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NON-PHARMACOLOGICAL INTERVENTIONS 23
NON-PHARMACOLOGICAL INTERVENTIONS FOR PAIN
MANAGEMENT
by
Mehrnoosh Ejlali
Evidence-based Practice Project
Submitted to the Faculty of NUR 49800 Capstone Course in
Nursing
College of Nursing
of Purdue University Northwest,
Hammond, Indiana
in partial fulfillment of course requirements for the degree of
Bachelor of Science
Month, 20xx
© copyright
Mehrnoosh Ejlali
2020
all rights reserved
acknowledgments
Begin optional acknowledgments here.
table of contents
SectionPage
acknowledgments iii
table of contents iv
abstract v
Sections
1. Introduction 6
2. Review of Literature and Synthesis of the Evidence 10
3. Plan for Implementation 21
4. Plan for Evaluation xx
5. Conclusions, Recommendations and Implications xx
references 34
appendices (If Applicable)
Appendix A – Put Title Here xx
List of tables
TablePage
Table 1 Summary of Reviewed
Evidence.......................................................................... 16
Table 2 Estimated Timetable Blueprint for
Implementation……………………………. 27
Table 3 Put Name of Table Here xx
ABSTRACT
Begin writing the abstract here. APA abstracts begin on margin
and do not indent. Please use headings in instructions
NON-PHARMACOLOGICAL INTERVENTIONS v
section 1
Non-pharmacological Interventions for Pain Management
Non-pharmacological involves the management of pain without
the use of medicines. However, this technique includes the
application of methods that alter a patient's thoughts. The
patient is enabled to concentrate on easy management and
reduction of pain. The arrangements show an essential benefit
in the control of pain. This chapter focuses on the purpose of
the non-pharmacological intervention, significance of the
Evidence-Based Practice Project (EBP), the potential outcomes
as well as clinical question applied.
Purpose
The purpose of this EBP is to develop an educational base that
might present non-pharmacological as well as pharmacological
intervention options for the management of pain. This is
intended to derive the benefits and risks associated with each
technique. The goal is to help the clinical officers by enabling
them to enlighten the patients on the best option that can be
adopted in the management of pain. Adult patients are reporting
a lack of satisfaction in their experiences to control pain. In
most cases, they record more expenses that are associated with
the pharmacological management of pain (Karabulut et al.,
2016). However, due to these statistics, the Legacy health care
center has decided to explore if the non-pharmacological are
safer and less expensive compared to pharmacological
interventions.
Perhaps one of the ways providers of health can manage the
pain of adult patients is by the introduction of less expensive
and safer methods. Besides, adult patients need education on
their options to boost their satisfaction as well as control in the
process. To contemplate the best techniques to be adopted on
the management of pain, research has proved that different
sufferings faced by patients need to be analyzed (Carr et al.,
2019). Legacy health care center intends to have an overview
that will provide pains faced by patients. The objective is to
explore the available approaches that patients require to manage
each pain with fewer costs.
This EBP project purpose to help patients to make the best
decision when selecting a non-pharmacological intervention. A
patient might want to eliminate the pain or even work with it.
Working with the illness will involve controlling the pain
during the recovery period, although the pain will still be
present. Eliminating the pain, on the other hand, consists in
controlling the pain at a manageable level that enables a patient
to undergo active recovery. Reducing the pain is only possible
through the use of pharmacological interventions, which indeed
is expensive to the majority of the citizens. Legacy health care
center would wish to assist patients to comprehend on the best
options to take in non-pharmacological responses and work with
the pain until recovery.
Relevance /Significance in Nursing
For the last five years, more than two million patients in a year
developed body pains with an approximation of ten percent of
the total dying as a result of pain and suffering (Connors et al.,
2018). Nurses need to be updated on better practices indicated
in research. Despite this, studies have concluded that pain
perception has been impacted by pain anticipated through
anxiety. The majority of nursing officers are less experienced in
non-pharmacological intervention practices. The practices are,
however, vital when managing and controlling pain in patients.
Notably, these practices should be in a position to help reduce
the suffering faced by patients due to body pain. During the
treatment of patients, nurses play a crucial role. The best way
they can be of assistance is through the provision of non-
pharmacological techniques. Nurses can help patients before
treatment by helping them to decide on the best options to adopt
in non-pharmacological methods.
During the patient's recovery, it wise for nurses to not only
provide advice on the best non-pharmacological methods but
also to aid in implementing these interventions (Cheung, 2019).
Therefore, a nurse will require to be equipped with knowledge
of non-pharmacological interventions to determine the best
experience that a patient needs. Nurses must manage the
physical and emotional pain of the patients. Nurses might want
to be well informed about current recommendations as well as
research on the management of pain before delivering the same
education to a patient. Studies have proved that knowledge
about pain interventions might minimize the patient's anxiety,
minimize pain experience, and boost overall satisfaction during
the recovery period of patients.
Adult patients have many options for pharmacological
interventions when managing pain. Nurses should be familiar
with all the approaches that help control pain and avoid the
suffering of patients. In fact, nurses should make their roles
active during their engagement with patients and notice their
desires to assist in educating them on available options to
manage pain. Research indicates that there is a need to evaluate
the current therapies in non-pharmacological interventions.
Legacy health care center suggests that nurses might depend on
the knowledge and skills to determine the efficiency of non-
pharmacological options for patients.
Potential Outcomes
Legacy health care center would like to evaluate the influence
in the implementation of non-pharmacological interventions in
the management of pain. The possible outcomes of the efforts
are to make patients safer and reduce their medication costs.
Clinical Question (PICO)
"In adult patients suffering pain, what is the effectiveness of
non-pharmacological treatment compared to pharmacological
treatment in controlling pain during the recovery period?"
Section 2
Introduction
This section focuses on the review of literature related to this
research. It explores a review of past studies done on non-
pharmacological interventions. Emphasis was on the adoption of
non-pharmacological treatments to adult patients. Besides, the
analysis depended on literature theories from books, research
papers, magazines, health reports, and information from the
Internet. Accurately, more attention was paid to scholar's
articles as well as those from health reports. Thus, the latter
seemed to explore more on the level to which non-
pharmacological treatment is effective compared to
pharmacological therapy.
Despite the study exploring a maximum of twelve sources,
systematic review concentrated on eight sources only. The four
sources eliminated had a lifespan of more than five years; thus,
they were considered not to have the most current evidence.
However, the eight sources used comprised of one source (5
years old), one source (4 years old), three references (3 years
old), two sources (2 years old), and one source (1-year-old).
Only three sources were from health reports, while the other
five (scholar articles) were extracted from Google scholar.
Evidence was generally narrowed from the eight sources,
clinical guidelines applied primarily in research, and opinion
made from the expertise gained.
Therefore, different themes were described as per the previous
authors depending on their contradictions and consistencies.
Results were used to identify the existing gaps in the studies;
thus, making them essential in the study. Besides, this section
covers the findings of the study, and later a well-illustrated
summary of the evidence was derived. The strategy of appraisal
was Melnyk's observational-analytic design level of proof.
Level I had three sources, level II two sources, level IV one
source, and level V two-source.
Review of Literature and Synthesis of Evidence
The paper's problem, intervention, as well as comparison and its
link to an outcome (PICO), involved the evaluation metrics
regarding groups on the issue non-pharmacological responses.
