Evidence-Based Practice Assignment Part 2
Patients undergoing palliative care undergoes pain and are unable to tolerate the pharmacological adverse effects of the copious amount of medicines ingested every day.
Thus, non-pharmacological methods such as music therapy are discussed as a replacement towards patients undergoing palliative care, reducing or eliminating the idea of medication to ease the pain. This brings about the question: Does music therapy helps with pain relief in patients undergoing palliative care? This assignment will thus cover the appraisal, implementation, the barriers to music therapy in palliative care patients.
Appraising the evidence
An article from Joanna Briggs Institute (Coelho, Parola, Cardoso, Bravo & Apóstolo, 2017), answers to the question of whether music therapy helps in alleviating pain in patients undergoing palliative care. This article is a systematic review and talks about the pain, anxiety, stress, fatigue of patients undergoing palliative care through the usage of non-pharmacological methods such as massage therapy and music therapy.
It contains research from quantitative, qualitative and systematic reviews addressing the improvement of the comfort level of patients undergoing palliative care with non-pharmacological methods. This is in relation to our question of whether non-pharmacological methods helps in alleviating pain. A limited comprehensive search using reliable databases such as MED-LINE (via PubMed), CINAHL, JBI Database Of Systematic Reviews and Implementation Reports, and articles from unpublished data was done with the search of keywords pain, suffering, well-being palliative, with the results obtained similarly to each other. Evidence obtained from the systematic review has three or more randomized control trials that are of good quality and have similar results. In the hierarchy of the level of evidence in evidence-based practice (Ahmad, Chinoy & Tayyab, 2014), it is the level I evidence, the highest grade of recommendation.
Evidence obtained from the article is beneficial as the subjects used in the study has a similar criterion to the population that is in the questionable question.
The second piece of the article obtained from Cochrane library (Warth et al., 2014), the article talks about using music therapy to palliative patients, promoting their psychological and physiological relaxation. This is a randomized controlled trial in which a sample of 84 participants from a palliative care unit were randomized to 30 minutes of either two sessions of music therapy or two sessions of a verbal relaxation exercise, with none of them knowing which of the two interventions were the experimental condition, thus eliminating the chances of a psychological placebo effect on the participants.
Using a computer-based permutation for the generation of randomization, everyone has an equal chance to participate in the experiment, eliminating the chances of selection bias.
This addresses the different non-pharmacological methodology for reducing pain in palliative care patients, giving a fair comparison and judgment to the patients undergoing the experiment.
Summary of best practice
After an extensive review of the two articles, there were several key findings in which music therapy was shown to have a significant reduction in pain in palliative care patients and improving their comfort level.
The article from Johanna Briggs Institute (Coelho, Parola, Cardoso, Bravo & Apóstolo, 2017) suggested using systematic reviews to obtain the best practice to answer the questionable question of whether music therapy helps in alleviating pain in elderly patients, whereas the article from Cochrane library (Warth et al., 2014) suggested using a randomized group clinical test, to better obtain accurate results.
Strategies for implementation
Equipped with the knowledge that music therapy helps with alleviating pain in palliative care patients, nurses in the hospital setting can make an evidence-based decision when intervening with a patient who has a high pain score.
However, implementation within a ward is complicated. Hence, the author would like to present to the nurse manager to support the practice change.
Naturally, there are barriers that may cause difficulties in implementing music therapy in palliative care patients.
Examples of the barriers are high drop-out rates of the patients, lack of compliance to implement music therapy.
To overcome these barriers, an education session should be held to talk about the positive effects of music therapy, followed by statistics to further support the evidence. This gives the nurses a better understanding of music therapy and is more compliant to use music therapy to alleviate pain. The education session can also teach to the nurses about what type of patients should music therapy be given to. Such examples would be patients who experience constant pain with a moderate pain score according to the Wong-Baker Faces pain rating and is a long-time patient in the palliative care setting, having to be in the ward for at least 3 days. This is to reduce the high drop-out rates of the patients, thus allowing the patients to experience a longer period of music therapy to have an effect on music therapy.
This essay has sought to promote a well-searched evidence to improve the current clinical practice of alleviating pain through music therapy, a non-pharmacological method. The writer plans to implement 2 hourly music therapy to palliative care patients with moderate pain and has been in the ward for more than 3 days, to help in alleviating pain in patients. Possible barriers to promote EBP and strategies to overcome them has been deliberated for the evidence to be successfully implemented.
Ahmad, T., Chinoy, M., & Tayyab, M. (2014). Using levels of evidence to compare clinical
impact from research. Journal Of Evidence-Based Medicine, 7(1), 38-44. doi: 10.1111/jebm.12085
Coelho, A., Parola, V., Cardoso, D., Bravo, M., & Apóstolo, J. (2017). Use of non-
pharmacological interventions for comforting patients in palliative care. JBI Database Of Systematic Reviews And Implementation Reports, 15(7), 1867-1904. doi: 10.11124/jbisrir-2016-003204
Warth, M., Kessler, J., Koenig, J., Wormit, A. F., Hillecke, T. K., & Bardenheuer, H. J.
(2014). Music therapy to promote psychological and physiological relaxation in palliative care patients: protocol of a randomized controlled trial. BMC Palliative Care, 13, 60. http://doi.org.libproxy.nyp.edu.sg/10.1186/1472-684X-13-60