In order to provide the best quality care, the nurse must use a holistic approach by addressing both the physical and psychological needs of a patient (Selimen & Andsoy, 2011). Guided imagery is a technique in which patients can correlate the psychological mind to the physical body, consequently diverting attention and managing pain. When used effectively these images can have a direct alteration of sensation, sight, sound, and smell resulting in a decrease perception of pain (Bonadies, 2009). This paper hopefully sheds light on the possibility of a future protocol and wide based acceptance of the benefits of using guided imagery to improve chronic pain management.
Findings from a variety of research support that EBP improves the quality of care, patient satisfaction, enhances health outcomes, and reduces costs (Melnyk & Fineout-Overholt, 2015). The use of evidence-based practice has a significant impact in reducing cost in the health care system, in contrast to using outdated practices and policies. (Saba, V. K. & McCormick, K. A., 2011). Implementation of EBP benefits nurses since they would use their resources effectively and methodically instead of being wasted in the trying to provide competent client care with unsupported traditions. (Hanberg & Brwon, 2006).
EBP has been recognized as a crucial factor in meeting the Triple Aim in healthcare, which are enhancing the patient experience, improving overall health population and reducing the cost of healthcare (Berwick, Nolan, & Whittington, 2008). The Institute for Healthcare Improvement formulated the Triple Aim to establish an approach to optimize overall healthcare performance. (Berwick, Nolan, & Whittington, 2008). EBP further enhances and improves nurses’ adaptability, skills, critical thinking and decision making since they have to constantly evaluate updated research that will be used to facilitate and enhance their practice. This is why The Triple Aim has been expanded to the Quadruple Aim. The fourth goal aims to improve overall work gratification and decrease burnout episodes among clinicians (Bodenheimer & Sinsky, 2014). EBP has been found to empower nurses and other practitioners resulting in higher levels of job satisfaction (Strout, 2005), doing so facilitates healthcare systems to achieve the Quadruple Aim.
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Over time nurses have done and modified the way they implement care in hope of providing the highest quality of care possible for their patients (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). What was once seen as rational standard practices, such as bathing children in alcohol is now contraindicated by evidence-based practice (BabyCenter Editorial Team, 2018). This only indicates that there is always room for improvement and nurses should always be looking for better ways to perform obsolete practices that may not be as effective or may be prolonging or affecting patient outcomes (Donnelly, 2014). This can only be achieved by understanding and undertaking the adequate research process.
Nurses may embark on a research study or quality improvement project depending on the intent, setting, benefit and other factors that come into play (Arndt & Netsch, 2012). By choosing the right method of scrutinizing an established process, nurses may save time and reduce cost as well as avoiding placing the nurse or organization at risk of harm or liability (Arndt & Netsch, 2012). For example, hospitals are doing everything possible to control Healthcare-Associated Infections (HAIs), but according to a Consumer Reports article written last year, at least 30 percent of the 99,000 annual hospital-infection-related deaths can be attributed to central line infections (Olin, 2012).
By conducting a successful through research, the National Institute of Nursing Research (NINR) was able to concluded that high compliance with central line preventive practices can decrease infection rates in the ICU (Olin, 2012). The data retrieved from research was later implemented in hospitals, which show an improvement in patients’ outcome, and a decrease in treatment cost (Scott II, 2009). As evidence-based-practice continues to change the way nurses care for their patients, it is crucial to continue gaining knowledge and looking for areas in need for improvement to guarantee the best possible care.
As demand increases for better and enhanced evidence-based practice, the need for more educated nurses will follow (Lippincott, 2015). Understanding the research process and how to conduct it, will enhance the way nurses deliver care based on the best available data and best proven practices. The purpose of conducting research is to generate new knowledge by carrying out a systematic investigation. The research process involves a scientific inquiry that puts established practices under scrutiny and generates data that can be used to support EBP. For research findings to be considered reliable and valid, researchers must use right method of application with sequential steps. (Arndt & Netsch, 2012).
