Generating Evidence of Critical Care Nurses' Perceptions, Knowledge, Beliefs, and Use of Music Therapy, Aromatherapy, and Guided Imagery.

BACKGROUND: Critical care settings are known to be fast-paced and technologically advanced. To optimize humanistic care, integration of evidence-based complementary and alternative therapies holds promise. However, evidence of critical care nurses' use of complementary and alternative therapies in clinical practice has not been evaluated recently. OBJECTIVES: This study sought to determine critical care nurses' perspectives of music therapy, aromatherapy, and guided imagery (GI) including perceptions of legitimacy, self-reported knowledge, interest in gaining knowledge, beliefs of harm/benefits, professional use, personal use, recommendations for use in critical care practice, and requests for these therapies by critical care patients or families. METHODS: A descriptive cross-sectional design with repeated measures was conducted with critical care nurses (N = 53) practicing in 3 intensive care units at a Midwestern academic-affiliated medical center. The nurses' current perceptions, knowledge, beliefs, and use of music therapy, aromatherapy, and GI were assessed. In addition, an evaluation of the consistency of participants' responses using the Critical Care Nurses' Use of Complementary Therapies survey was performed on a subset of the sample (n = 15) at 2 time points 4 to 6 weeks apart. RESULTS: Most nurses (66%-83%) endorsed the legitimacy of these therapies for use with their patients. Nurses had the most knowledge of aromatherapy, followed by music therapy and GI; they showed interest in gaining further knowledge of the therapies even when reporting "some" to "a lot" of knowledge. Nurses showed a positive response regarding their beliefs about the benefits of each therapy. Professional use was highest for aromatherapy (85%), followed by music therapy (75%), corresponding with greater self-reported knowledge and personal use. A majority recommended aromatherapy (79%) and music therapy in practice (64%) and reported that these therapies were requested by patients or families. Responses on the survey items at 2 time points of administration showed consistency. DISCUSSION: On the basis of the overall survey responses, developing a robust scientific base and addressing educational needs through expanding resources and continuing education programs may promote use of these therapies to benefit patients in critical care.

Part II: The Effects of Aromatherapy and Guided Imagery for the Symptom Management of Anxiety, Pain, and Insomnia in Critically Ill Patients: An Integrative Review of Current Literature.

This review is part II of a 2-part series that presents evidence on the effectiveness of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in adult critically ill patients. Evidence from this review supports the use of aromatherapy for management of pain, insomnia, and anxiety in critically ill patients. Evidence also supports the use of guided imagery for managing these symptoms in critical care; however, the evidence is sparse, mixed, and weak. More studies with larger samples and stronger designs are needed to further establish efficacy of guided imagery for the management of anxiety, pain, and insomnia of critically ill patients; to accomplish this, standardized evidence-based intervention protocols to ensure comparability and to establish optimal effectiveness are needed. Discussion and recommendations related to the use of these therapies in practice and needs for future research in these areas were generated.

Part I: The Effects of Music for the Symptom Management of Anxiety, Pain, and Insomnia in Critically Ill Patients: An Integrative Review of Current Literature.

Critical care environments are known for provoking anxiety, pain, and sleeplessness. Often, these symptoms are attributed to patients' underlying physiological conditions; life-sustaining or life-prolonging treatments such as ventilators, invasive procedures, tubes, and monitoring lines; and noise and the fast-paced technological nature of the critical care environment. This, in turn, possibly increases length of stay and morbidity and challenges the recovery and healing of critically ill patients. Complementary therapies can be used as adjunctive therapies alongside pharmacological interventions and modalities. One complementary therapy with promise in critical care for improving symptoms of anxiety, pain, and sleeplessness is music. A review of current literature from Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and PubMed was conducted to examine the evidence for the use of this complementary therapy in critical care settings. This review presents the evidence on effectiveness of music for the symptom management of anxiety, pain, and insomnia in critically ill adult patients. The evidence from this review supports music in symptom management of pain, insomnia, and anxiety in critically ill patients. This review provides practice recommendations, generates dialog, and promotes future research. This review is part I of a 2-part series that focuses on evidence for use of music, aromatherapy and guided imagery for improving anxiety, pain, and sleeplessness of patients in critically ill patients.