Biomedical subjects

L Chlan

Publications and source records attributed to L Chlan.

9 recordsLinked to original sources

PubMed2001

Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy.

BACKGROUND: Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. OBJECTIVES: To determine if nurses' personal beliefs about and attitudes toward critical illness and their goals for sedation influence the nurses' sedative practice, to discover whether social factors influence sedative therapy, and to describe the processes that nurses use to assess patients' need for sedative therapy. METHODS: Audiotapes of focus group interviews with 5 groups of 34 experienced medical and surgical intensive care unit nurses from 2 hospitals were transcribed verbatim. Two investigators independently analyzed the verbatim text, and a sample of the participants validated the category summaries and interpretations. RESULTS: Patients' family members can affect sedative practice directly or indirectly, and demands for efficient delivery of care can influence sedative therapy. Primary indications for sedation included patients' comfort and amnesia and prevention of patients' self-injurious behaviors. Conflicts between physicians and nurses arose when explicit and shared goals for sedation were lacking. Participants noted that numerous factors impede routine use of sedation protocols even though use of the protocols may improve communication and promote uniformity of sedative practice. CONCLUSION: Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.

Critical Illness↗

PubMed1999

Music therapy.

Nurses have used music as an intervention for many years. A sizeable number of investigations to determine the efficacy of music in managing pain, in decreasing anxiety and aggressive behaviors, and in improving performance and well-being have been conducted by nurses and other health professionals. Nursing and non-nursing research reports published between the years 1980-1997 were reviewed. Great variation existed in the type of musical selection used, the dose of the intervention (number of sessions and length exposure), the populations studied, and the methodologies used. Overall, music was found to be effective in producing positive outcomes.

Anxiety↗

PubMed1999

Music therapy in critical care: indications and guidelines for intervention.

Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

Adult↗

PubMed1998

Promoting adherence to an electronic home spirometry research program after lung transplantation.

Adherence with any long-term treatment or research protocol is a challenge; this has been found to be the case with lung transplant recipients participating in an electronic home spirometry research program. Because the purpose of the current study is to develop a system for detecting early infection and rejection in lung transplant recipients, regular transmission of data by subjects to the research data center is imperative to the success of the study. Various adherence-promoting strategies have been developed by the research team to increase subject adherence with the program. An increased adherence rate has been reported after implementation of these various strategies, yet work remains to promote continually regular participation in the program by all subjects. It remains a challenge for the research team to devise creative and effective strategies for increasing adherence to regular spirometer use to provide data to develop a computerized system for detecting early infection and rejection of transplanted lung tissue.

Algorithms↗

PubMed1998

Home monitoring of pulmonary function.

The use of healthcare technology in homes is increasing. This article details an electronic home spirometry unit used by lung transplant patients. The unit can also be used with other populations including persons with asthma or cystic fibrosis, or persons awaiting transplants. Home health nurses are in a prime position to assist patients in using technology that provides direction for the treatment regimen.

Community Health Nursing↗

PubMedDate not supplied

Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance.

OBJECTIVE: To test the effects of music therapy on relaxation and anxiety reduction for patients receiving ventilatory assistance. DESIGN: Two-group, pretest-posttest experimental design with repeated measures. Subjects randomized to either a 30-minute music condition or a rest period. SETTING: Four urban midwestern intensive care units. SUBJECTS: Fifty-four alert, nonsedated patients receiving mechanical ventilation. OUTCOME MEASURES: State anxiety (pretest and posttest), heart rate, and respiratory rate obtained every 5 minutes for 30 minutes. RESULTS: Subjects who received music therapy reported significantly less anxiety posttest (10.1) than those subjects in the control group (16.2). Heart rate and respiratory rate decreased over time for those subjects in the music group as compared with the control group subjects. CONCLUSIONS: A single music therapy session was found to be effective for decreasing anxiety and promoting relaxation, as indicated by decreases in heart rate and respiratory rate over the intervention period with this sample of patients receiving ventilatory assistance.

Adolescent↗

PubMedDate not supplied

Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy.

