Introduction
The integumentary system serves critical duties in the body since it is the system that holds the human skin, the largest organ of the body. The skin remains exposed daily to harm but acts in protecting the inner organs from any damage, being the outermost organ. Therefore, any injury on the skin, including a burn on any area of the skin, presents a challenge to the entire body. Skin burns can occur from many sources, including the less severe burns from exposure to the sun to the acute cases of exposure to flames, acid burns, and many others. Being the largest organ burns on the surface of the skin present with unexplainable pain for most individuals. However, the levels of the pain are different based on the degree and area of the burn. First-degree burns are those that occur in a mild manner causing pain and reddening of the skin’s outer layer, while second-degree pains affect the lower layers as well as the inner layer, causing swellings and the development of blisters (Warby & Maani, 2019). The third and fourth-degree burns have been known to be the most lethal of all burns as they penetrate through the second layer of the skin to affect the innermost tissues, such as the muscles and the bones (Warby & Maani, 2019). Therefore, pain from burns is a serious medical problem that should be addressed promptly.
As an intervention, burns are generally managed with pharmacological alternatives such as analgesics to offer relief to pain-obsessed areas of the body. According to Nosanov et al. (2020), pain is the less pleasant feeling related to the physiological, mental, and sensory feelings that result from injuries and damage to body tissues. Burns pain is, therefore, the pain that is a result of injuries over the skin that could penetrate the inner body tissues. In so far as the use of drugs such as opioids is known to offer quick relief from burns-related pain, the body quickly adapts to these medications. This adaptation may lead to increased dosages of the drug, which may result in toxicities and undesirable health outcomes such as opioid addictions. Therefore, to support or acting as an alternative to pharmacological interventions are the less preferred non-pharmacological interventions. Several non-pharmacological options exist for pain management as alternatives to drugs, including the use of therapeutic interventions such as music therapy and virtual reality. These alternative interventions have received massive support from various studies, illustrating their benefits and proper use for burns patients.
These therapeutic alternatives have been shown to bear zero or limited side effects, especially when used alongside medical interventions, for providing relief to the burnt body area. In this analytical research study, the intention is to highlight and illustrate the benefits of using two non-pharmacological interventions that are music therapy and virtual reality, in an evidence-based approach. The study seeks to describe and inform on the role of non-pharmacological mechanisms in reducing the painful experiences of burns patients.
Triggering Issues for the EBP
Burns is reported daily among patients of varied ages in the pediatric wards as well as most hospital surgical units in varying degrees. The scary screams and sounds that emanate from the wards while nurses perform wound dressing on burns patients confer a depressive effect on most people and patients. However, the screams are mostly justified because of the corresponding pain that burns patients experience while the wound dressing process continues. Wound dressing pain has been described as the painful physical and emotional disturbance that occurs in an individual when the skin is affected, and the injured tissues respond to the wound dressing effects (Wiechman & Sharar, 2019). It is therefore worth noting that wound dressing is no easy fit as it touches on the body’s painful area, though with the good aim of cleaning the wounded area of microbes.
In a study that was conducted on pediatric burn wound effects, the levels of pain were rated as moderate at 66% and severe pain at 25%, with the effects of the pain being experienced years after the burns period (Wu et al., 2021). According to Wu et al. (2021), infants who undergo intense burns-related pain in their early life experience chronic mental, physical, and behavioral changes expressed through the sensitive responses to pain, increased fear of pain, and circumventive behaviors. In most cases, opioid analgesics and anesthetics are always administered to the patients to help alleviate the pain during procedures, though the painful experiences persist. In this regard, the need for appropriate pain management mechanisms has emerged as a matter of public health interest and concern.
Most of the pain in burns is hard to manage and control owing to the changes involved as well as the various levels of the burns. According to Rohilla et al. (2018), music therapy and other alternative treatment protocols for burns-related pain should be considered. Further Rohilla et al. (2018), note that a host of options for the various types of burns and avoid overreliance on pain medications. In this regard, it is important to make use of the already identified evidence-based non-pharmacological pain management alternatives in a bid to effectively control pain in burns. To achieve the perceived better outcomes in burns management using complementary methods such as music therapy and virtual reality, several considerations must be put in place. The healthcare providers must have a good knowledge of available alternatives to burns management and must be able to work in collaboration to achieve better outcomes.