Primarily, this focused on a thirty-day experience in the
management of adult patients undergoing non-pharmacological
treatment. However, PICO elements involved in adult patients
(population); thus, examining the effectiveness of non-
pharmacological therapy, compared to pharmacological
treatment, in controlling pain during the recovery period.
Besides, the intervening interest in this involved the
effectiveness of reducing treatment costs to adult patients
through non-pharmacological treatment. Increased safety of
adult patients during their recovery period was pronounced as
the outcome. Therefore, there was the intent to minimize if not
end the use rate of pharmacological treatment in Legacy health
care, if possible, within a time limit of thirty days after
initiating a patient's recovery period.
However, to address the PICO questions, the literature review
was based on critical terms; that is, adult patients, non-
pharmacological intervention, pain management, and pain relief.
Concerning the health care projects, the focus was on Google
scholar articles, Cochrane Library, Virginia Henderson
International Nursing Library, and Nursing Reference Center
Plus database. Attention was based on this to bring different and
vital meaning when it comes to analyzing different categories of
non-pharmacological interventions.
Common Themes in the Literature Review
By analyzing the above databases, a reveal of common topics
was evident. These included raise in cognitive exercise, family
therapies as well as physical therapy impacts.
Raise of Cognitive Exercise
Studies reveal that cognitive exercise is positively impacted,
especially to adults suffering from depression pains. Cintoli et
al. (2019), says exercising groups need to undergo aerobic
training to reduce the pain caused in mind due to anxieties.
Adult patients underwent mental illness when recovering from
various diseases (Wexler, 2017). Therefore, there was
anticipation that the majority of adult patients participating in
cognitive exercises exhibit more significant improvements.
Hence, such individuals could not be compared to those
undergoing pharmacological medication. Despite cognitive tasks
having a substantial effect in relieving mental pain, it also
impacts positively on function ability on the brain (Edmond et
al., 2019). Brain training ability emerged to be the most form of
effective non-pharmacological intervention to relieve pain.
Family Therapies
Loneliness was identified to be a primary cause of mental pain
to adult patients. As Bucci et al. (2016) would say, anxiety and
isolation terminate older people when recovering from an
illness. Studies indicated that nurses did not provide adequate
medication to relieve pain to adult patients. As a result, adult
patients were encouraged to make close contact with family
members. In fact, in family therapy, patients share their feelings
and comfort from the family members' relief their pain (Edmond
et al., 2018). According to Chiasson et al. (2020), adult patients
with close family contacts boost their self-esteem: Hence, avoid
suicide attempts resulting from failure to endure pain. In
comparison, patients undergoing pharmacological treatments
fail to manage pain due to increased costs (Theleritis et al.,
2018); thus, prone to attempted suicide.
Physical Therapies Impacts
Physical activities improve adult quality to sleep; thus, helpi ng
them to avoid daily routines that trigger their pain. Poor
sleeping to adult patients influences the recovery process due to
inadequate pain management (Vancampfort et al., 2019).
Despite this, studies reveal that even disabled adult patients are
granted opportunities to exercise. Exercise programs are
initiated to help them relieve pain. Indeed, it was anticipated
that they contribute to cognitive practices. That is, the former
helps to reduce depression in the patient's mind. Ceballos-Laita
et al. (2019) would agree that pain management can never be
useful if one is undergoing depression and anxiety.
Consistencies and Contradictions in the Literature.
Wexler (2017), says non-pharmacological interventions in pain
management have been an alarming concern for adult patients.
Nurses have faced inadequate knowledge of initiating non-
pharmacological medications. Therefore, they have led to
failure in the consistency of pain management. Thus, Theleritis
et al. (2018) argue the ability of adult patients to reli eve pain is
reduced. Besides, minimal non-pharmacological interventions
are associated with high costs of Medicare (Bucci et al., 2016).
Despite this, confusion arises due to the failure to identify the
best approaches in the non-pharmacological intervention.
Existing Gaps in the Literature Review
The majority of review from the authors failed to focus on the
ways to be adopted to educate nurses with knowledge about
non-pharmacological treatment. Also, no distinction on the
specific approaches regarding non-pharmacological
interventions. In fact, no studies had indicated the adverse
effects of therapies undertaken in non-pharmacological
treatment. The authors failed to incorporate particular numerical
data on adult patients in need of non-pharmacological therapy.
According to Wexler (2017), there is a lack of public
information represented in pain management rates for adult
patients in different age brackets.
Findings
According to the review of literature, it is evident that
pharmacological treatment outweighs non-pharmacological
interventions. However, the majority of adult patients cannot
afford real medications due to high costs. Pharmacological
treatments are much more expensive and unsafe for adult
patients (Bucci et al., 2016). Either way, patients might want to
manage pain; hence results indicated that non-pharmacological
interventions were a practical approach to adult patients.
Chiasson et al. (2020) argue that nursing officers might want to
be equipped with skills in various non-pharmacological
intervention approaches.
PICO Question: "In adult patients suffering pain, what is the
effectiveness of non-pharmacological treatment compared to
pharmacological treatment in controlling pain during the
recovery period?"
Keywords: Adult patients, non-pharmacological intervention,
pain management, and pain relief.
Databases Searched: Google scholar articles, Cochrane Library,
Virginia Henderson International Nursing Library, and Nursing
Reference Center Plus database.
Table 1
Summary of Reviewed Evidence
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses, and Conclusions
Level of Evidence (LOE)
(Bucci et al., 2016)
Design:
Literature review
Setting:
Acute care
Sample:
N= 18 studies
Case studies
1. Pharmacological intervention has raised costs.
2. 12 reports represent inadequate care for adult patients
undergoing pharmacological treatment.
Strengths:
Analyzed studies were quality based on Clinician reports.
Weaknesses:
Some information omitted for confidentiality.
Conclusions:
Non-pharmacological intervention can improve adult patients
care and medication cost.
Level I
(Ceballos-Laita et al., 2019)
Design:
Literature review
Setting:
Patients checklists in various hospitals
Sample:
N= 17 studies
Single interventions in questionnaires
1. Pain management is less initiated through non-
pharmacological intervention.
Strengths:
Quality study intervention using questionnaires.
Weaknesses:
The information in the questionnaire might be inaccurate
Conclusions:
No certainty of details from some single intervention studies.
Level I
(Cintoli et al., 2019)
Design:
Cohort
prospective
study
Setting:
20 units
Case study
1. Suicidal cases of adult patients result from the inability to
endure pain.
Strengths:
More than 400 patients examined in the study.
Weaknesses:
No control in random selection.
Conclusions:
Intervening the patients called for a lot of care.
Level V
(Chiasson et al., 2020)
Design:
Clinical practice guideline
Setting
Quality improvement teams at six medical centers.
Sample
N=46 papers
Studies include expert opinion, systematic reviews, and
consensus recommendations.
1. Social networks encouraged as the primary approach to
family therapy.
Strengths:
Clinical experts developed the toolkit, which is recommended
by five other hospitals. Initiatives for quality improvement were
applied.
Weaknesses:
Data from six health care centers are eliminated from the
toolkit.
Conclusions:
The clinical guideline has considerable recommendations
valuable in implementation.
Level IV
(Edmond et al., 2018)
Design:
Literature review
Setting:
Readmission checklists in various hospitals
Sample:
N= 24 studies
Questionnaires single intervention.
1. Cognitive exercise outweighs other therapies.
Strengths:
Study interventions appraised of quality through the use of
questionnaires
Weaknesses:
The inaccuracy of data in polls.
Conclusions:
Some single intervention studies could not demonstrate impacts.
Level I
(Theleritis et al., 2019)
Design:
Clinician guidelines
Setting:
Worldwide settings
Sample:
N=27 hospitals
The survey, case series, and quasi-experiments
1. Adult Patients need to have support all through unhealthy
periods-based on the review
Strengths:
Highest level of evidence from clinical report and guidelines
Recommendation strength provided.
Weaknesses:
Psychological information from the case series might be pseudo.
Conclusions:
Interventions in the guidelines are recommended to be evidence-
based
Level V
(Vancampfort et al., 2019)
Design:
Cluster randomized controlled trial (RCT)
Setting:
Secondary hospitals
Sample:
N=28 different hospitals.
Demographic data collection tools
1. Inadequate facilities to offer non-pharmacological
interventions.
2. Less distinction in non-pharmacological response approaches.
Strengths:
Strength of patients undergoing the process. Thus, the advanced
technology used.
Weaknesses:
The small number leads to the irrelevance of information.
Conclusions:
Major significant effects after initiating random approaches.
Level II
(Wexler, 2017)
Design:
Clinician guidelines
Setting:
Worldwide settings
Sample:
N= 15 hospitals
Case series and quasi-experiments
1. Non-pharmacological interventions might favour any patient.
Including the disabled.
Strengths:
Highest level of evidence from clinical reports and guidelines.
Recommendation strength provided.
Weaknesses:
Psychological information seemed to be pseudo.
Conclusions:
Information analyzed must be demonstrated.
Level II
Section 3
Plan for Implementation
This section focuses on the project implementation by the
Legacy health care center relative to the EBP. The plan
encouraged a systematic review of the findings. Therefore,
Abbigail (RN facilitator) was involved in implementation
alongside other clinical officers. Following was a conference set
aside with Legacy health care center administration to enlighten
them on the intended plan of action. New members were
recruited for their readiness in the project. Adult patients were
expected to acquire information from the nurses regarding non-
pharmacological treatments. Adult patients were to share these
skills with the nursing officers within their initial stages of
recovery. Abbigail, the RN facilitator, encouraged a survey on
the adult patients undergoing non-pharmacological treatments.
Results from the study were used to analyze implementation
plan outcomes.
The RN facilitator deliberately introduced Promoting Action on
Research Implementation in Health Services (PARIHS) to make
EBP implementation effective. According to Ward et al. (2017),
PARIHS comprise of evidence, context, and facilitation. Based
on the framework, the proof was included in the phase for
stakeholders. Also, clinical experience, patients, and proj ect
research data were composed as evidence. The context
component in the framework represented the occupation or
ecosystem of implementing the practice. This context, according
to Rycroft-Malone (2010), would enable the consideration of
leadership and cultural dedication in Legacy health care center
while implanting EBP.
However, context features were discussed under the Legacy
health care center phase for organization structure
(organizational fit) and barriers for the implementation phase.
Facilitation involved relating to enable individuals to
contemplate strategies for the implementation of EBP.
Therefore, the procedure of facilitation would best be addressed
under the facilitation strategies for implementing EBP and the
phase of needed resources.
Stakeholders
Apart from Abbigail (RN facilitator), Legacy health care center
involved other stakeholders like clinical officers, government
firms obligated with health care implementation as well as the
patients undergoing both non-pharmacological and
pharmacological interventions. However, the target population
for the project was explicitly patients in need of non–
pharmacological interventions. As the study progressed, the
focus was on specific adult patients in need of non–
pharmacological treatments. This made the primary stakeholders
comprise of; The RN facilitator, adult patients only, and
assisting nurses who undertook the central role. However, less
significant stakeholders were the; patients managing the pain
but did not require non-pharmacological interventions,
physicians, insurance firms, as well as other employees.
The team offering therapies was persuaded to engineer the
project. The team involved individuals dealing with physical
and cognitive exercises for patients. An essential plan was
designed to help deliver treatments to adult patients without
future challenges in pain relief ways. As far as pain
management is concerned, I would say, adult patients, as well as
the nurses, were the most affected persons. Therefore, EBP
implementation deserved the two to be aware of it. This was
aimed at the practical application of non-pharmacological
therapies by nurses to adult patients. The best moment to be
mindful of this information was considered to be before the
initial stages of planning the implementa tion. Reasons being it
would limit and avoid inconveniences to both patents and
nurses.
Patient's and nurse's awareness was achieved through drafting a
proposal following the health guidelines and protocols
deserved. However, to maintain a legit study, the persuaded
group was involved in offering both internal and external
support. According to Stetler et al. (2011), allocation and
division of time into different phases were essential in the
PARIHS framework. The RN facilitator insisted on the periods
covering the initial paperwork of the EBP, its discussion with
the staff, administration as well as the rest of the team, until its
actual moments of implementation. A six-month time frame
with each task allocated different week periods was drafted by
the RN facilitator. Hence, beginning from May to September of
the same year (2019) (Refer to Table 2). The RN facilitator
indicated that the project proposal would be written within the
first week (05/01/2020 to 05/06/2020), discussed with the team
before approval (08/05/20 to 23/06/20), adjustments made
(06/25/2020 to 07/21/2020), and final implementation
(07/29/2020 to 09/07/2020).
Organizational Fit
Pain relief for patients is a crucial aspect, especially for adult
patients in the Legacy health care center. To ensure the
implementation plan was effective, RN facilitator aligned to the
mission, values, and primary goals of Legacy health care center.
The mission for Legacy health care center care focused on the
provision of outweighing care services regarding the health of
community persons. A task is vital as it results in the
facilitation of adequate standards of health to all in a society
(Mirvis, Googins, & Kinnicutt, 2010). With a well-defined
purpose, then the achievement of ABC's vision was evident and
depended as a core factor for effective plan implementation.
Legacy health care center implemented determination value,
respect value, integrity value, vision value, excellence value,
and nurturing value. The determination was to boost, respect the
needs of patients, show integrity through the persistence of
addressing issues, implement EBP through visions, excellently
focus on care for patients, and nurture their ecosystems for
more exceptional outcomes.
The integration of the aspects in Legacy health care center was,
as a result of earlier successful projects which applied the same
technique in the implementation plan. An EBP had been
implemented earlier in the Legacy health care center regarding
acupressure/acupuncture methods to relieve pain. This non-
pharmacological therapy involves the managing of pain in
different patients (Abraham, 2008). However, the
implementation plan for the EBP was effective due to the
coordination and following aspects of values, mission, and
vision of Legacy health care center. Despite this, strategies and
techniques were considered as an incentive to help implement
plans for non-pharmacological interventions.
Barriers to Implementation of EBP
The RN facilitator was aware of the potential primary obstacles
facing the Legacy health care center, like the lack of policies to
coordinate administration of non-pharmacological interventions.
Besides, lack of expertise and inadequate pieces of equipment
to facilitate physical therapies were recognized. The barriers
went further to limit the desire to grab the opportunities of
implementing or exercising the project proposals. The RN
facilitator stated that the efforts to eliminate the obstacles could
not be reflected. According to Dyeson (2005), obstacles in the
EBP plan for implementation arise due to assumptions of fewer
impacts on the same being too high.
The clinical officers could not easily cope with the sudden
dynamics in the Legacy health care center; thus, taking more
time to adapt to the new ecosystem. Although efforts and
strategies were later put in place to eliminate the barriers, this
took an extended time than expected. Conditioning the mind and
body to new activities require time to master the practices
(Kleinbongard et al., 2017). The RN facilitator (Abbigail) and
his assisting nurses in Legacy health care center were the most
connected with the barriers.