A research study can be easily confused with a thorough quality improvement project due to its contribution to EBP. (Arndt & Netsch, 2012). Quality improvement projects aim to ameliorate practices by executing systematic and continuous actions that leads to measurable improvement (Arndt & Netsch, 2012). The intention behind the inquiry, timeline, setting, and institutional regulations among other factors, will guide nurses to differentiate and choose between the two approaches (Arndt & Netsch, 2012). The findings of a properly conducted study will save time, reduce cost, ensure all government regulations are met and last but not least, it will ensure better patient outcomes.
Chronic pain is one of the physical component that has a tremendous impact on the quality of life of the patient. Through research and EBP non-pharmacologic therapies have become an essential part of managing chronic pain. They are often used as stand-alone therapies or to enhance and complement pharmacologic treatments (Charalambous, et al., 2016).
Priyanka Singh, 2015 article in the Indian Journal of Palliative Care, illustrates how guided imagery has been the most promising psychosocial intervention in the treatment of chronic, cancer pain (Singh & Chaturvedi, 2015). The process is initiated when nurses that have undergone proper training, teach the patient how visualize pleasant imagery and body awareness. The patient is to focus on a pleasant or distracting scene to redirect their sensations, sights, sounds, smell etc. The findings obtained by Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srikot, India, demonstrate that once the patient develops this skill, it will enable them to control the intensity and divert their attention from pain. (Singh & Chaturvedi, 2015)
The integration of guided Imagery with the standard pharmacological approach, as opposed to merely using a pharmacological approach, is called into question when treating patients with chronic pain. Peggy Burhenn, 2014 article tittle “Guided Imagery for Pain Control” reviews the process of implementing EBP of guided imagery for pain managements on a medical oncology unit at a comprehensive cancer center. Guided imagery was conducted by properly trained nurses and patient’s pain levels were measured pre and post-intervention (Burhenn, Olausson, Villegas, & Kravits, 2014). On average patients reported an immediate decrease in pain postintervention and nurses who provided guided imagery stated a positive experience and a reciprocal benefit. (Burhenn, Olausson, Villegas, & Kravits, 2014).
These benefits included personal relaxation and calmness, as well as internal satisfaction of proving high quality care to patients. (Burhenn, Olausson, Villegas, & Kravits, 2014). The findings support the notion that patients that experience periods of pain for a chronic amount of time, like cancer patients, can benefits from the use of guided imagery. Also, job satisfaction was shown to improve, since nurses were equipped to provide evidence-based services, along with the standard pharmacological approach. This allowed for a broaden range of nursing intervention as well as offered patients flexibility in the pain management approach.
A third EBP project supported the effectiveness of using guided imagery in combination with conventional medications, to treat chronic pain. Dobson, Cassandra, 2014 article on the usage of “Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease” tested the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease (Dobson & Byrne, 2014). Through the implementation of a quasi-experimental approach, researches were able to identify changes in pain perception and analgesic use, from the month before training to the month after (Dobson & Byrne, 2014). Patients reported less severe pain for all pain episodes during the first month post-training, in contrast to the pre-training phase. Dobson & Byrne, 2014). These evidence-based findings, are relevant for nurses, who can now confidently educate about guided imagery practices to children so that they become better at using their imaging skills to manage pain.
It was concluded that integrating guided imagery with conventional medications, to treat chronic pain, increases patient and nurse satisfaction, improve overall pain management, and decreases costs and wasteful spending. The EBP quality improvement projects done by Burhenn, Peggy and Dobson, Cassandra, 2014 used reliable and properly conducted approaches to confirm the effectiveness of using guided imagery for pain management. The subjects in the research projects, ranged from school-age to adult patients, who shared similar episodes of chronic pain. This offered a realistic representation of the targeted population. Through evidence-based-practices it was determined that guided imagery brings indisputable benefits to the healthcare system and any clinical unit whose goes is to management of chronic pain and offer quality care.
References
- Addressing the Physical and Psychological Needs of Patients – Selimen & Andsoy
- Guided Imagery Technique for Pain Management – Bonadies
- Benefits of Evidence-Based Practice – Melnyk & Fineout-Overholt
- Impact of Evidence-Based Practice in Reducing Costs – Saba & McCormick
- Benefits of Implementing Evidence-Based Practice for Nurses – Hanberg & Brwon
