The use of antipsychotic medications in older adults with dementia increases risk of mortality; therefore, it is critical that nurses use nonpharmacological interventions in dementia care. The nurses' role is integral to implementation of treatment strategies to dementia patients and efforts to improve care in patients with dementia using a nonpharmacological approach are necessary. Therefore, guidelines outlining nonpharmacologic dementia care management will enable nurses to provide a wider spectrum of care to dementia patients. The purpose of this project was to make recommendations for the development and implementation of interdisciplinary practice guidelines to standardize care in the organizational setting. An integrative literature review was conducted using the Fineout-Overholt, Melnyk, Stillwell, and Williamson's analytical approach to reviewing evidence using 7 levels for evaluating the hierarchy of evidence. Inclusion criteria were limited to studies from January 2010 to October 2017 in English with full text. A total of 16 studies were reviewed and categorized according to 1 of the 7 hierarchical levels. Findings were summarized at each appropriate level and included systematic review or meta-analysis, randomized controlled trials, controlled trial without randomization, case-control or cohort studies, qualitative or descriptive studies and expert opinion or consensus. Non-pharmacological approaches including music therapy, cognitive-behavioral therapy, distraction, horticultural therapy, ear acupressure, and cognitive stimulation were all shown to be effective in dementia care. Social change based on this project targets improving nurses' knowledge of nonpharmacological interventions in dementia care.

Alzheimer's disease is a form of dementia associated with disturbing and disruptive behaviors that account for many negative health and well-being outcomes, including declines in functional status, social engagement, and physical activity (Lyketsos, 2007). These behavioral consequences diminish patients' quality of life (QoL) and increase caregiver burden and the cost of care, often ultimately necessitating that patients be placed in a nursing home (Murman and Colenda, 2005). Nature can profoundly affect people's health, well-being, and QoL; indeed, it is an old concept that the healing properties of nature can be used therapeutically. Accordingly, naturally restorative environmental (NRE) interventions stimulate one or more of the senses using natural things: elements of the earth that are living and animate, geographic, or solar and climatic (Gibson, Chalfont, Clarke, Torrington, and Sixsmith, 2007). For persons with dementia, interventions that incorporate NRE elements have demonstrated a variety of benefits, including decreased agitation; less use of psychotropic drugs); normalization of the circadian rhythm; and enhanced sociability, affect, cognitive capacity, and attention (Detweiler, Murphy, Kim, Meyers, and Ashai, 2009; Colenda, Cohen, McCall, and Rosenquist, 1997; LeGrace, 2002). Self-reported improvements in well-being, quality of life, and participation in meaningful activities have also been documented (Collins and O'Callaghan, 2008; Duggan, Blackman, Martyr, and Van Schaik, 2008; Nowak and Davis, 2011). Thus, NREs provide caregivers potential options for addressing physical, spiritual, psychological, and social needs, while at the same time, affecting behavioral responses. These widespread benefits justify further investigation and clarification. Despite the rich potential of NRE interventions for treating dementia, the research to support NRE use has not been synthesized and defined in terms of specific behaviors that may be affected, their dosage, the optimal NRE settings, and other specific characteristics. Further research is needed to develop the most effective interventions. The purpose of this dissertation is to produce a comprehensive meta-analysis of the studies, both published and unpublished, that detail the use of NRE in interventions for behaviors and QoL in dementia care. A meta-regression was conducted of moderator variables to guide development of NRE interventions for dementia care. Additionally, the characteristics of different types of programs were synthesized. Data from thirty three articles were pooled for effect size (ES) estimates on two outcomes: disruptive behaviors and quality of life. In two-group comparisons, treatment and control, an ES = 0.484 + .138, k= 17, CI (0.215, 0.745) favored the interpretation that disruptive behaviors were attenuated with NRE interventions. Findings were higher in single, pre- post-test design studies, with an ES= 0.758+ 0.109. k= 7, CI (0.544, 0.973) for diminishing disruptive behaviors. In the two-group comparisons assessing the quality of life outcome, the ES= 0.579 + 0.171, k= 10, CI (0.243, 0.915); for single group designs, the ES= 1.347+ 0.256, k=7, CI (0.020, 0.719). Thus both design analyses indicated improved measures of QoL for persons with dementia. Moderator analysis by type of NRE, two-group design, showed statistically significant lessening in disruptive behaviors using aromatherapy, but not bright light or horticulture therapy. Better QoL was shown independently by the moderators, aromatherapy and horticulture therapy, but not bright light therapy. When single group analysis was done for each type of NRE, they all independently showed significance for both behaviors and QoL; except there were no single group designs in AT or BLT. Despite the considerable heterogeneity of the interventions, individual moderators all showed potential benefits, in a variety of settings, and in different contexts.