Facilitation Strategies for EBP Implementation
The RN facilitator discussed the strategies to be applied in the
plan, among them the establishment of a control system or
technique that is mutual to all clinicians in monitoring adult
patients in the Legacy health care center. As Klingbeil, &
Gibson (2018) would argue, a system act as a reminder to the
officials to consistently follow on the adult patients’ non-
pharmacological interventions, enabling them in pain relief.
Despite monitoring, the system would allow gaining patient's
feedback based on the outcome (therapies). The system was
introduced after a review of earlier feedbacks and intended to
improve the EBP implementation plan.
The team persuaded to offer support was to be guided on the
bases of clinical guidelines. This was to assist in following the
role of the project by maintaining but not veering off the
course. Individuals involved were allowed to acquire skills and
knowledgeable experience from EBP projects that had
previously occurred. The majority of the stakeholders
speculated and believed they would witness the success of the
implementation plan. As a result, the RN facilitator encouraged
the division of labor in which duties would be delegated
according to the unique skills of clinicians. According to Kizza
& Muliira (2015), this enabled each stakeholder to participated
and operated within his or her domain. Through these strategies,
the RN facilitator was satisfied that stakeholders involved were
convinced to work on implementing the EBP project.
Resources Needed
In full project implementation, the RN facilitator requested for
specific resources. As a resource, the cooperation of society
around the Legacy health care center was more significant.
Kleinbongard et al. (2017) say the peace of mind when
associated is a vital requirement in the project implementation.
Financial support could not be omitted in the project since
acquiring training, and reading facilities demanded finances.
Besides the technological gathering of information, the project
was backed by funds. Kizza & Muliira (2015) agrees that time
resources are much be appreciated when visiting and spending
time with the patients. Therefore, balancing time became
essential to make sure that all the requirements were attended to
at a higher rate. The people's cooperation and trust were earned
by letting them know the importance of this project.
Additionally, the RN facilitator deliberately suggested that time
could be gathered by strictly being in the right place when
required.
Table 2
Estimated Timetable Blueprint for Implementation
Task
Estimated Date
of Start
Estimated Date of Completion
Person/s Responsible
Considering the acceptance of the RN facilitator in the EBP
project before start-up.
05/01/2020(1 week)
05/06/2020
· Adult patients therapy team
· RN facilitator
· Clinical top executives
Allocation of support team roles.
Reviewing the roles depending on support team potentials.
05/08/2020 (1 week)
05/14/2020
· Adult patients therapy team
· RN facilitator
· Clinical top executives
Allocation of stakeholders to enable adjustment of possible
requirements when moving forward.
05/15/2020 (2 weeks)
05/28/2020
· Adult patients therapy team
· Clinical top executives
Evaluating the capability of the support team before
implementation.
06/02/2020 (1 week)
06/10/2020
· Adult patients therapy team
· RN facilitator
· Clinical top executives
Countercheck and approval of the evidence to be considered in
project implementation.
06/16/2020 (1 week)
06/23/2020
· RN facilitator
Analyzing possible modifications that can fit new strategies in
the EBP project.
06/25/2020 (1 week)
07/01/2020
· Adult patients therapy team
· RN facilitator
· Clinical top executives
Determine the appropriate approach to acquiring clinical
materials.
Prioritizing the most useful sources.
07/07/2020
(2 Consistent weeks)
07/21/2020
· Adult patients therapy team
Clinical guidelines allocation before
Extracting important materials.
07/29/2020 (1 week)
08/06/2020
· Adult patients therapy team
Visitation of adult patients undergoing therapies to explain the
essentiality of non-pharmacological interventions.
08/11/2020(4 weeks)
09/10/2020
· Adult patients therapy team
· Clinical top executives
Guidance of less-skilled stakeholders. Especially the primary
stakeholders.
09/14/2020 (2weeks)
09/29/2020
· Clinical top executives
section 4
Plan for Evaluation
Begin writing here.
Table 3
EBP Evaluation Plan
Outcome(s)
Measures/Measurement
Time of Collection/Person Responsible
section 5
Conclusions, Recommendations and Implications
Begin writing here.
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Chiasson, A., Brooks, A., Ricker, M., Lebensohn, P., Chen, M.
K., & Maizes, V. (2020). Educating Physicians in Family
Medicine Residencies about Nonpharmacologic Approaches to
Pain: Results of an Online Integrative Course. Family Medicine,
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Dyeson, T. B. (2005). Home health social work: Obstacles to
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Edmond, S. N., Becker, W. C., Driscoll, M. A., Decker, S. E.,
Higgins, D. M., Mattocks, K. M., & Haskell, S. G. (2018). Use
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Kizza, I. B., & Muliira, J. K. (2015). Nurses' pain assessment
practices with critically ill adult patients. Internatio nal nursing
review, 62(4), 573-582.
Karabulut, N., Gürçayır, D., & Aktaş, Y. Y. (2016). Non-
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Kleinbongard, P., Gedik, N., Stoian, L., Frey, U., Zandi, A.,
Thielmann, M., & Heusch, G. (2017). Cardioprotection by
Remote Ischemic Conditioning in Humans: Improved
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Trabeculae. Circulation, 136(suppl_1), A15363-A15363.
Klingbeil, C., & Gibson, C. (2018). The teach back project: a
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Mirvis, P., Googins, B., & Kinnicutt, S. (2010). Vision,
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Rycroft-Malone, J. (2010). Promoting action on research
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H. J. (2011). A guide for applying a revised version of the
PARIHS framework for implementation. Implementation
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Theleritis, C., Siarkos, K., Politis, A. A., Katirtzoglou, E., &
Politis, A. (2018). A systematic review of non‐ pharmacological
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Studies in Medicine, 7(3), 79-83.
APPENDICES
Begin here.
Infant Car Seat Safety & Car Seat Basics
· use scholarly sources and provide link to the website
· APA format
· Put information bullet points
· introduction
· Describe the selected topic and provide at least one statistic
supporting the importance of the topic.
· Statistics on how often parents do not strap infants in the car
seat correctly, percentage of infants that get injured due to them
not being correctly secured in the car seat (statistics on how it
prevents infant death and safety) This statistic must be from an
original scholarly source.
