saves in overall costs of patient and the facility.
Application to Facility
Protocols should be developed.
Education regarding interventions provided by a
multidisciplinary team to hospital staff
References
References, continued
Dijkstra, B. M., Gamel, C., Van der Biijl, J. J., Bots, M. L., & Kesecioglu, J. (2010). The effects of music on physiological responses and
http://pub.azdhs.gov/hospital-discharge-stats/2011/util/std/hospDXCCS/MED0257_DXCCS_All.html
sedation scores in sedated, mechanically ventilated patients. Journal of Nursing, 19, 1030-1039. doi: 10.1111/j.
Banner University Medical Center. (2015). Patient amenities. Retrieved from http://www.uahealth.com/patients-visitors/patient-
1365-277022009.02968.x
amenities
Gorji, M. A. H., Araghiyansc, F., Jafari, H., Gorgi, A. M. H., & Yazdani, J. (2014). Effects of auditory stimulation on traumatic coma
Beaulieu-Boire, G., Bourque, S., Chagnon, F., Chouinard, L., Gallo-Payet, N., & Olivier, L. (2013). Music and biological stress
duration in intensive care unit of Medical Sciences University of Mazandarn, Iran. Saudi Journal of Anaesthesia, 8(1), 69-72. doi: 10.
dampening in mechanically-ventilated patients at the intensive care unit ward: A prospective interventional randomized crossover trial.
4103/1658-354X.125940
Han, L., Li, J.P., Sit, J. W. H., Chung, L., Jiao, Z. Y., & Ma, W. G. (2010). Effects of music intervention on physiological stress response
Bulk Quantity Disposable Headphones. (2015). Encore Data Products, Inc. Retrieved from http://www.encoredataproducts.com/bulk-
and anxiety level of mechanically ventilated patients in China: A randomized controlled trial. Journal of Clinical Nursing, 19, 978987.
quantity-disposable-headphones/?gclid=CjwKEAjwlsSoBRDoid2ihqnjjlISJABZoG9-
doi: 10.1111/j.1365-2702.2009.02845.x
Ucx8BErMIYvvWtCdXlwsaqzNLmLmZMOWlsofmeujgRoCd9fw_wcB
Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skarr, D. J., Guttormson, J. L., & Savik, K. (2013). Effects of patient-directed
Korhan, E. A., Khorshid, L. and Uyar, M. (2011), The effect of music therapy on physiological signs of anxiety in patients receiving
mechanical ventilatory support. Journal of Clinical Nursing, 20: 10261034. doi:10.1111/j.1365-2702.2010.03434.x
music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: A randomized
Lakie, A. S., Bolhasani M., Noubahar M., Movahedi, A. F., & Mahmoudi, H. (2012). The effect of touch on the arterial blood oxygen saturation
clinical trial. Journal of the Medical American Association, 309(22), 2335-2344. doi:10.1001/jama.2013.5670.
in agitated patients undergoing mechanical ventilation. Iran Journal of Critical Care Nursing, 5(3):125-132.
Critical Care Fellowship Program Overview. (2015). The University of Arizona: Emergency Medicine. Retrieved from http://
emergencymed.arizona.edu/fellowships/critical-care/program-overview
12/1/15
References, continued
Portable Fashin Mini MP3 Player. (2015). Deals Machine. Retrieved from
http://www.dealsmachine.com/best_158867.html?currency=USD&gclid=CjwKEAjwlsSoBRDoid2ihqnjjlISJABZoG9IAmxInTnMyJKgLa4f90XsxVuEvzuBEEmGfGnWQudCRoCI7vw_wcB
Propofol Emulsion. (2015). MD Wholesale Pharmacy. Retrieved from
http://www.mdwholesalepharmacy.com/Propofol-Emulsion-10-mg-mL-100-mL-SDV-Pack-of-1-p/4282918.htm
References, continued
Vanderbilt University Medical Center. (2013). Pain, agitation-sedation, and delirium protocol. Retrieved from
https://medschool.vanderbilt.edu/trauma-and-scc/files/trauma-and-scc/public_files/Manual/Pain,%20Agitation-sedation,%20Delirium
%20Protocol.pdf
Salary by State (2013). Registered Nurse ICU Salary By State. Retrieved from http://salarybystate.org/tag/icu-nurse-pay
Yousefi, H., Naderi, M., & Daryabeigi, R. (2015). The effect of sensory stimulation provided by family on arterial blood oxygen
saturation in critical care patients. Iranian Journal of Nursing and Midwifery Research, 20(1), 63-68.
Saadatmand, V., Rejeh, N., Heravi-Karimooi, M., Tadrisi, S. D., Zayeri, F., Vaismoradi, M., & Jasper, M. (2013). Enature-based sounds
intervention on agitation, anxiety, and stress in patients under mechanical ventilator support: A randomised controlled trial. International
Journal of Nursing Studies, 50, 895-904. doi: 10.1016/j.ijnurstu.2012.11.018