The opioid epidemic in the United States continues to be a national health crisis affecting all populations. From 1999 to 2016, more than half a million people died from drug overdose. Nonpharmacological therapies are underused in nursing practice due to the gap in nurses' baseline knowledge and confidence related to nonpharmacological techniques for pain management. The purpose of this scholarly project was to develop and implement an expert-reviewed, evidence-based education program focused on nonpharmacological techniques for pain management. Participants included 18 registered nurses (RNs) from an orthopedic unit in a large academic medical center. A 45-minute educational session was conducted for RNs. A pre/postquestionnaire, including a 5-point Likert scale on nurses' self-perceived knowledge and confidence in using selected nonpharmacological techniques, was the method of data collection. Descriptive statistics were used to analyze the data. The results indicated an increase in nurses' self-perceived knowledge in all nonpharmacological techniques. The most significant increase in knowledge posteducation intervention was guided imagery with an increase of 72% in terms of the response Good. The data analysis indicates that the nurses self-perceived confidence posteducation intervention increased in terms of the response Good by 50 % and response Excellent by 33% demonstrating the efficacy of an evidence- based education program on nonpharmacological techniques. The implications of this project for social change include the empowerment of nurses to provide holistic patient-centered care, opioid sparing in keeping in alignment with patient safety, and the development of an evidence-based program that can be replicated in other settings.

The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices in healthcare settings may improve patient conditions such as pain and decrease the cost of healthcare. A wealth of literature can be found describing barriers and facilitators of evidence-based practice (EBP), and a movement in research has begun to focus on what influences the use of EBP. This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPP) using an existing data set of nurses and providers caring for children in the Emergency Department. Initial analysis found several significant correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and Magnet Status and EBNPP for nurse or providers. Nurse regression analyses showed knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the nurse and provider models. A pooled regression analysis with Registered Nurses and Providers found nurses had a significant increased use of EBNPP when compared to providers. Regression analyses found that while overall context is a significant predictor of EBNPP, no single element was significant when all three were added to the model. The effect of context on EBNPP did not differ by profession in this sample. Results of this study indicate that while context is important in the uptake of EBNPP, one area does not have more influence than another. The variables explored in this study account for 13% of the variance in EBNPP. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.

Infants in the NICU undergo many painful procedures and literature supports KMC as an effective intervention to diminish pain however, it is not used routinely in NICUs. The purpose of this qualitative study is to provide NICU nurses an opportunity to describe their experience of utilizing KMC for pain, and to interpret this experience with the goal of generating patterns that explain this understanding. The findings can be used to formulate interventions that foster the use of KMC. Using Interpretive Description as a philosophy of inquiry and research methodology, 8 NICU nurses were interviewed and participated in a focus group. Four patterns emerged: (1)”Seeing is Believing”; (2) Human Heartedness: “It’s the Least I can do”; (3) Playing it Safe; and (3) Creating the Possibility within Constraints.

Pain is a multidimensional experience that involves physical, emotional, and behavioral components. It is well documented that pain in children·has been treated inadequately for over 20 years. Pain medication is often inadequate to reduce pain and has potential negative side effects. This integrative literature review examines studies that test the effectiveness of nonpharmacological pain management strategies in pediatric patients. Nonpharmacological interventions have been shown to decrease pain, distress, and anxiety in children undergoing painful procedures, such as intravenous insertion, laceration repair and burn dressing changes. Distraction techniques including listening to music, watching cartoons, looking at books, and playing virtual reality games have been studied to determine their effectiveness in reducing pain, anxiety, and distress in children. Virtual reality was the most effective in decreasing pain and anxiety. The goal of this thesis is to establish the role of the nurse as an advocate, as well as explain different methods of nonpharmacological pain management that can be used along with analgesics. Finally, this thesis will encourage additional research on the undertreatment of pain in children with acute pain.