Problem Statement
Even though the use of standardized pharmacological interventions in burns has been in use for decades, severe shortcomings in their use indicate a rather different perspective as to their use in the continued management of burns-related pain. According to Nosanov et al. (2020), the use of opioids and non-opioid options in the management of burns is losing its grip owing to the prevailing epidemic of opioid use amongst most populations across the world. Burn pains are associated with increased psychosocial disturbances as expressed in fear and anxiety over the wound cleaning procedures, increased incidences of insomnia related to pain, and the itchy feeling that provokes scratching the burnt area (Nosanov et al., 2020). Most of the psychosocial-related painful effects of the burns have been proven to be easily managed by non-pharmacological interventions using the avoidance, approach, relaxation, and cognitive techniques, virtual reality, music therapy, and massage therapy (Fauziyah, & Gayatri, 2018).
Non-pharmacological interventions are also vital in addressing burns-related pain issues as they help in decreasing tensions and anxiety among patients to invoke a calming effect. According to Scheffler et al. (2018), inadequate management of pain and anxiety among burns patients has the potential to lead to decreased wound healing rate. Therefore, making use of non-pharmacological interventions is beneficial in addressing the pain problem.
Organization
The proposed non-pharmacological pain management among burns patients will be undertaken at a local healthcare facility, namely the Molloy Hospital. The choice for this hospital is timely as it is equipped with both a surgical and pediatrics section organized to manage burns cases.
Purpose
This evidence-based proposal (EBP) is aimed at introducing the use of non-drug-based interventions, namely music therapy and virtual reality, to complement the direct use of drugs in managing severe and less severe burns cases at Molly Hospital.
Priority/Need
Treatment outcomes for burns patients depend on a multitude of factors ranging from patient-based needs to their perception of the healthcare provider’s role in managing the pain. The use of drug medications alone in alleviating the pain is limited, and chances of increasing opioid addictions among individuals undergoing treatment for burns. In this regard, making use of complementary interventions such as music therapy and virtual reality has been proven to be viable alternatives in the management of burns. Thus, this change process is needed because pain is not only physiological but also holds some strong psychosocial effects for which drugs alone are ineffective in managing.
Team Members, Disciplines, Expertise
Nurses play the primary role in patients’ care across all care environments, in close relations with the patients, their families, and the rest of the healthcare providers. The MSN nurse’s role will be critical in the project, giving directives on best practices as well as disseminating evidence-based knowledge. Other healthcare providers such as physicians, surgeons’ dietitians, physiotherapists, occupational therapists, and nursing care staff will be involved in implementing the project. This multidisciplinary team will work in cooperation with each other to realize the success of the process.
Patient Preference
The proposal aims to conduct its affairs within the well surgically equipped Molly Hospital that currently has a high burns patient admission rate in the region. The study aims at correcting the ill effects of burns among the community members of Molly Hospital by involving music therapy as part of the treatment protocol for burns.
Inclusion and Exclusion Criteria
Inclusion Criteria
The study will include all burns patients admitted at Molly Hospitals’ surgical and pediatrics wings without the consideration of ethnicity, gender, age, or religion. The study will include all medically responsive patients with regard to various degrees of burns that patients exhibit.
Exclusion Criteria
The non-pharmacological interventions alternative will exclude any other patients admitted in the surgical and the pediatrics units who are admitted for any other reasons other than burns. The proposal will also exclude the patients admitted for burns but who are incapacitated and unable to consent to the study. Lastly, the study will also exclude any other burns patients who willingly request to be omitted from the study.
Search Details
The proposal is based upon a critical analytical question asking model highlighting the problem, the intervention, the comparison, outcome, and the period as stated; PICOT question “Among burns patients, how does the use of non-pharmacological interventions alongside the standard pharmacological intervention compare to the use of standard pharmacological interventions alone, in enhancing pain management during wound dressing changes and throughout the recovery period in hospitalization?”. The evidence-based articles cited for this proposal were obtained from online search engines, including Google search, Google Scholar, and PubMed articles. The keywords used for the proposal include burns, music therapy, virtual reality, and pain.
Literature Review
Evidence Synthesis
Several studies have highlighted the use of various methods in the management of burns pain resulting from wound dressing processes. In a study investigating the use of rapid induction analgesia (RIA), the researchers performed two RIA medications in a sample of fifteen patients and reported positive results in decreased anxiety with reduced cases of individual painful experiences at wound dressing (Wright & Drummond, 2000). The study confirmed the positive association between non-pharmacological interventions in pain management as opposed to the use of analgesics.
In yet another systematic study review highlighting the usefulness of complementary mechanisms in addressing the problem of pain from wound cleaning among adults whose wounds are dressed, distraction interventions including virtual reality were observed to have the highest effects in alleviating the painful experiences linked to the wound cleaning (Scheffler et al., 2018). This study further reinforced the place of complementary therapies in effectively addressing the pain related to wound cleaning procedures.
Similarly, in another study that made use of randomized sampling consisting of an experimental and a control group to determine the usefulness of music therapy mechanisms in addressing pain sensations and general fear of wound cleaning, the healthcare environment was found to contribute to the negative perceptions. A calming care environment that makes use of music as a form of therapy was shown to drastically reduce patients’ pain and anxiety episodes in the wound cleaning processes (Hsu et al., 2016). In this study, the active participants and the inactive participants were selected without a clear format. Both the active and the inactive participants’ painful and anxious states were recorded in three phases, one prior to, another in the course of, and the last one conducted after the painful area’s cleaning process while also using morphine for the pain. The results indicated a progressive decline in pain sensations with the involvement of music therapy.
In another quasi-experimental study on the effect of music therapy on anxiety and pain, the study findings indicated better outcomes in the experimental group as concerns the use of music therapy (Rohilla et al., 2018). In the study results, the median pain scores were correspondingly lower (5, interquartile range IQR: 3-7 and IQR: 5-8) than the Median anxiety scores (12, IQR; 8-17; and 14, IQR: 10-19). This study finding indicates that music therapy is beneficial in alleviating both pain and anxiety.
The use of technology in healthcare delivery has been accepted for the management of many health complications, with burns not being an exception. As such, virtual reality is one of the aspects of non-drug interventions, useful in drawing patients’ minds away from the thought of pain before wound dressing (Furness et al., 2019). This method is commonly used concurrently with analgesics to confer positive changes in the pain perception among patients for whom painful procedures are indicated. A small-scale qualitative study on patients and staff’s views on virtual reality was engaged in a focus group discussion on VRs effectivity (Furness et al., 2019). From this study, it was reported that user-informed active virtual reality helped patients reduce their anxiety and painful experience. Therefore, virtual reality as a form of non-pharmacological intervention is useful in addressing wound change challenges among burns patients.
Further, a supportive systematic study highlighting the effects of music intervention on burn patients during treatment procedures, the study reviewed data findings from 17 different electronic databases in a study sample of 804 participants (Li et al., 2017). The study findings indicated that music therapy interventions as compared to non-music interventions proved to be positive (SMD=-1.26, 95%CI [-1.83,-0.68]), confirming that music intervention positively reduces pain for burn patients. Music therapy is also shown to decrease pain-related anxiety remarkably (SMD= -1.22, 95% CI [-1.75, -0.69]) (Li et al., 2017). Therefore, these study findings on the effects of music therapy in managing burn wounds proved positive, especially in providing relief over anxiety and in reduction of the patients’ heart rate.
In the above-reviewed studies, most of the study samples were small except for one which made use of 804 participants, therefore raising questions over the effects of music therapy and virtual reality in the wider population of burns patients. In most of the studies, the validation of non-pharmaceutical interventions in reducing anxiety and pain before, during, and after the procedure was found to be extremely beneficial. In one particular study, the opioid medications, when used alongside virtual reality, were found to be effective in alleviating anxiety and calming the patients during the procedure (Furness et al., 2019). Finally, the studies have all validated the need for timely involvement of non-pharmacological aspects of pain management in treating burn wounds. This can be achieved as a complementary way to the use of analgesics and anesthetics drugs.
Steps in Design Implementation
This change strategy will be initiated as a protocol in the daily operations of the surgical unit’s performance in wound management. Attending clinicians will be required to involve either music therapy or virtual reality, as deemed appropriate, before starting the wound dressing procedure. Further, the implementation will limit the use of opioid drugs concurrently with virtual reality. In this case, nurses will be required to conduct the pain scale assessment and instead of prescribing opioid medications first, will request patients to have a virtual reality experience. The patient’s wound will be cleaned safely as virtual reality takes on the attention of the patient. Music therapy will be initiated in ten to fifteen minutes prior to the burns wound cleaning procedure to help relax the patients by alleviating anxiety and worry. The confidence in these strategies is in the fact they are evidence-based and have been proven effective in many care settings.
Pilot Test Design
This evidence-based practice will be evaluated against reported outcomes of recorded pain sensations in the pain determination index. The patients will be required to record the outcomes of pain when music therapy or virtual reality was used as opposed to when the process used only analgesics. Therefore, the proposal will seek to review the indications and outcomes from the recorded findings.