· Risk factors and benefits
· Compile 4 – 5 risks factors and/or benefits related to the topic
and explain them
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18-04-UA_REPORT_MEDIALITERAСY_INDEX-DM_23-1-final-eng.pdf
 

NON-PHARMACOLOGICAL INTERVENTIONS 23NON-PHARMACOLOGICAL

  • 1. NON-PHARMACOLOGICAL INTERVENTIONS 23 NON-PHARMACOLOGICAL INTERVENTIONS FOR PAIN MANAGEMENT by Mehrnoosh Ejlali Evidence-based Practice Project Submitted to the Faculty of NUR 49800 Capstone Course in Nursing College of Nursing of Purdue University Northwest, Hammond, Indiana in partial fulfillment of course requirements for the degree of Bachelor of Science Month, 20xx © copyright Mehrnoosh Ejlali 2020 all rights reserved acknowledgments
  • 2. Begin optional acknowledgments here. table of contents SectionPage acknowledgments iii table of contents iv abstract v Sections 1. Introduction 6 2. Review of Literature and Synthesis of the Evidence 10 3. Plan for Implementation 21 4. Plan for Evaluation xx 5. Conclusions, Recommendations and Implications xx references 34 appendices (If Applicable) Appendix A – Put Title Here xx List of tables TablePage Table 1 Summary of Reviewed Evidence.......................................................................... 16 Table 2 Estimated Timetable Blueprint for Implementation……………………………. 27 Table 3 Put Name of Table Here xx ABSTRACT Begin writing the abstract here. APA abstracts begin on margin and do not indent. Please use headings in instructions NON-PHARMACOLOGICAL INTERVENTIONS v section 1 Non-pharmacological Interventions for Pain Management Non-pharmacological involves the management of pain without
  • 3. the use of medicines. However, this technique includes the application of methods that alter a patient's thoughts. The patient is enabled to concentrate on easy management and reduction of pain. The arrangements show an essential benefit in the control of pain. This chapter focuses on the purpose of the non-pharmacological intervention, significance of the Evidence-Based Practice Project (EBP), the potential outcomes as well as clinical question applied. Purpose The purpose of this EBP is to develop an educational base that might present non-pharmacological as well as pharmacological intervention options for the management of pain. This is intended to derive the benefits and risks associated with each technique. The goal is to help the clinical officers by enabling them to enlighten the patients on the best option that can be adopted in the management of pain. Adult patients are reporting a lack of satisfaction in their experiences to control pain. In most cases, they record more expenses that are associated with the pharmacological management of pain (Karabulut et al., 2016). However, due to these statistics, the Legacy health care center has decided to explore if the non-pharmacological are safer and less expensive compared to pharmacological interventions. Perhaps one of the ways providers of health can manage the pain of adult patients is by the introduction of less expensive and safer methods. Besides, adult patients need education on their options to boost their satisfaction as well as control in the process. To contemplate the best techniques to be adopted on the management of pain, research has proved that different sufferings faced by patients need to be analyzed (Carr et al., 2019). Legacy health care center intends to have an overview that will provide pains faced by patients. The objective is to explore the available approaches that patients require to manage each pain with fewer costs. This EBP project purpose to help patients to make the best decision when selecting a non-pharmacological intervention. A
  • 4. patient might want to eliminate the pain or even work with it. Working with the illness will involve controlling the pain during the recovery period, although the pain will still be present. Eliminating the pain, on the other hand, consists in controlling the pain at a manageable level that enables a patient to undergo active recovery. Reducing the pain is only possible through the use of pharmacological interventions, which indeed is expensive to the majority of the citizens. Legacy health care center would wish to assist patients to comprehend on the best options to take in non-pharmacological responses and work with the pain until recovery. Relevance /Significance in Nursing For the last five years, more than two million patients in a year developed body pains with an approximation of ten percent of the total dying as a result of pain and suffering (Connors et al., 2018). Nurses need to be updated on better practices indicated in research. Despite this, studies have concluded that pain perception has been impacted by pain anticipated through anxiety. The majority of nursing officers are less experienced in non-pharmacological intervention practices. The practices are, however, vital when managing and controlling pain in patients. Notably, these practices should be in a position to help reduce the suffering faced by patients due to body pain. During the treatment of patients, nurses play a crucial role. The best way they can be of assistance is through the provision of non- pharmacological techniques. Nurses can help patients before treatment by helping them to decide on the best options to adopt in non-pharmacological methods. During the patient's recovery, it wise for nurses to not only provide advice on the best non-pharmacological methods but also to aid in implementing these interventions (Cheung, 2019). Therefore, a nurse will require to be equipped with knowledge of non-pharmacological interventions to determine the best experience that a patient needs. Nurses must manage the physical and emotional pain of the patients. Nurses might want to be well informed about current recommendations as well as
  • 5. research on the management of pain before delivering the same education to a patient. Studies have proved that knowledge about pain interventions might minimize the patient's anxiety, minimize pain experience, and boost overall satisfaction during the recovery period of patients. Adult patients have many options for pharmacological interventions when managing pain. Nurses should be familiar with all the approaches that help control pain and avoid the suffering of patients. In fact, nurses should make their roles active during their engagement with patients and notice their desires to assist in educating them on available options to manage pain. Research indicates that there is a need to evaluate the current therapies in non-pharmacological interventions. Legacy health care center suggests that nurses might depend on the knowledge and skills to determine the efficiency of non- pharmacological options for patients. Potential Outcomes Legacy health care center would like to evaluate the influence in the implementation of non-pharmacological interventions in the management of pain. The possible outcomes of the efforts are to make patients safer and reduce their medication costs. Clinical Question (PICO) "In adult patients suffering pain, what is the effectiveness of non-pharmacological treatment compared to pharmacological treatment in controlling pain during the recovery period?" Section 2 Introduction This section focuses on the review of literature related to this research. It explores a review of past studies done on non-
  • 6. pharmacological interventions. Emphasis was on the adoption of non-pharmacological treatments to adult patients. Besides, the analysis depended on literature theories from books, research papers, magazines, health reports, and information from the Internet. Accurately, more attention was paid to scholar's articles as well as those from health reports. Thus, the latter seemed to explore more on the level to which non- pharmacological treatment is effective compared to pharmacological therapy. Despite the study exploring a maximum of twelve sources, systematic review concentrated on eight sources only. The four sources eliminated had a lifespan of more than five years; thus, they were considered not to have the most current evidence. However, the eight sources used comprised of one source (5 years old), one source (4 years old), three references (3 years old), two sources (2 years old), and one source (1-year-old). Only three sources were from health reports, while the other five (scholar articles) were extracted from Google scholar. Evidence was generally narrowed from the eight sources, clinical guidelines applied primarily in research, and opinion made from the expertise gained. Therefore, different themes were described as per the previous authors depending on their contradictions and consistencies. Results were used to identify the existing gaps in the studies; thus, making them essential in the study. Besides, this section covers the findings of the study, and later a well-illustrated summary of the evidence was derived. The strategy of appraisal was Melnyk's observational-analytic design level of proof. Level I had three sources, level II two sources, level IV one source, and level V two-source. Review of Literature and Synthesis of Evidence The paper's problem, intervention, as well as comparison and its link to an outcome (PICO), involved the evaluation metrics regarding groups on the issue non-pharmacological responses. Primarily, this focused on a thirty-day experience in the management of adult patients undergoing non-pharmacological
  • 7. treatment. However, PICO elements involved in adult patients (population); thus, examining the effectiveness of non- pharmacological therapy, compared to pharmacological treatment, in controlling pain during the recovery period. Besides, the intervening interest in this involved the effectiveness of reducing treatment costs to adult patients through non-pharmacological treatment. Increased safety of adult patients during their recovery period was pronounced as the outcome. Therefore, there was the intent to minimize if not end the use rate of pharmacological treatment in Legacy health care, if possible, within a time limit of thirty days after initiating a patient's recovery period. However, to address the PICO questions, the literature review was based on critical terms; that is, adult patients, non- pharmacological intervention, pain management, and pain relief. Concerning the health care projects, the focus was on Google scholar articles, Cochrane Library, Virginia Henderson International Nursing Library, and Nursing Reference Center Plus database. Attention was based on this to bring different and vital meaning when it comes to analyzing different categories of non-pharmacological interventions. Common Themes in the Literature Review By analyzing the above databases, a reveal of common topics was evident. These included raise in cognitive exercise, family therapies as well as physical therapy impacts. Raise of Cognitive Exercise Studies reveal that cognitive exercise is positively impacted, especially to adults suffering from depression pains. Cintoli et al. (2019), says exercising groups need to undergo aerobic training to reduce the pain caused in mind due to anxieties. Adult patients underwent mental illness when recovering from various diseases (Wexler, 2017). Therefore, there was anticipation that the majority of adult patients participating in cognitive exercises exhibit more significant improvements.
