The dnp project: evidence-based intervention | NURSING | Chamberlain College of Nursing

PICOT Question:

In adult oncology patients at an infusion Center at Queens Hospital Center, does the implementation of a music therapy program compared to current practice, impact pain scores during chemotherapy over 8-10 weeks?

Please discuss your evidence-based intervention and the rationale behind choosing this option.

 The evidence-based intervention for the proposed project is implementing therapeutic music to reduce pain scores among cancer patients. Pain is the most reported complaint among cancer patients and is inadequately controlled with current treatment modalities (Behzadmehr et al., 2020; Fernando et al., 2019; Yangoz & Ozer, 2019). Complementary and alternative medicine interventions are getting more popularity and acceptance among cancer patients (Behzadmehr et al., 2020; Fernando et al., 2019). The healing power of music has been well recognized in many cultures for several centuries and is used to cure the disorders of mind and body (Schnieider,2018; Spilioti et al., 2017). Music is beneficial, safe, and economical adjuvant treatment modality and is frequently used in palliative care (Bro et al., 2019; Li et al., 2020). Additionally, music is a universal language, which produces phenomena of music-induced analgesia ( Lu et al., 2019) and positively influences physical and emotional symptoms of cancer ( Bro et al., 2019). In other words, music distracts unpleasant symptoms, promotes expressing their inner feelings, and causes reduction of anxiety, depression, and pain (Antoich et al., 2020; Li et al., 2020; Sibanda et al., 2018; Spilioti et al., 2017). Furthermore, listening to favorite music reduces pain perception and feeling of well-being secondary to the release of dopamine and serotonin (Antoich et al., 2020; Sibanda et al., 2018; Wurjatmiko,2019). Music stimulates the limbic system to release endorphins and parasympathetic system activation and leads to relaxation of the body and natural analgesia (Antoich et al., 2020; Sibanda et al., 2018; Wurjatmiko,2019). Strong neuroscientific evidence of music-induced analgesia is revealed with the help of real-time functional magnetic imaging, which showed unique brain activation for subjects in pain while listening to music (Li et al., 2020). Also, the study (Li et al., 2020) found a very promising fact that subjects in pain listening to music also developed activation of descending pain pathway and dorsal gray matter of spinal cord, which causes diminished pain perception. In short, music is a beneficial, safe, and economical adjuvant treatment modality and is recommended in cancer pain management (Bro et al., 2019; Li et al., 2020; Wurjatmiko, 2019; Yangoz and Ozer, 2019).

  There is robust research evidence to support the use of music as an adjunct non-pharmacological intervention. An extensive systematic review by Wurjatmiko (2019) and another systematic review and meta-analysis by Yangoz and Ozer (2019) revealed music reduces cancer pain. Both studies strongly support using passive listening of nonlyrical/ instrumental music from a CD player using earphones to reduce pain. The music selection in the reviewed studies was different ( Wurjatmiko, 2019; Yangoz and Ozer, 2019), and Wurjatmiko (2019) concluded from the reviewed evidence that using soft melodic music with a tempo of 60 to 80 beats per minute is therapeutic in reducing pain. Poulsen and Coto (2018) also found closely similar findings after an extensive literature search and formulated a music protocol that nurses could quickly adapt to manage pain. Even though nurses appreciate the benefits and scientific evidence of many multi-modal treatment modalities for cancer pain management, use is limited secondary to lack of resources, knowledge, and clinical care coordination (Erol et al., 2018; Rini et al., 2017). The DNP student is highly motivated to implement this evidence-based intervention to improve the pain scores of adult cancer patients at the practicum site.

Did you consider the needs of the project site? Did you feel the resources available at the site and the potential cost? What about buy-in from stakeholders for your chosen intervention?

 The practicum site manages cancer pain with opioids and invasive procedures when appropriate. The DNP student identified gaps in cancer pain management after carefully evaluating the data extracted from medical records. Poorly controlled cancer pain adversely affects the patient outcome and subsequent poor quality of life. In addition, frequent emergency room visits and prolonged hospitalization negatively influence patient satisfaction scores and causes an incredible financial burden to the hospital. Stakeholders agree with implementing evidence-based interventions to improve cancer pain management and are extremely pleased with the proposed project. Currently, the practicum site provides resources such as conference rooms, computers, projectors, office space, and nursing staff. The DNP student is buying MP3 players, earphones, and office supplies. There are no funds or grants allotted for this project. Stakeholders are excited to know the project’s outcome and convey their interest in sustaining this evidence-based intervention.

Provide your instructor and student colleagues with an update on your implementation plans for your DNP Project. Share any successes, challenges, or barriers you experienced this week.