Resources for Implementation
If the proposal is agreed to, the National Health Committee on alternative medications and therapies will support the proposal in financing and equipment supply. The committee thrives on finding healthcare providers whose aims in practice are to increase patients’ healthcare experience by adopting holistic patient management approaches to care delivery. The committee is part of a Federal government’s task force on Public Healthcare delivery, specifically tasked by the office of the President and mandated by the Constitution to increase healthcare practices across the country.
Barriers or Constraints to Implementation
In this proposal implementation, potential barriers would include lowered patient expectations and perceptions about the intervention. Healthcare providers’ willingness to embrace the proposed therapies as a means of treatment may also be a challenge.
Methods to Promote Dissemination
The dissemination of this proposal can be enhanced through healthcare workers’ training and workshops on complementary and alternative pain management alternatives. The proposal can also be promoted through the practical implementation of virtual reality and music therapy within the hospital’s burns unit.
Conclusion
In conclusion, virtual reality and music therapies are non-pharmacological interventions that are less utilized in most healthcare environments but harbor great benefits, if timely incorporated in pain management for burns patients. Burns are painful sensations whose effects have been shown to daunt an individual’s health and body systems, with the possibility of imprinting lasting effects throughout an individual’s life. Children, for instance, should be well cared for in cases of burns wounds majorly to avert the negative psychosocial effects of the pain management even for their later life. The proposal’s study findings have been in agreement with the research’s PICOT question by validating the use of non-pharmacological interventions as opposed to the use of pharmacological interventions in the management of wounds from burns. However, more studies ought to be conducted on the proposed complementary alternatives, which include music therapy and virtual reality. For successful implementation, inter-professional coordination is one that has appropriately and widely been accepted as a critical aspect that helps to increase proper staff-to-staff and staff-to-patient information relay. Nursing care staff must be well equipped with adequate knowledge of alternative methods of pain management among patients admitted with the various forms of pain.
References
Fauziyah, H., & Gayatri, D. (2018). Pain, stress, and sleep quality in chronic wound patients. Enfermeria Clinica, 28, 176−179. Web.
Furness, P. J., Phelan, I., Babiker, N. T., Fehily, O., Lindley, S. A., & Thompson, A. R. (2019). Reducing pain during wound dressings in burn care using virtual reality: A study of perceived impact and usability with patients and nurses. Journal of Burn Care & Research, 40(6), 878−885. Web.
Hsu, K.-C., Chen, L., & Hsiep, P. (2016). Effect of music intervention on burn patients’ pain and anxiety during dressing changes. Burns, 42(8), 1789–1796. Web.
Li, J., Zhou, L., & Wang, Y. (2017). The effects of music intervention on burn patients during treatment procedures: A systematic review and meta-analysis of randomized controlled trials. BMC Complementary and Alternative Medicine, 17(1). Web.
Nosanov, L. B., Brandt, J. L., Schneider, D. M., & Johnson, L. S. (2020). Pain management in burn patients. Current Trauma Reports, 1−13. Web.
Rohilla, L., Agnihotri, M., Trehan, S. K., Sharma, R. K., & Ghai, S. (2018). Effect of music therapy on pain perception, anxiety, and opioid use during dressing change among patients with burns in India: A quasi-experimental, cross-over pilot study. Ostomy Wound Manage, 64(10), 40−46. Web.
Scheffler, M., Koranyi, S., Meissner, W., Strauß, B., & Rosendahl, J. (2018). Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: A systematic review and meta-analysis of randomized controlled trials. Burns, 44(7), 1709–1720. Web.
Shpichka, A., Butnaru, D., Bezrukov, E. A., Sukhanov, R. B., Atala, A., Burdukovskii, V., Zhang, Y., & Timashev, P. (2019). Skin tissue regeneration for burn injury. Stem Cell Research & Therapy, 10(1), 1−16. Web.
Warby, R., & Maani, C. V. (2019). Burns Classification. Web.
Wiechman, S., & Sharar, S. (2019). Management of burn wound pain and itching. Web.
Wright, B. R., & Drummond, P. D. (2000). Rapid induction analgesia for the alleviation of procedural pain during burn care. Burns, 26(3), 275–282. Web.
Wu, Y., Zhao, Y., Lin, G., Sharma, M., Wang, Y., Chen, L., & Wu, L. (2021). Measures and effects of pain management for a wound dressing change in outpatient children in Western China. Journal of Pain Research, 14, 399. Web.