  • 8. Hence, such individuals could not be compared to those undergoing pharmacological medication. Despite cognitive tasks having a substantial effect in relieving mental pain, it also impacts positively on function ability on the brain (Edmond et al., 2019). Brain training ability emerged to be the most form of effective non-pharmacological intervention to relieve pain. Family Therapies Loneliness was identified to be a primary cause of mental pain to adult patients. As Bucci et al. (2016) would say, anxiety and isolation terminate older people when recovering from an illness. Studies indicated that nurses did not provide adequate medication to relieve pain to adult patients. As a result, adult patients were encouraged to make close contact with family members. In fact, in family therapy, patients share their feelings and comfort from the family members' relief their pain (Edmond et al., 2018). According to Chiasson et al. (2020), adult patients with close family contacts boost their self-esteem: Hence, avoid suicide attempts resulting from failure to endure pain. In comparison, patients undergoing pharmacological treatments fail to manage pain due to increased costs (Theleritis et al., 2018); thus, prone to attempted suicide. Physical Therapies Impacts Physical activities improve adult quality to sleep; thus, helpi ng them to avoid daily routines that trigger their pain. Poor sleeping to adult patients influences the recovery process due to inadequate pain management (Vancampfort et al., 2019). Despite this, studies reveal that even disabled adult patients are granted opportunities to exercise. Exercise programs are initiated to help them relieve pain. Indeed, it was anticipated that they contribute to cognitive practices. That is, the former helps to reduce depression in the patient's mind. Ceballos-Laita et al. (2019) would agree that pain management can never be useful if one is undergoing depression and anxiety. Consistencies and Contradictions in the Literature.
  • 9. Wexler (2017), says non-pharmacological interventions in pain management have been an alarming concern for adult patients. Nurses have faced inadequate knowledge of initiating non- pharmacological medications. Therefore, they have led to failure in the consistency of pain management. Thus, Theleritis et al. (2018) argue the ability of adult patients to reli eve pain is reduced. Besides, minimal non-pharmacological interventions are associated with high costs of Medicare (Bucci et al., 2016). Despite this, confusion arises due to the failure to identify the best approaches in the non-pharmacological intervention. Existing Gaps in the Literature Review The majority of review from the authors failed to focus on the ways to be adopted to educate nurses with knowledge about non-pharmacological treatment. Also, no distinction on the specific approaches regarding non-pharmacological interventions. In fact, no studies had indicated the adverse effects of therapies undertaken in non-pharmacological treatment. The authors failed to incorporate particular numerical data on adult patients in need of non-pharmacological therapy. According to Wexler (2017), there is a lack of public information represented in pain management rates for adult patients in different age brackets. Findings According to the review of literature, it is evident that pharmacological treatment outweighs non-pharmacological interventions. However, the majority of adult patients cannot afford real medications due to high costs. Pharmacological treatments are much more expensive and unsafe for adult patients (Bucci et al., 2016). Either way, patients might want to manage pain; hence results indicated that non-pharmacological interventions were a practical approach to adult patients. Chiasson et al. (2020) argue that nursing officers might want to be equipped with skills in various non-pharmacological intervention approaches. PICO Question: "In adult patients suffering pain, what is the effectiveness of non-pharmacological treatment compared to
  • 10. pharmacological treatment in controlling pain during the recovery period?" Keywords: Adult patients, non-pharmacological intervention, pain management, and pain relief. Databases Searched: Google scholar articles, Cochrane Library, Virginia Henderson International Nursing Library, and Nursing Reference Center Plus database. Table 1 Summary of Reviewed Evidence Author(s) and Date of Publication ONLY Sample/Setting/ Design Data Collection Tools Findings/Results Appraisal of Evidence: Worth to Practice include Strengths, Weaknesses, and Conclusions Level of Evidence (LOE) (Bucci et al., 2016) Design: Literature review Setting: Acute care Sample:
  • 11. N= 18 studies Case studies 1. Pharmacological intervention has raised costs. 2. 12 reports represent inadequate care for adult patients undergoing pharmacological treatment. Strengths: Analyzed studies were quality based on Clinician reports. Weaknesses: Some information omitted for confidentiality. Conclusions: Non-pharmacological intervention can improve adult patients care and medication cost. Level I (Ceballos-Laita et al., 2019) Design: Literature review Setting: Patients checklists in various hospitals Sample: N= 17 studies Single interventions in questionnaires 1. Pain management is less initiated through non- pharmacological intervention. Strengths: Quality study intervention using questionnaires. Weaknesses: The information in the questionnaire might be inaccurate Conclusions: No certainty of details from some single intervention studies. Level I (Cintoli et al., 2019) Design: Cohort prospective
  • 12. study Setting: 20 units Case study 1. Suicidal cases of adult patients result from the inability to endure pain. Strengths: More than 400 patients examined in the study. Weaknesses: No control in random selection. Conclusions: Intervening the patients called for a lot of care. Level V (Chiasson et al., 2020) Design: Clinical practice guideline Setting Quality improvement teams at six medical centers. Sample N=46 papers Studies include expert opinion, systematic reviews, and consensus recommendations. 1. Social networks encouraged as the primary approach to family therapy. Strengths: Clinical experts developed the toolkit, which is recommended by five other hospitals. Initiatives for quality improvement were applied. Weaknesses: Data from six health care centers are eliminated from the toolkit. Conclusions: The clinical guideline has considerable recommendations valuable in implementation. Level IV
  • 13. (Edmond et al., 2018) Design: Literature review Setting: Readmission checklists in various hospitals Sample: N= 24 studies Questionnaires single intervention. 1. Cognitive exercise outweighs other therapies. Strengths: Study interventions appraised of quality through the use of questionnaires Weaknesses: The inaccuracy of data in polls. Conclusions: Some single intervention studies could not demonstrate impacts. Level I (Theleritis et al., 2019) Design: Clinician guidelines Setting: Worldwide settings Sample: N=27 hospitals The survey, case series, and quasi-experiments 1. Adult Patients need to have support all through unhealthy periods-based on the review Strengths: Highest level of evidence from clinical report and guidelines Recommendation strength provided. Weaknesses: Psychological information from the case series might be pseudo.
  • 14. Conclusions: Interventions in the guidelines are recommended to be evidence- based Level V (Vancampfort et al., 2019) Design: Cluster randomized controlled trial (RCT) Setting: Secondary hospitals Sample: N=28 different hospitals. Demographic data collection tools 1. Inadequate facilities to offer non-pharmacological interventions. 2. Less distinction in non-pharmacological response approaches. Strengths: Strength of patients undergoing the process. Thus, the advanced technology used. Weaknesses: The small number leads to the irrelevance of information. Conclusions: Major significant effects after initiating random approaches. Level II (Wexler, 2017) Design: Clinician guidelines Setting: Worldwide settings Sample: N= 15 hospitals Case series and quasi-experiments 1. Non-pharmacological interventions might favour any patient. Including the disabled.