Screening flexible sigmoidoscopy (FS) is an effective tool for the detection of colon cancer. Nonetheless, persons are reluctant to undergo FS for a variety of reasons such as anxiety, discomfort, and the possibility of abnormal findings. Nurses caring for FS patients can implement interventions to allay anxiety and promote comfort in an effort to enhance satisfaction and future compliance. Music therapy is one nonpharmacologic intervention that has been shown to be effective in allaying anxiety, reducing discomfort, and promoting satisfaction in other patient populations. A two-group pretest, posttest experimental design with repeated measures study recruited 64 subjects undergoing FS from one Midwestern tertiary care center. Subjects were randomly assigned to a control condition of usual procedural care or to an experimental condition of music therapy during the examination. State and trait anxieties were measured at pretest. State anxiety, discomfort, satisfaction, and perceived compliance with future screening were measured after the procedure. Subjects in the music group reported less anxiety and discomfort than subjects in the control group. There were no differences on satisfaction ratings or perceived compliance with screening guidelines. Nurses caring for patients undergoing screening FS can offer music therapy as one nonpharmacologic intervention to ameliorate anxiety and reduce discomfort.

Analysis of Variance↗

PubMedDate not supplied

Monitoring progress after lung transplantation from home-patient adherence.

A paperless electronic spirometer/diary instrument has been employed in a home monitoring programme for lung and heart-lung transplant patients at the University of Minnesota. The monitoring programme is part of a long term study to develop a system which will detect the earliest signs of developing rejection or infection in the transplanted organs. It is based on patient daily self-measurements of standard spirometry, vital signs, and symptoms recorded at home and transmitted weekly to the study data center over the telephone using a modern built into the instrument. This report summarizes adherence behaviour for 41 subjects enrolled in the study over a 12 month period. The number of subjects from whom home data has been received each week was used to measure adherence at the subject level. The number of records received each week measured adherence at the daily recording level. A data record consists of a daily set of spirometry, vital signs, and symptom values from a given subject. Approximately 82% of subjects transmitted records each week, over the 52 week review period. There was an average of 4.5 records received each week from each subject. Transmitted records had missing vital sign or symptom items in less than 2% of cases, spirometry data was always present. This evaluation showed than lung transplant recipients are willing and able to use a home-monitoring instrument, and that basic spirometry, data entry, and data transmission can be performed satisfactorily.

Adolescent↗

PubMedDate not supplied

Feasibility of a music intervention protocol for patients receiving mechanical ventilatory support.

CONTEXT: Music has been found to be an effective nonpharmacologic adjunct for managing anxiety and promoting relaxation in limited trials of critically ill patients receiving mechanical ventilation. No data are available to determine the effect of the intervention over repeated trials or to determine whether patients or staff will use music intervention independently. OBJECTIVE: To test the feasibility of a patient-initiated music intervention protocol over a 3-day trial and to discern the associated barriers to adherence by study participants and nursing staff. DESIGN: Descriptive pilot study. SETTING: Two adult critical care units contained in 1 university-affiliated tertiary care center in the urban Midwest. PATIENTS: Five alert, critically ill adults receiving mechanical ventilatory support. INTERVENTION: Patient-selected music listening via audiotapes and head-phones with frequency and length of session determined by each patient. MAIN OUTCOME MEASURES: Anxiety, heart rate, respiratory rate, blood pressure, and identified barriers to protocol adherence. RESULTS: Subjects averaged 2 self-initiated music interventions (mode = 3; range = 1-5) and listened for an average of 67.8 minutes per session (SD 34.3; mode = 50; range = 25-120 minutes). Barriers to this intervention included inaccessibility of the equipment and lack of knowledge and experience of the nursing staff. Due to missing data, physiological measures were not interpretable. CONCLUSIONS: Patient-initiated music is a feasible intervention protocol: subjects were able to request music independently and nursing staff were cooperative. Findings will be used in future studies to refine the protocol and attendant measures to implement music intervention in the critical care setting and to develop detailed staff education materials.

Adult↗