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.

Creating a collaborative environment to care for complex patients and families.

Today's critical care environment is increasingly complex due to technological advancements, greater intensity of interventions, and a myriad of healthcare providers. Critically ill patients and their families can feel overwhelmed with the stress of the environment in addition to the acute illness. This stress affects the patients' and families' ability to function, cope, and understand complex information. For some families, this experience precipitates distrustful relationships with care providers. The resulting impact on quality of care, staff morale, length of stay, and cost is high. The purpose of this article is to describe issues encountered by one medical center in caring for complex patients and families. A representative case outlines the types of issues the staff in the adult intensive care units faced. Use of a comprehensive problem-solving model to address concerns resulted in structured approaches to guide healthcare providers in caring for complex patients and families. The goal of these approaches was to support all parties involved in the care of complex patients, improve communication, and avoid crises that resulted from distrustful relationships and lack of skill in resolving conflict.

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.

Force exertion in awkward working postures--strength capability while twisting or working overhead.

Isometric strength data have been collected for three of the awkward work situations often imposed by workplace constraints in industry, as found in jobs such as maintenance and repair. The effects of the task layout factors (location of the workpiece, reach distance and direction of force exertion) were investigated and the data has been tabulated to show the degree to which strength may be reduced in different situations. Strength measurements in the present study were found to be considerably higher than previous measurements, apparently due to differences in instructions on foot placement that were given to subjects, which indicates that even small constraints on posture within the workplace may have large effects on the ability to exert force.

Strength capability while kneeling.

Work sometimes has to be carried out kneeling, particularly where jobs are performed in confined spaces as is common for miners, aircraft baggage handlers and maintenance workers. In order to assess the risks in performing forceful tasks under such conditions, data is needed on strength capabilities of kneeling subjects. A study was undertaken to measure isometric strength in single-handed exertions for male subjects and to investigate the effects on this of task layout factors (direction of force exertion, reach distance, height of the workpiece and orientation relative to the subject's sagittal plane). The data has been tabulated to show the degree to which strength may be reduced in different situations and analysis of the task factors showed their influence to be complex with direction of exertion and reach distance having the greatest effect. The results also suggest that exertions are weaker when subjects are kneeling on two knees than when kneeling on one knee, although this needs to be confirmed by direct experimental comparison.

Peer review of nursing research proposals.

The grant review process that operationalizes peer review for the critique, scoring, approval, and selection of research grants for funding may intimidate a novice reviewer. This article describes the peer review panel and process of grant review, specifies the role and responsibilities of the reviewer in the review session, and presents considerations for the evaluation of proposals and the preparation of a written critique. A sample critique is provided.

Overcoming the obstacles to research-based clinical practice.

The utilization of research findings in the practice of critical care nursing is essential to obtain optimal patient outcomes. However, the speed and extent to which new research-based findings are applied to clinical practice falls short of expectations. The authors identify obstacles to the timely utilization of research. Strategies to overcome the obstacles to research-based clinical practice are presented.

Developing nursing guidelines for the PTCA patient.

Developing guidelines for the care of complicated patients is not an easy task. This article describes how a group of critical care nurses produced guidelines for the nursing care of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Guidelines are important in guiding nursing actions without the legal restrictions implicit in using standards.

Loads on the body during static tasks: software incorporating the posture targetting method.

The biomechanical evaluation of loads on the body is one of the tools that facilitate the assessment of manual handling tasks. A computer program has been developed to determine moments about joints during static tasks. It differentiates between flexion/ extension, rotation and adduction/abduction requirements so that the major efforts can be identified and compared with population strength data. It also evaluates loads on the spine and within low-back muscles for purposes of comparison with many manual handling studies. Posture and a variety of external forces are input to the system with a choice of two interchangeable methods: one uses a 'CODA' scanner for on-line posture recording in the laboratory, the other is 'posture targetting', a pen-and-paper method adapted for the computer.

A biomechanical manikin for the evaluation of loads on the body.

A simple tool to evaluate loads at body joints is described. Its function is to analyse static tasks performed in the sagittal plane. It consists of an articulated plastic manikin placed in the required posture on a magnetic board. The manikin has a set of scales which indicate moments of forces around the elbow, shoulder, lumbosacral or knee joints generated by any force exertion. The readings take into account several percentiles of stature and body weight and any value and direction of force applied in the task. A graph also provides an estimate of the intervertebral compression forces.

Three-dimensional force model of the low-back for simple computer programming.

A three-dimensional static model is described to evaluate the forces on low-back muscles and on the spine during manual handling tasks and other forceful activities. It is simple to use either with a calculator or programmed onto a micro-computer, whilst being more accurate than existing simple models. Comparisons are made with a more sophisticated model that requires mathematical libraries and programming skills. As predictions are similar, so is the area of validity: the proposed model's accuracy is good for light tasks but poorer for strenuous ones.

The geometry of the muscles of the lumbar spine determined by magnetic resonance imaging.

Magnetic Resonance Imaging (MRI) is a new multiplanar imaging technique that clearly demonstrates soft tissue anatomy. The lumbar spines of 26 males have been scanned. From the transverse scans, the position and cross-sectional areas of the muscles of the lumbar region were recorded. Regression analysis was performed to relate these values to trunk measurements and body weight. Sagittal scans were used to measure the angles to the vertical of the lumbar discs and of the skin overlying the spinous processes. The position of each lumbar disc relative to two skin points was measured. These parameters can then be used in biochemical calculations of low-back forces.