  • 15. Strengths: Highest level of evidence from clinical reports and guidelines. Recommendation strength provided. Weaknesses: Psychological information seemed to be pseudo. Conclusions: Information analyzed must be demonstrated. Level II Section 3 Plan for Implementation This section focuses on the project implementation by the Legacy health care center relative to the EBP. The plan encouraged a systematic review of the findings. Therefore, Abbigail (RN facilitator) was involved in implementation alongside other clinical officers. Following was a conference set aside with Legacy health care center administration to enlighten them on the intended plan of action. New members were recruited for their readiness in the project. Adult patients were expected to acquire information from the nurses regarding non- pharmacological treatments. Adult patients were to share these skills with the nursing officers within their initial stages of recovery. Abbigail, the RN facilitator, encouraged a survey on the adult patients undergoing non-pharmacological treatments. Results from the study were used to analyze implementation plan outcomes. The RN facilitator deliberately introduced Promoting Action on Research Implementation in Health Services (PARIHS) to make EBP implementation effective. According to Ward et al. (2017), PARIHS comprise of evidence, context, and facilitation. Based on the framework, the proof was included in the phase for
  • 16. stakeholders. Also, clinical experience, patients, and proj ect research data were composed as evidence. The context component in the framework represented the occupation or ecosystem of implementing the practice. This context, according to Rycroft-Malone (2010), would enable the consideration of leadership and cultural dedication in Legacy health care center while implanting EBP. However, context features were discussed under the Legacy health care center phase for organization structure (organizational fit) and barriers for the implementation phase. Facilitation involved relating to enable individuals to contemplate strategies for the implementation of EBP. Therefore, the procedure of facilitation would best be addressed under the facilitation strategies for implementing EBP and the phase of needed resources. Stakeholders Apart from Abbigail (RN facilitator), Legacy health care center involved other stakeholders like clinical officers, government firms obligated with health care implementation as well as the patients undergoing both non-pharmacological and pharmacological interventions. However, the target population for the project was explicitly patients in need of non– pharmacological interventions. As the study progressed, the focus was on specific adult patients in need of non– pharmacological treatments. This made the primary stakeholders comprise of; The RN facilitator, adult patients only, and assisting nurses who undertook the central role. However, less significant stakeholders were the; patients managing the pain but did not require non-pharmacological interventions, physicians, insurance firms, as well as other employees. The team offering therapies was persuaded to engineer the project. The team involved individuals dealing with physical and cognitive exercises for patients. An essential plan was designed to help deliver treatments to adult patients without future challenges in pain relief ways. As far as pain management is concerned, I would say, adult patients, as well as
  • 17. the nurses, were the most affected persons. Therefore, EBP implementation deserved the two to be aware of it. This was aimed at the practical application of non-pharmacological therapies by nurses to adult patients. The best moment to be mindful of this information was considered to be before the initial stages of planning the implementa tion. Reasons being it would limit and avoid inconveniences to both patents and nurses. Patient's and nurse's awareness was achieved through drafting a proposal following the health guidelines and protocols deserved. However, to maintain a legit study, the persuaded group was involved in offering both internal and external support. According to Stetler et al. (2011), allocation and division of time into different phases were essential in the PARIHS framework. The RN facilitator insisted on the periods covering the initial paperwork of the EBP, its discussion with the staff, administration as well as the rest of the team, until its actual moments of implementation. A six-month time frame with each task allocated different week periods was drafted by the RN facilitator. Hence, beginning from May to September of the same year (2019) (Refer to Table 2). The RN facilitator indicated that the project proposal would be written within the first week (05/01/2020 to 05/06/2020), discussed with the team before approval (08/05/20 to 23/06/20), adjustments made (06/25/2020 to 07/21/2020), and final implementation (07/29/2020 to 09/07/2020). Organizational Fit Pain relief for patients is a crucial aspect, especially for adult patients in the Legacy health care center. To ensure the implementation plan was effective, RN facilitator aligned to the mission, values, and primary goals of Legacy health care center. The mission for Legacy health care center care focused on the provision of outweighing care services regarding the health of community persons. A task is vital as it results in the facilitation of adequate standards of health to all in a society (Mirvis, Googins, & Kinnicutt, 2010). With a well-defined
  • 18. purpose, then the achievement of ABC's vision was evident and depended as a core factor for effective plan implementation. Legacy health care center implemented determination value, respect value, integrity value, vision value, excellence value, and nurturing value. The determination was to boost, respect the needs of patients, show integrity through the persistence of addressing issues, implement EBP through visions, excellently focus on care for patients, and nurture their ecosystems for more exceptional outcomes. The integration of the aspects in Legacy health care center was, as a result of earlier successful projects which applied the same technique in the implementation plan. An EBP had been implemented earlier in the Legacy health care center regarding acupressure/acupuncture methods to relieve pain. This non- pharmacological therapy involves the managing of pain in different patients (Abraham, 2008). However, the implementation plan for the EBP was effective due to the coordination and following aspects of values, mission, and vision of Legacy health care center. Despite this, strategies and techniques were considered as an incentive to help implement plans for non-pharmacological interventions. Barriers to Implementation of EBP The RN facilitator was aware of the potential primary obstacles facing the Legacy health care center, like the lack of policies to coordinate administration of non-pharmacological interventions. Besides, lack of expertise and inadequate pieces of equipment to facilitate physical therapies were recognized. The barriers went further to limit the desire to grab the opportunities of implementing or exercising the project proposals. The RN facilitator stated that the efforts to eliminate the obstacles could not be reflected. According to Dyeson (2005), obstacles in the EBP plan for implementation arise due to assumptions of fewer impacts on the same being too high. The clinical officers could not easily cope with the sudden dynamics in the Legacy health care center; thus, taking more time to adapt to the new ecosystem. Although efforts and
  • 19. strategies were later put in place to eliminate the barriers, this took an extended time than expected. Conditioning the mind and body to new activities require time to master the practices (Kleinbongard et al., 2017). The RN facilitator (Abbigail) and his assisting nurses in Legacy health care center were the most connected with the barriers. Facilitation Strategies for EBP Implementation The RN facilitator discussed the strategies to be applied in the plan, among them the establishment of a control system or technique that is mutual to all clinicians in monitoring adult patients in the Legacy health care center. As Klingbeil, & Gibson (2018) would argue, a system act as a reminder to the officials to consistently follow on the adult patients’ non- pharmacological interventions, enabling them in pain relief. Despite monitoring, the system would allow gaining patient's feedback based on the outcome (therapies). The system was introduced after a review of earlier feedbacks and intended to improve the EBP implementation plan. The team persuaded to offer support was to be guided on the bases of clinical guidelines. This was to assist in following the role of the project by maintaining but not veering off the course. Individuals involved were allowed to acquire skills and knowledgeable experience from EBP projects that had previously occurred. The majority of the stakeholders speculated and believed they would witness the success of the implementation plan. As a result, the RN facilitator encouraged the division of labor in which duties would be delegated according to the unique skills of clinicians. According to Kizza & Muliira (2015), this enabled each stakeholder to participated and operated within his or her domain. Through these strategies, the RN facilitator was satisfied that stakeholders involved were convinced to work on implementing the EBP project. Resources Needed In full project implementation, the RN facilitator requested for