Chronic pain is a condition that impacts millions of men and women around the globe. It is a compelling disease that particularly impacts quality of life (QOL) for many veterans with undertreated or untreated pain. The focus of this systematic literature review was the appraisal of articles and clinical practice guidelines to better understand best-practice nonpharmacological strategies for management of chronic pain. Key words used in the literature search included chronic pain and veterans, complementary alternative medicine (yoga, tai chi, music therapy, acupuncture, and massage), and cognitive behavioral therapy (CBT). The articles included in the review were limited to those pertaining to adults over the age of 18 with non-cancer musculoskeletal chronic pain. The review excluded articles pertaining to patients reporting headache, cancer-related pain, fibromyalgia, mental health problems, or gynecological pain. Polit and Beck's levels of evidence were used to appraise each article. The Stetler model was used as the change model for this project. Thirty-six articles met the criteria and were included. Nine clinical practice guidelines were appraised. Four articles were pilot studies, 3 met the criteria for Evidence Levels V-VII, 3 met the criteria for Levels III-IV, 8 were Level II, and 18 were systematic reviews of randomized controlled trials (Level I). The analysis of evidence supported the use of yoga, CBT, acupuncture, and massage therapy as best-practice methods of personalized nonpharmacological pain management. This project is important for those who care for veterans and other adult chronic pain patients. Application of the findings may lead to changes in chronic pain management that will enhance social change and improve QOL for veterans and others living with untreated or undertreated chronic pain.

The presented work deals with the issue of non-pharmacological pain relief in patients with thermal trauma. Burn pain is considered to be one of the worst, unlike common surgical pain due to numerous surgical procedures and often large dressing changes. The basis of pain treatment is pharmacotherapy, but an important part are also non-pharmacological methods that can be applied by nurses. The main goal of the study was to find out which available and easy-to-use non- pharmacological methods of pain relief are the most effective according to burn patients. The partial goals were evaluating the impact of fear and anxiety on pain and the question of whether patients' pain is adequately managed. The author's questionnaire, which was partly based on a survey conducted among the patients themselves, was used for the research. A total of 98.3% of respondents gave a positive evaluation of the adequacy of analgesia. Apart from analgesics, the following methods were then identified as the most effective: undisturbed sleep, relief position, rest, close people visits and interviews with the caring staff. The research confirmed that apart from quality sleep human contact is the most important for pain relief. In addition to relieving pain, it also affects the mental state of patients and helps reduce the...

Cancer pain is a complex symptom that affects the quality of life of oncology patients, caregivers, and families. The limitations of pain management treatment for cancer patients can be attributed to the lack of knowledge and availability of nonpharmacological treatments. The purpose of this project was to identify and gather evidence on the effectiveness of nonpharmacological interventions in the treatment of cancer pain using the methodology of a systematic review. Watson's theory of human caring supported the project by incorporating the perception of treating the human being holistically during the illness process. The Johns Hopkins nursing evidence-based practice model provided a structured approach to address the practice problem and practice-focused question. The tools used to assess the quality and synthesize the findings of the studies were the Research and Evidence Appraisal Tool and the Synthesis Process and Recommendations Tool. The practice-focused question explored whether nonpharmacological interventions could be used to complement opioid treatments for cancer pain. A systematic review of the literature indicated 11 studies in which 2 interventions--music therapy and exercise--addressed the practice-focused question. Psychological distress, decreased physical function, and decreased involvement in social activities can all be attributed to the poor management of cancer pain. The study of alternatives to opioids could support social change by increasing the knowledge of healthcare professionals and the range of treatment options for pain management in cancer patients.

Yes / Objectives: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. Design and methods: Parallel group multi-centre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer’s, vascular or mixed dementia and mild-to-moderate cognitive impairment (MMSE score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received ten weekly sessions over three months and four maintenance sessions over six months. Participants were followed up three and nine months post-randomisation by blinded researchers. The primary outcome was self-reported goal attainment at three months. Secondary outcomes at three and nine months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition, and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR=281) were included in the intention to treat analysis at three months, and 426 (CR=208) at nine months. At three months there were statistically-significant large positive effects for participant-rated goal attainment (d=0.97, 95% CI 0.75 to 1.19), corroborated by informant ratings (d=1.11, 0.89 to 1.34). These effects were maintained at nine months for both participant (d=0.94, 0.71 to 1.17) and informant ratings (d=0.96, 0.73 to 1.2). The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: Cognitive rehabilitation enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy. / National Institute for Health, Health Technology Assessment Programme, Grant/Award Number: 11/15/04