Classmate 1: Being a nurse who currently serves in the United States Army, a topic that truly interests me for this research course is posttraumatic stress disorder (PTSD) in military veterans. Being both a Christian and a healthcare worker, I like to involve prayer for my patients as much as possible. In a larger Christian world view I believe that God gifts nurses with the knowledge and power to combine both treatments earthly treatments along with treatments that only God can provide. To me it is best summed up through the verse that says, "If you have faith when you pray for sick people, they will get well. The Lord will heal them, and if they have sinned, he will forgive" (English Standard Version Bible, 2001, James. 5:15).
I want to research eye movement desensitization and reprocessing (EMDR) therapy, in particular, in order to see if it has the capability to reduce PTSD in veterans. EMDR stands apart because it does not require talking in detail about the distressing issue or completing homework between sessions. EMDR therapy, rather than focusing on changing the emotions, thoughts, or behaviors resulting from the distressing issue, allows the brain to resume its natural healing process (Emdria, 2021). I searched both "PTSD" and "EMDR" in the EPC Reports section on the Agency for Healthcare Research and Quality website. For the searches mentioned, the EPC reports primarily focused on pharmacologic and nonpharmacologic PTSD in adult populations. There were no results found with researched tailored to military veterans. There were 5 results relating to PTSD and for this discussion I chose to evaluate the report, "Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update." This is classified as a final report from the University of North Carolina at Chapel Hill, and is from May, 2018.
In the EBP section within the Evidence Report, the authors made recommendations based on the current systematic review along with previous research that was submitted in a 2013 report. The current review focused on updating their earlier work, in regards to psychological and pharmacological interventions used in the treatment for patients with PTSD. Psychological interventions studied included cognitive behavioral therapy (CBT), EMDR, and other behavioral therapies such as hypnosis, mindfulness-based stress reduction, and brainwave neurofeedback. Pharmacological methods included selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, anticonvulsants, benzodiazepines, and other medications. Based on the information from 207 published articles reporting on 193 studies, the authors stated that overall some psychological therapies and some pharmacological treatments are effective treatments for adults with PTSD. The review found high strength of evidence (SOE) of efficacy for CBT treatments and moderate SOE of efficacy for cognitive processing therapy (CPT) and EMDR. Among pharmacotherapies, the authors found moderate SOE of efficacy for fluoxetine, paroxetine, and venlafaxine. The report also stressed in the recommendations that insufficient evidence was found for specific treatment correlations relating to multiple types of traumas. Recommendations also lacked evidence in adverse reactions or events from the treatments mentioned. After research was concluded, for the most part, the conclusions made in the update remained unchanged from the researchers prior review published in 2013.
Classmate 2: The area of interest I have selected for this research project is about delirium prevention and treatment more specifically, within the postoperative setting. Delirium is an acute disruption of normal cognitive function and includes inability to pay attention, fluctuating consciousness, and disorganized thinking (Reddy et. al, 2017). Delirium can have significant consequences, especially in the elderly population, which include increased length of stay, impaired recovery, and increased mortality (Reddy et. al, 2017). Because of the profound adverse outcomes delirium has on recovery and overall patient outlook, it is imperative that the risk of developing delirium is assessed and preventative measures and treatments are employed.
In conducting an evidence-based research review from the Agency of Healthcare Research and Quality, there is actually limited evidence about screening and prevention of postoperative delirium. Interestingly enough, even though delirium is a widespread concern for hospitalized patients, there was only one report listed. The report focused on antipsychotics for the prevention and treatment of delirium. Neufeld et. al (2019) published a report which examined the use of antipsychotic treatment for the prevention of delirium among patients aged 65 and older among various hospital settings including the ICU, postoperative setting, acute care, and palliative care. The recommendations outlined that the use of antipsychotic medications such as Haldol, did not decrease length of hospital stay or decrease the severity of delirium (Neufeld et. al, 2019). The evidence is currently relatively weak concerning the use of antipsychotic treatments for patients experiencing delirium.
Concerning the postoperative population, it was found that second generation antipsychotics may be beneficial in preventing delirium in vulnerable populations, although the author does disclose that this evidence is limited (Neufeld et. al, 2019). There was little evidence that the treatment with any antipsychotic decreased the length of stay, there was also insufficient evidence that the treatment with antipsychotics decreased the severity of the delirious episode, or had any effect on risk of falls while hospitalized (Neufeld et. al, 2019). The evidence based on this report is more or less inconclusive about the use of antipsychotics for the prevention and treatment of delirium in elderly patients, despite the fact that the review was scoping and included patients admitted in a variety of clinical settings. Given these current recommendations, it is clear that more research should be conducted, or a review of other elements of delirium treatment and prevention. For the research proposal, I hope to conduct a review based on delirium screening within the perioperative period to establish evidence for preventative measures amongst the elderly surgical population.
As Christian nurses, we are called to the challenge of utilizing critical thinking skills and synthesizing new research into actionable protocols in order to benefit our patients. Proverbs 18:15 states, “an intelligent heart acquires knowledge, and the ear of the wise seeks knowledge” (English Standard Version Bible, 2001). The Bible teaches us to continually seek knowledge, and it is our duty as nurses and as educators, to rise to the challenge of the frequently changing healthcare climate in order to provide the best care possible.