  • 20. specific resources. As a resource, the cooperation of society around the Legacy health care center was more significant. Kleinbongard et al. (2017) say the peace of mind when associated is a vital requirement in the project implementation. Financial support could not be omitted in the project since acquiring training, and reading facilities demanded finances. Besides the technological gathering of information, the project was backed by funds. Kizza & Muliira (2015) agrees that time resources are much be appreciated when visiting and spending time with the patients. Therefore, balancing time became essential to make sure that all the requirements were attended to at a higher rate. The people's cooperation and trust were earned by letting them know the importance of this project. Additionally, the RN facilitator deliberately suggested that time could be gathered by strictly being in the right place when required. Table 2 Estimated Timetable Blueprint for Implementation Task Estimated Date of Start Estimated Date of Completion
  • 21. Person/s Responsible Considering the acceptance of the RN facilitator in the EBP project before start-up. 05/01/2020(1 week) 05/06/2020 · Adult patients therapy team · RN facilitator · Clinical top executives Allocation of support team roles. Reviewing the roles depending on support team potentials. 05/08/2020 (1 week) 05/14/2020 · Adult patients therapy team · RN facilitator · Clinical top executives Allocation of stakeholders to enable adjustment of possible requirements when moving forward. 05/15/2020 (2 weeks) 05/28/2020 · Adult patients therapy team · Clinical top executives Evaluating the capability of the support team before implementation. 06/02/2020 (1 week) 06/10/2020 · Adult patients therapy team · RN facilitator · Clinical top executives Countercheck and approval of the evidence to be considered in project implementation. 06/16/2020 (1 week)
  • 22. 06/23/2020 · RN facilitator Analyzing possible modifications that can fit new strategies in the EBP project. 06/25/2020 (1 week) 07/01/2020 · Adult patients therapy team · RN facilitator · Clinical top executives Determine the appropriate approach to acquiring clinical materials. Prioritizing the most useful sources. 07/07/2020 (2 Consistent weeks) 07/21/2020 · Adult patients therapy team Clinical guidelines allocation before Extracting important materials. 07/29/2020 (1 week) 08/06/2020 · Adult patients therapy team Visitation of adult patients undergoing therapies to explain the essentiality of non-pharmacological interventions. 08/11/2020(4 weeks) 09/10/2020 · Adult patients therapy team · Clinical top executives Guidance of less-skilled stakeholders. Especially the primary stakeholders. 09/14/2020 (2weeks)
  • 23. 09/29/2020 · Clinical top executives section 4 Plan for Evaluation Begin writing here. Table 3 EBP Evaluation Plan Outcome(s) Measures/Measurement Time of Collection/Person Responsible
  • 24. section 5 Conclusions, Recommendations and Implications Begin writing here. References Abraham, J. (2008). Acupressure and acupuncture in preventing and managing postoperative nausea and vomiting in adults. Journal of perioperative practice, 18(12), 543-551. Bucci, S., Berry, K., Barrowclough, C., & Haddock, G. (2016). Family interventions in psychosis: a review of the evidence and barriers to implementation. Australian Psychologist, 51(1), 62- 68. Connors, M. H., Quinto, L., McKeith, I., Brodaty, H., Allan, L., Bamford, C., & O'Brien, J. T. (2018). Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychological medicine,48(11), 1749-1758. Carr, D., Elissa Charbonneau, D. O., Tedra Cleveland, M. S. H. A., Senelick, R. C., & Stillo, J. (2019). Non-Pharmacological Pain Management Interventions. Birmingham: Encompass Health Corporation. 1241-1428. Ceballos-Laita, L., Estébanez-de-Miguel, E., Martín-Nieto, G., Bueno-Gracia, E., Fortún-Agúd, M., & Jiménez-del-Barrio, S. (2019). Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review.
  • 25. Complementary therapies in medicine, 42, 214-222. Cintoli, S., Radicchi, C., Noale, M., Maggi, S., Meucci, G., Tognoni, G., & Maffei, L. (2019). Effects of combined training on neuropsychiatric symptoms and quality of life in patients with cognitive decline. Aging clinical and experimental research, 1-9. Cheung, A. (2019). The Importance of Non-Pharmacological Pain Management in Pediatric Palliative Care (Doctoral dissertation, Azusa Pacific University). 358-711. Chiasson, A., Brooks, A., Ricker, M., Lebensohn, P., Chen, M. K., & Maizes, V. (2020). Educating Physicians in Family Medicine Residencies about Nonpharmacologic Approaches to Pain: Results of an Online Integrative Course. Family Medicine, 52(3), 189-197. Dyeson, T. B. (2005). Home health social work: Obstacles to evidence-based practice. Home Health Care Management & Practice, 17(4), 316-319. Edmond, S. N., Becker, W. C., Driscoll, M. A., Decker, S. E., Higgins, D. M., Mattocks, K. M., & Haskell, S. G. (2018). Use of non-pharmacological pain treatment modalities among veterans with chronic pain: results from a cross-sectional survey. Journal of general internal medicine, 33(1), 54-60. Kizza, I. B., & Muliira, J. K. (2015). Nurses' pain assessment practices with critically ill adult patients. Internatio nal nursing review, 62(4), 573-582. Karabulut, N., Gürçayır, D., & Aktaş, Y. Y. (2016). Non- pharmacological interventions for pain management used by nursing students in Turkey. Kontakt, 18(1), e22-e29. Kleinbongard, P., Gedik, N., Stoian, L., Frey, U., Zandi, A., Thielmann, M., & Heusch, G. (2017). Cardioprotection by Remote Ischemic Conditioning in Humans: Improved Contractile Function and Mitochondrial Respiration of Atrial Trabeculae. Circulation, 136(suppl_1), A15363-A15363. Klingbeil, C., & Gibson, C. (2018). The teach back project: a system-wide evidence based practice implementation. Journal of pediatric nursing, 42, 81-85.
  • 26. Mirvis, P., Googins, B., & Kinnicutt, S. (2010). Vision, mission, values. Organizational Dynamics, 39(4), 316. Rycroft-Malone, J. (2010). Promoting action on research implementation in health services (PARIHS). Models and frameworks for implementing evidence-based practice: linking evidence to action, 109, 135. Stetler, C. B., Damschroder, L. J., Helfrich, C. D., & Hagedorn, H. J. (2011). A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science, 6(1), 99. Theleritis, C., Siarkos, K., Politis, A. A., Katirtzoglou, E., & Politis, A. (2018). A systematic review of non‐ pharmacological treatments for apathy in dementia. International journal of geriatric psychiatry, 33(2), e177-e192. Vancampfort, D., Firth, J., Correll, C. U., Solmi, M., Siskind, D., De Hert, M., & Stubbs, B. (2019). The impact of pharmacological and non‐ pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐ review of meta‐ analyses of randomized controlled trials. World Psychiatry, 18(1), 53-66. Ward, M. M., Baloh, J., Zhu, X., & Stewart, G. L. (2017). Promoting Action on Research Implementation in Health Services framework applied to Team STEPPS implementation in small rural hospitals. Health care management review, 42(1), 2. Wexler, B. E. (2017). Non-pharmacologic interventions for the management of cognitive symptoms. Johns Hopkins Advanced Studies in Medicine, 7(3), 79-83.
  • 27. APPENDICES Begin here. Infant Car Seat Safety & Car Seat Basics · use scholarly sources and provide link to the website · APA format · Put information bullet points · introduction · Describe the selected topic and provide at least one statistic supporting the importance of the topic. · Statistics on how often parents do not strap infants in the car seat correctly, percentage of infants that get injured due to them not being correctly secured in the car seat (statistics on how it prevents infant death and safety) This statistic must be from an original scholarly source. · Risk factors and benefits · Compile 4 – 5 risks factors and/or benefits related to the topic and explain them