 This week, I spent most of my time doing literature analysis and preparing John Hopkin’s table. I also spend many hours discussing with stakeholders about the implementation plan and facing some challenges to get all the key stakeholders together. I am trying hard to put everything together and keep up with the flow.

References

Antioch, I., Furuta, T., Uchikawa, R., Okumura, M., Otogoto, J., Kondo, E., Sogawa, N., Ciobica, A., & Tomida, M. (2020).

favorite music mediates pain-related responses in the anterior cingulate cortex and skin pain thresholds

. Journal of Pain Research, Volume 13, 2729–2737. https://doi.org/10.2147/jpr.s276274 (Links to an external site.)

Behzadmehr, R., Dastyar, N., Moghadam, M., Abavisani, M., & Moradi, M. (2020). Complementary and alternative medicine interventions on cancer-related pain among breast cancer patients: A systematic review. Complementary Therapies in Medicine, 49, 102318. https://doi.org/10.1016/j.ctim.2020.102318 (Links to an external site.)

Bro, M., Jespersen, K., Hansen, J., Vuust, P., Abildgaard, N., Gram, J., & Johansen, C. (2017). Kind of blue: A systematic review and meta-analysis of music interventions in cancer treatment. Psycho-Oncology, 27(2), 386–400. https://doi.org/10.1002/pon.4470 (Links to an external site.)

Erol, O., Unsar, S., Yacan, L., Pelin, M., Kurt, S., & Erdogan, B. (2018). Pain experiences of patients with advanced cancer: A qualitative descriptive study. European Journal of Oncology Nursing, 33, 28–34. https://doi.org/10.1016/j.ejon.2018.01.005 (Links to an external site.)

Fernando, G., Wanigabadu, L., Vidanagama, B., Samaranayaka, T., & Kamal Chandima Jeewandara, J. (2019). “adjunctive effects of a short session of music on pain, low mood and anxiety modulation among cancer patients” – a randomized crossover clinical trial. Indian Journal of Palliative Care, 25(3), 367. https://doi.org/10.4103/ijpc.ijpc_22_19 (Links to an external site.)

Li, Y., Xing, X., Shi, X., Yan, P., Chen, Y., Li, M., Zhang, W., Li, X., & Yang, K. (2020). The effectiveness of music therapy for patients with cancer: A systematic review and meta‐analysis. Journal of Advanced Nursing, 76(5), 1111–1123. https://doi.org/10.1111/jan.14313 (Links to an external site.)

Lu, X., Thompson, W., Zhang, L., & Hu, L. (2019).

music reduces pain unpleasantness: Evidence from an EEG study

. Journal of Pain Research, Volume 12, 3331–3342. https://doi.org/10.2147/jpr.s212080 (Links to an external site.)

Poulsen, M. J., & Coto, J. (2018). Nursing music protocol and postoperative pain. Pain Management Nursing, 19(2), 172–176. https://doi.org/10.1016/j.pmn.2017.09.003 (Links to an external site.)

Rini, C., Vu, M. B., Lerner, H., Bloom, C., Carda-Auten, J., Wood, W. A., Basch, E. M., Voorhees, P. M., Reeder-Hayes, K. E., & Keefe, F. J. (2017). A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain. Palliative and Supportive Care, 16(2), 155–169. https://doi.org/10.1017/s1478951517000086 (Links to an external site.)

Schneider, M. A. (2018). The effect of listening to music on postoperative pain in adult orthopedic patients. Journal of Holistic Nursing, 36(1), 23–32. https://doi.org/10.1177/0898010116677383 (Links to an external site.)

Sibanda, A., Carnes, D., Visentin, D., & Cleary, M. (2018). A systematic review of the use of music interventions to improve outcomes for patients undergoing hip or knee surgery. Journal of Advanced Nursing, 75(3), 502–516. https://doi.org/10.1111/jan.13860 (Links to an external site.)

Spilioti, E. D., Galanis, P. A., Konstantakopoulou, O. K., & Kalokairinou, A. G. (2017). The Effects of Music on Cancer Patients Submitted to Chemotherapy Treatment. International Journal of Caring Sciences, 10(3), 1465–1477. www.internationaljournalofcaringsciences.org

Wurjatmiko, A. (2019). The effects of music therapy intervention on the pain and anxiety levels of cancer patient: A systematic review. International Journal of Nursing Education, 11(4), 14. https://doi.org/10.5958/0974-9357.2019.00079.5 (Links to an external site.)

Yangöz, Ş., & Özer, Z. (2019). The effect of music intervention on patients with cancer‐related pain: A systematic review and meta‐analysis of randomized controlled trials. Journal of Advanced Nursing, 75(12), 3362–3373. https://doi.org/10.1111/jan.14184

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