Development of a Moral Resilience Collaborative Program During a Pandemic.

Elevated psychological stress can lead to moral distress affecting health care workers and organizations affecting patient care, job satisfaction, and retention. A Moral Resilience Collaborative program was implemented through an academic partnership between a school of nursing and a rehabilitation facility to provide the health care workers in the facility the skills necessary for self-management of moral distress and move them toward moral resilience. Moral distress and resiliency were measured pre-implementation using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) and Short Resiliency Survey (SRS), respectively. Unfortunately, postsurvey quantitative data collection failed due to COVID-19 surges though qualitative data obtained during debriefing sessions demonstrated effectiveness of the project. Based on debriefing comments and the preimplementation MMD-HP mean score and SRS decompression score, the staff in this facility experienced similar types of moral distress as those working in acute care or critical care settings. Even when resiliency programs are needed the most and readily available, patient care demands, a busy work environment, and external factors can hinder staff participation in such endeavors.

The Impact of Guided Imagery on Pain and Anxiety in Hospitalized Adults.

BACKGROUND: The use and impact of guided imagery in the acute care setting is limited. AIMS: The purpose of this quality improvement project was to evaluate the feasibility of a guided imagery intervention to change pain scores, anxiety scores, and opioid analgesia usage among hospitalized adults in an acute care setting. DESIGN: Quality improvement project using three measurements (baseline, 24 hours, and 48 hours). SETTINGS: Acute care hospital. PARTICIPANTS/SUBJECTS: Adult inpatients referred to an APRN-led pain management service. METHODS: The intervention was the use of a 30-minute guided imagery recording delivered via MP3 player which patients used twice daily. RESULTS: Limited changes were seen in pain scores, with no statistically significant results (p = .449). Statistically significant reductions were found in both anxiety scores (p < .001) and opioid analgesia usage (p = .043). CONCLUSIONS: Findings from this quality improvement project support the impact of guided imagery on anxiety and opioid analgesia use. Changes in pain scores were not demonstrated in this project. Additional research with a rigorous design is needed to determine cause and effect conclusions. CLINICAL IMPLICATIONS: The use of guided imagery as an adjunctive intervention for pain control may engage and empower the patient in self-care activities, which may have an impact on how care is perceived. Guided imagery is a low-cost, easily implemented approach that can be incorporated into patient care to reduce anxiety and, potentially, opioid analgesia use.

Psychosocial Issues and Lifestyle Changes for the Renal Patient.

This article provides an overview of the psychosocial issues faced by those with renal disease. The article discusses the physiologic connection between anxiety, depression, and pain-symptoms commonly seen in renal disease and other chronic illnesses. The application of integrative medicine or nonallopathic medicine and its role in the management of anxiety, depression, and pain are presented. Also presented is evidence surrounding several frequently used nonallopathic modalities appropriate for incorporation into a comprehensive management regimen for renal patients to reduce symptom burden. The article concludes with a discussion on the role of palliative care in treatment decisions for renal patients.

A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit.

IMPORTANCE: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit. OBJECTIVE: To examine whether CoQ10 could slow disease progression in early PD. DESIGN, SETTING, AND PARTICIPANTS: A phase III randomized, placebo-controlled, double-blind clinical trial at 67 North American sites consisting of participants 30 years of age or older who received a diagnosis of PD within 5 years and who had the following inclusion criteria: the presence of a rest tremor, bradykinesia, and rigidity; a modified Hoehn and Yahr stage of 2.5 or less; and no anticipated need for dopaminergic therapy within 3 months. Exclusion criteria included the use of any PD medication within 60 days, the use of any symptomatic PD medication for more than 90 days, atypical or drug-induced parkinsonism, a Unified Parkinson's Disease Rating Scale (UPDRS) rest tremor score of 3 or greater for any limb, a Mini-Mental State Examination score of 25 or less, a history of stroke, the use of certain supplements, and substantial recent exposure to CoQ10. Of 696 participants screened, 78 were found to be ineligible, and 18 declined participation. INTERVENTIONS: The remaining 600 participants were randomly assigned to receive placebo, 1200 mg/d of CoQ10, or 2400 mg/d of CoQ10; all participants received 1200 IU/d of vitamin E. MAIN OUTCOMES AND MEASURES: Participants were observed for 16 months or until a disability requiring dopaminergic treatment. The prospectively defined primary outcome measure was the change in total UPDRS score (Parts I-III) from baseline to final visit. The study was powered to detect a 3-point difference between an active treatment and placebo. RESULTS: The baseline characteristics of the participants were well balanced, the mean age was 62.5 years, 66% of participants were male, and the mean baseline total UPDRS score was 22.7. A total of 267 participants required treatment (94 received placebo, 87 received 1200 mg/d of CoQ10, and 86 received 2400 mg/d of CoQ10), and 65 participants (29 who received placebo, 19 who received 1200 mg/d of CoQ10, and 17 who received 2400 mg/d of CoQ10) withdrew prematurely. Treatments were well tolerated with no safety concerns. The study was terminated after a prespecified futility criterion was reached. At study termination, both active treatment groups showed slight adverse trends relative to placebo. Adjusted mean changes (worsening) in total UPDRS scores from baseline to final visit were 6.9 points (placebo), 7.5 points (1200 mg/d of CoQ10; P = .49 relative to placebo), and 8.0 points (2400 mg/d of CoQ10; P = .21 relative to placebo). CONCLUSIONS AND RELEVANCE: Coenzyme Q10 was safe and well tolerated in this population, but showed no evidence of clinical benefit. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00740714.

Music as an adjuvant therapy in control of pain and symptoms in hospitalized adults: a systematic review.

The objective of this review is to evaluate the evidence regarding the use of music as an adjuvant therapy for pain control in hospitalized adults. The search terms music, music therapy, pain, adults, inpatient, and hospitalized were used to search the Cochrane Library, Cinahl, Medline, Natural Standard, and Scopus databases from January 2005 to March 2011. (A systematic review conducted by the Cochrane Collaboration has extensively covered the time frame from 1966 to 2004.) Seventeen randomized controlled trials met criteria for review and inclusion. Seven of the research studies were conducted with surgical patients, three with medical patients, one with medical-surgical patients, four with intensive care patients, and two with pregnant patients. The combined findings of these studies provide support for the use of music as an adjuvant approach to pain control in hospitalized adults. The use of music is safe, inexpensive, and an independent nursing function that can be easily incorporated into the routine care of patients.

Perceptions of successful aging among older Latinos, in cross-cultural context.

Latinos are the largest and fastest growing minority group in the U.S. but they have been overlooked in studies of successful aging. This study used a multi-method approach with an open-ended question and Phelan et al.'s (Journal of American Geriatrics Society 52:211-216, 2004) Successful Aging Measure to determine whether the quantitative measure fully captured perceptions of successful aging of 60 older Latinos living in three Western states. Then, the findings were compared with other studies that had used the measure with Anglo, Japanese, Japanese-American, and Latin American samples. The results revealed that Latinos and Latin Americans responses are very similar to each other, and somewhat different from other cultural groups. Latinos focus on maintaining a positive outlook, living in the present, enjoying a sense of community, and relying on spirituality and family for comfort and meaning as they age, but they also worry about finances. There are several components of this study that professionals can use to guide their practice, including a summary of methodological challenges and ongoing conceptual debates in the successful aging literature.