Patients receiving mechanical ventilation endure high levels of stress and anxiety due to the invasiveness of the procedure. These critically ill patients are often uncomfortable as a result of their serious conditions and the high-intensity environments in which they are placed. Health care workers heavily sedate these patients to minimize pain and induce a state of relaxation. However, sedatives are known for their wide-ranging, and often deleterious, side effects. Music therapy is an intervention that has been studied in a variety of hospital settings to determine any potential beneficial effects on patients. Many studies have demonstrated a relationship between music therapy and decreased anxiety levels. This thesis reviewed studies on outcomes of music therapy on anxiety in mechanically-ventilated patients. A total of 10 studies that addressed the use of music to decrease anxiety in ventilated patients were analyzed and incorporated into the literature review. The articles were selected from a variety of databases on EBSCOhost, including MEDLINE, PsycINFO, ScienceDirect, and CINAHL. The literature review provides positive evidence for the support of music therapy to help alleviate anxiety in mechanically-ventilated patients.

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Background: Delirium is a common condition in intensive care patients with symptoms such as confusion,hallucination, and insomnia. About 80% of patients admitted to the intensive care unit suffer fromdelirium, with an increased risk of mental and physical ill-health as a result. Identifying delirium in goodtime is a good prerequisite for both the care provider and the care recipient to reduce suffering incare. Purpose: The purpose of the literature study is to shed light on intensive care nurses' experience ofcaring for adult patients with delirium.Method: Literature study with a qualitative structured approach based on scientific articles. Results: Emerged from five subcategories and two categories describing the following: experience ofinadequacy and the time for recovery. Conclusion: Caring for delirious patients is time-consuming and stressful for intensive care nurses.Opportunities and conditions to be able to provide optimal care require an extent of less work-relatedstress and various trainings that identify delirium.

Background: Insufficient resources and dynamic infection control policies during the COVID-19 pandemic created a resource-strained environment which necessitated frontline Health Care Providers (HCPs) to make ethical decisions frequently. Many of these ethical decisions included allocating scarce resources to optimally prioritize patients, resources, and clinician time. The transition from usual patient-centred care to care centred around infection control mandates and rationing resources forced HCPs to balance competing demands while trying to uphold high standards of care. This research aimed to understand the resource allocation decisions HCPs had to navigate during the pandemic and the ethical considerations guiding them. Methods: Using a qualitative case study approach, we aimed to document the type of ethical decision, reasoning used, and the action frontline HCPs took during the pandemic. Twenty-five semi-structured interviews were conducted with multi-disciplinary HCPs employed in a single community Intensive Care Unit (ICU) in Ontario. Resource allocation decisions were extracted from the transcripts and were analyzed using conventional content analysis. Results: Resource allocation decisions within critical care practice were ubiquitous and diverse. The constraints imposed by the pandemic and multiple provincial and organizational policies formed the context that necessitated these decisions. HCPs drew upon a range of ethical theories, notably Utilitarianism and Virtue Ethics, while prioritizing HCP safety and patient well-being. Resulting actions included prioritizing clinical tasks, establishing boundaries, and adapting practice patterns. Although these situations commonly evoked stress and frustration amongst HCPs, some positive internal responses were also described, including feelings of self-efficacy, resourcefulness, and team cohesion. Conclusion: In conclusion, analysis of resource allocation-derived decision-making illuminated a variety of challenges that HCPs faced during the COVID-19 pandemic, driven by institutional policies and pragmatic limitations. Insights from this study underscore how these ethical decisions are an inherent part of clinical practice and have the potential to foster positive professional development amidst adversity. / Thesis / Master of Health Sciences (MSc) / During the COVID-19 pandemic, Health Care Providers (HCPs) faced difficult choices due to limited resources and evolving infection control rules. HCPs had to decide how to allocate scarce resources and balance competing demands while maintaining high standards of care. This research aimed to understand the types of resource allocation decisions HCPs made and the ethical considerations guiding them. Through twenty-five interviews with HCPs from an Intensive Care Unit in Ontario, we found that such decisions were both frequent and diverse. HCPs considered ethical theories like Utilitarianism and Virtue Ethics, prioritizing patient well-being and HCP safety. They often had to adapt their practices, establish boundaries, and determine priorities. Although these decisions caused stress and frustration, they also fostered team cohesion and personal growth. Overall, this research sheds light on some challenges HCPs faced during the COVID-19 pandemic and underscores the importance of preparing learners to navigate ethical decision-making in clinical practice.

京都大学 / 新制・論文博士 / 博士(人間健康科学) / 乙第13614号 / 論人健博第14号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 古田 真里枝, 教授 宮下 美香, 教授 片岡 仁美 / 学位規則第4条第2項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM