Week 4: Plan to Evaluate Implementation

NON-PHARMACOLOGICAL INTERVENTIONS 23

NON-PHARMACOLOGICAL INTERVENTIONS FOR PAIN MANAGEMENT

by

Mehrnoosh Ejlali

Evidence-based Practice Project

Submitted to the Faculty of NUR 49800 Capstone Course in Nursing

College of Nursing

of Purdue University Northwest,

Hammond, Indiana

in partial fulfillment of course requirements for the degree of

Bachelor of Science

Month, 20xx

© copyright

Mehrnoosh Ejlali

2020

all rights reserved

acknowledgments

Begin optional acknowledgments here.

table of contents

Section Page

acknowledgments iii

table of contents iv

abstract v

Sections

1. Introduction 6

2. Review of Literature and Synthesis of the Evidence 10

3. Plan for Implementation 21

4. Plan for Evaluation xx

5. Conclusions, Recommendations and Implications xx

references 34

appendices (If Applicable)

Appendix A – Put Title Here xx

List of tables

Table Page

Table 1 Summary of Reviewed Evidence.......................................................................... 16

Table 2 Estimated Timetable Blueprint for Implementation……………………………. 27

Table 3 Put Name of Table Here xx

ABSTRACT

Begin writing the abstract here. APA abstracts begin on margin and do not indent. Please use headings in instructions

NON-PHARMACOLOGICAL INTERVENTIONS v

section 1

Non-pharmacological Interventions for Pain Management

Non-pharmacological involves the management of pain without the use of medicines. However, this technique includes the application of methods that alter a patient's thoughts. The patient is enabled to concentrate on easy management and reduction of pain. The arrangements show an essential benefit in the control of pain. This chapter focuses on the purpose of the non-pharmacological intervention, significance of the Evidence-Based Practice Project (EBP), the potential outcomes as well as clinical question applied.

Purpose

The purpose of this EBP is to develop an educational base that might present non-pharmacological as well as pharmacological intervention options for the management of pain. This is intended to derive the benefits and risks associated with each technique. The goal is to help the clinical officers by enabling them to enlighten the patients on the best option that can be adopted in the management of pain. Adult patients are reporting a lack of satisfaction in their experiences to control pain. In most cases, they record more expenses that are associated with the pharmacological management of pain (Karabulut et al., 2016). However, due to these statistics, the Legacy health care center has decided to explore if the non-pharmacological are safer and less expensive compared to pharmacological interventions.

Perhaps one of the ways providers of health can manage the pain of adult patients is by the introduction of less expensive and safer methods. Besides, adult patients need education on their options to boost their satisfaction as well as control in the process. To contemplate the best techniques to be adopted on the management of pain, research has proved that different sufferings faced by patients need to be analyzed (Carr et al., 2019). Legacy health care center intends to have an overview that will provide pains faced by patients. The objective is to explore the available approaches that patients require to manage each pain with fewer costs.

This EBP project purpose to help patients to make the best decision when selecting a non-pharmacological intervention. A patient might want to eliminate the pain or even work with it. Working with the illness will involve controlling the pain during the recovery period, although the pain will still be present. Eliminating the pain, on the other hand, consists in controlling the pain at a manageable level that enables a patient to undergo active recovery. Reducing the pain is only possible through the use of pharmacological interventions, which indeed is expensive to the majority of the citizens. Legacy health care center would wish to assist patients to comprehend on the best options to take in non-pharmacological responses and work with the pain until recovery.

Relevance /Significance in Nursing

For the last five years, more than two million patients in a year developed body pains with an approximation of ten percent of the total dying as a result of pain and suffering (Connors et al., 2018). Nurses need to be updated on better practices indicated in research. Despite this, studies have concluded that pain perception has been impacted by pain anticipated through anxiety. The majority of nursing officers are less experienced in non-pharmacological intervention practices. The practices are, however, vital when managing and controlling pain in patients. Notably, these practices should be in a position to help reduce the suffering faced by patients due to body pain. During the treatment of patients, nurses play a crucial role. The best way they can be of assistance is through the provision of non-pharmacological techniques. Nurses can help patients before treatment by helping them to decide on the best options to adopt in non-pharmacological methods.

During the patient's recovery, it wise for nurses to not only provide advice on the best non-pharmacological methods but also to aid in implementing these interventions (Cheung, 2019). Therefore, a nurse will require to be equipped with knowledge of non-pharmacological interventions to determine the best experience that a patient needs. Nurses must manage the physical and emotional pain of the patients. Nurses might want to be well informed about current recommendations as well as research on the management of pain before delivering the same education to a patient. Studies have proved that knowledge about pain interventions might minimize the patient's anxiety, minimize pain experience, and boost overall satisfaction during the recovery period of patients.

Adult patients have many options for pharmacological interventions when managing pain. Nurses should be familiar with all the approaches that help control pain and avoid the suffering of patients. In fact, nurses should make their roles active during their engagement with patients and notice their desires to assist in educating them on available options to manage pain. Research indicates that there is a need to evaluate the current therapies in non-pharmacological interventions. Legacy health care center suggests that nurses might depend on the knowledge and skills to determine the efficiency of non-pharmacological options for patients.

Potential Outcomes

Legacy health care center would like to evaluate the influence in the implementation of non-pharmacological interventions in the management of pain. The possible outcomes of the efforts are to make patients safer and reduce their medication costs.

Clinical Question (PICO)

"In adult patients suffering pain, what is the effectiveness of non-pharmacological treatment compared to pharmacological treatment in controlling pain during the recovery period?"

Section 2

Introduction

This section focuses on the review of literature related to this research. It explores a review of past studies done on non-pharmacological interventions. Emphasis was on the adoption of non-pharmacological treatments to adult patients. Besides, the analysis depended on literature theories from books, research papers, magazines, health reports, and information from the Internet. Accurately, more attention was paid to scholar's articles as well as those from health reports. Thus, the latter seemed to explore more on the level to which non-pharmacological treatment is effective compared to pharmacological therapy.

Despite the study exploring a maximum of twelve sources, systematic review concentrated on eight sources only. The four sources eliminated had a lifespan of more than five years; thus, they were considered not to have the most current evidence. However, the eight sources used comprised of one source (5 years old), one source (4 years old), three references (3 years old), two sources (2 years old), and one source (1-year-old). Only three sources were from health reports, while the other five (scholar articles) were extracted from Google scholar. Evidence was generally narrowed from the eight sources, clinical guidelines applied primarily in research, and opinion made from the expertise gained.

Therefore, different themes were described as per the previous authors depending on their contradictions and consistencies. Results were used to identify the existing gaps in the studies; thus, making them essential in the study. Besides, this section covers the findings of the study, and later a well-illustrated summary of the evidence was derived. The strategy of appraisal was Melnyk's observational-analytic design level of proof. Level I had three sources, level II two sources, level IV one source, and level V two-source.

Review of Literature and Synthesis of Evidence

The paper's problem, intervention, as well as comparison and its link to an outcome (PICO), involved the evaluation metrics regarding groups on the issue non-pharmacological responses. Primarily, this focused on a thirty-day experience in the management of adult patients undergoing non-pharmacological treatment. However, PICO elements involved in adult patients (population); thus, examining the effectiveness of non-pharmacological therapy, compared to pharmacological treatment, in controlling pain during the recovery period.

Besides, the intervening interest in this involved the effectiveness of reducing treatment costs to adult patients through non-pharmacological treatment. Increased safety of adult patients during their recovery period was pronounced as the outcome. Therefore, there was the intent to minimize if not end the use rate of pharmacological treatment in Legacy health care, if possible, within a time limit of thirty days after initiating a patient's recovery period.

However, to address the PICO questions, the literature review was based on critical terms; that is, adult patients, non-pharmacological intervention, pain management, and pain relief. Concerning the health care projects, the focus was on Google scholar articles, Cochrane Library, Virginia Henderson International Nursing Library, and Nursing Reference Center Plus database. Attention was based on this to bring different and vital meaning when it comes to analyzing different categories of non-pharmacological interventions.

Common Themes in the Literature Review

By analyzing the above databases, a reveal of common topics was evident. These included raise in cognitive exercise, family therapies as well as physical therapy impacts.

Raise of Cognitive Exercise

Studies reveal that cognitive exercise is positively impacted, especially to adults suffering from depression pains. Cintoli et al. (2019), says exercising groups need to undergo aerobic training to reduce the pain caused in mind due to anxieties. Adult patients underwent mental illness when recovering from various diseases (Wexler, 2017). Therefore, there was anticipation that the majority of adult patients participating in cognitive exercises exhibit more significant improvements. Hence, such individuals could not be compared to those undergoing pharmacological medication. Despite cognitive tasks having a substantial effect in relieving mental pain, it also impacts positively on function ability on the brain (Edmond et al., 2019). Brain training ability emerged to be the most form of effective non-pharmacological intervention to relieve pain.

Family Therapies

Loneliness was identified to be a primary cause of mental pain to adult patients. As Bucci et al. (2016) would say, anxiety and isolation terminate older people when recovering from an illness. Studies indicated that nurses did not provide adequate medication to relieve pain to adult patients. As a result, adult patients were encouraged to make close contact with family members. In fact, in family therapy, patients share their feelings and comfort from the family members' relief their pain (Edmond et al., 2018). According to Chiasson et al. (2020), adult patients with close family contacts boost their self-esteem: Hence, avoid suicide attempts resulting from failure to endure pain. In comparison, patients undergoing pharmacological treatments fail to manage pain due to increased costs (Theleritis et al., 2018); thus, prone to attempted suicide.

Physical Therapies Impacts

Physical activities improve adult quality to sleep; thus, helping them to avoid daily routines that trigger their pain. Poor sleeping to adult patients influences the recovery process due to inadequate pain management (Vancampfort et al., 2019). Despite this, studies reveal that even disabled adult patients are granted opportunities to exercise. Exercise programs are initiated to help them relieve pain. Indeed, it was anticipated that they contribute to cognitive practices. That is, the former helps to reduce depression in the patient's mind. Ceballos-Laita et al. (2019) would agree that pain management can never be useful if one is undergoing depression and anxiety.

Consistencies and Contradictions in the Literature.

Wexler (2017), says non-pharmacological interventions in pain management have been an alarming concern for adult patients. Nurses have faced inadequate knowledge of initiating non-pharmacological medications. Therefore, they have led to failure in the consistency of pain management. Thus, Theleritis et al. (2018) argue the ability of adult patients to relieve pain is reduced. Besides, minimal non-pharmacological interventions are associated with high costs of Medicare (Bucci et al., 2016). Despite this, confusion arises due to the failure to identify the best approaches in the non-pharmacological intervention.

Existing Gaps in the Literature Review

The majority of review from the authors failed to focus on the ways to be adopted to educate nurses with knowledge about non-pharmacological treatment. Also, no distinction on the specific approaches regarding non-pharmacological interventions. In fact, no studies had indicated the adverse effects of therapies undertaken in non-pharmacological treatment. The authors failed to incorporate particular numerical data on adult patients in need of non-pharmacological therapy. According to Wexler (2017), there is a lack of public information represented in pain management rates for adult patients in different age brackets.

Findings

According to the review of literature, it is evident that pharmacological treatment outweighs non-pharmacological interventions. However, the majority of adult patients cannot afford real medications due to high costs. Pharmacological treatments are much more expensive and unsafe for adult patients (Bucci et al., 2016). Either way, patients might want to manage pain; hence results indicated that non-pharmacological interventions were a practical approach to adult patients. Chiasson et al. (2020) argue that nursing officers might want to be equipped with skills in various non-pharmacological intervention approaches.

PICO Question: "In adult patients suffering pain, what is the effectiveness of non-pharmacological treatment compared to pharmacological treatment in controlling pain during the recovery period?"

Keywords: Adult patients, non-pharmacological intervention, pain management, and pain relief.

Databases Searched: Google scholar articles, Cochrane Library, Virginia Henderson International Nursing Library, and Nursing Reference Center Plus database.

Table 1

Summary of Reviewed Evidence

Author(s) and Date of Publication ONLY	Sample/Setting/ Design	Data Collection Tools	Findings/Results	Appraisal of Evidence: Worth to Practice include Strengths, Weaknesses, and Conclusions	Level of Evidence (LOE)
(Bucci et al., 2016)	Design: Literature review Setting: Acute care Sample: N= 18 studies	Case studies	1. Pharmacological intervention has raised costs. 2. 12 reports represent inadequate care for adult patients undergoing pharmacological treatment.	Strengths: Analyzed studies were quality based on Clinician reports. Weaknesses: Some information omitted for confidentiality. Conclusions: Non-pharmacological intervention can improve adult patients care and medication cost.	Level I
(Ceballos-Laita et al., 2019)	Design: Literature review Setting: Patients checklists in various hospitals Sample: N= 17 studies	Single interventions in questionnaires	1. Pain management is less initiated through non-pharmacological intervention.	Strengths: Quality study intervention using questionnaires. Weaknesses: The information in the questionnaire might be inaccurate Conclusions: No certainty of details from some single intervention studies.	Level I
(Cintoli et al., 2019)	Design: Cohort prospective study Setting: 20 units	Case study	1. Suicidal cases of adult patients result from the inability to endure pain.	Strengths: More than 400 patients examined in the study. Weaknesses: No control in random selection. Conclusions: Intervening the patients called for a lot of care.	Level V
(Chiasson et al., 2020)	Design: Clinical practice guideline Setting Quality improvement teams at six medical centers. Sample N=46 papers	Studies include expert opinion, systematic reviews, and consensus recommendations.	1. Social networks encouraged as the primary approach to family therapy.	Strengths: Clinical experts developed the toolkit, which is recommended by five other hospitals. Initiatives for quality improvement were applied. Weaknesses: Data from six health care centers are eliminated from the toolkit. Conclusions: The clinical guideline has considerable recommendations valuable in implementation.	Level IV
(Edmond et al., 2018)	Design: Literature review Setting: Readmission checklists in various hospitals Sample: N= 24 studies	Questionnaires single intervention.	1. Cognitive exercise outweighs other therapies.	Strengths: Study interventions appraised of quality through the use of questionnaires Weaknesses: The inaccuracy of data in polls. Conclusions: Some single intervention studies could not demonstrate impacts.	Level I
(Theleritis et al., 2019)	Design: Clinician guidelines Setting: Worldwide settings Sample: N=27 hospitals	The survey, case series, and quasi-experiments	1. Adult Patients need to have support all through unhealthy periods-based on the review	Strengths: Highest level of evidence from clinical report and guidelines Recommendation strength provided. Weaknesses: Psychological information from the case series might be pseudo. Conclusions: Interventions in the guidelines are recommended to be evidence-based	Level V
(Vancampfort et al., 2019)	Design: Cluster randomized controlled trial (RCT) Setting: Secondary hospitals Sample: N=28 different hospitals.	Demographic data collection tools	1. Inadequate facilities to offer non-pharmacological interventions. 2. Less distinction in non-pharmacological response approaches.	Strengths: Strength of patients undergoing the process. Thus, the advanced technology used. Weaknesses: The small number leads to the irrelevance of information. Conclusions: Major significant effects after initiating random approaches.	Level II
(Wexler, 2017)	Design: Clinician guidelines Setting: Worldwide settings Sample: N= 15 hospitals	Case series and quasi-experiments	1. Non-pharmacological interventions might favour any patient. Including the disabled.	Strengths: Highest level of evidence from clinical reports and guidelines. Recommendation strength provided. Weaknesses: Psychological information seemed to be pseudo. Conclusions: Information analyzed must be demonstrated.	Level II

Section 3

Plan for Implementation

This section focuses on the project implementation by the Legacy health care center relative to the EBP. The plan encouraged a systematic review of the findings. Therefore, Abbigail (RN facilitator) was involved in implementation alongside other clinical officers. Following was a conference set aside with Legacy health care center administration to enlighten them on the intended plan of action. New members were recruited for their readiness in the project. Adult patients were expected to acquire information from the nurses regarding non-pharmacological treatments. Adult patients were to share these skills with the nursing officers within their initial stages of recovery. Abbigail, the RN facilitator, encouraged a survey on the adult patients undergoing non-pharmacological treatments. Results from the study were used to analyze implementation plan outcomes.

The RN facilitator deliberately introduced Promoting Action on Research Implementation in Health Services (PARIHS) to make EBP implementation effective. According to Ward et al. (2017), PARIHS comprise of evidence, context, and facilitation. Based on the framework, the proof was included in the phase for stakeholders. Also, clinical experience, patients, and project research data were composed as evidence. The context component in the framework represented the occupation or ecosystem of implementing the practice. This context, according to Rycroft-Malone (2010), would enable the consideration of leadership and cultural dedication in Legacy health care center while implanting EBP.

However, context features were discussed under the Legacy health care center phase for organization structure (organizational fit) and barriers for the implementation phase. Facilitation involved relating to enable individuals to contemplate strategies for the implementation of EBP. Therefore, the procedure of facilitation would best be addressed under the facilitation strategies for implementing EBP and the phase of needed resources.

Stakeholders

Apart from Abbigail (RN facilitator), Legacy health care center involved other stakeholders like clinical officers, government firms obligated with health care implementation as well as the patients undergoing both non-pharmacological and pharmacological interventions. However, the target population for the project was explicitly patients in need of non–pharmacological interventions. As the study progressed, the focus was on specific adult patients in need of non–pharmacological treatments. This made the primary stakeholders comprise of; The RN facilitator, adult patients only, and assisting nurses who undertook the central role. However, less significant stakeholders were the; patients managing the pain but did not require non-pharmacological interventions, physicians, insurance firms, as well as other employees.

The team offering therapies was persuaded to engineer the project. The team involved individuals dealing with physical and cognitive exercises for patients. An essential plan was designed to help deliver treatments to adult patients without future challenges in pain relief ways. As far as pain management is concerned, I would say, adult patients, as well as the nurses, were the most affected persons. Therefore, EBP implementation deserved the two to be aware of it. This was aimed at the practical application of non-pharmacological therapies by nurses to adult patients. The best moment to be mindful of this information was considered to be before the initial stages of planning the implementation. Reasons being it would limit and avoid inconveniences to both patents and nurses.

Patient's and nurse's awareness was achieved through drafting a proposal following the health guidelines and protocols deserved. However, to maintain a legit study, the persuaded group was involved in offering both internal and external support. According to Stetler et al. (2011), allocation and division of time into different phases were essential in the PARIHS framework. The RN facilitator insisted on the periods covering the initial paperwork of the EBP, its discussion with the staff, administration as well as the rest of the team, until its actual moments of implementation. A six-month time frame with each task allocated different week periods was drafted by the RN facilitator. Hence, beginning from May to September of the same year (2019) (Refer to Table 2). The RN facilitator indicated that the project proposal would be written within the first week (05/01/2020 to 05/06/2020), discussed with the team before approval (08/05/20 to 23/06/20), adjustments made (06/25/2020 to 07/21/2020), and final implementation (07/29/2020 to 09/07/2020).

Organizational Fit

Pain relief for patients is a crucial aspect, especially for adult patients in the Legacy health care center. To ensure the implementation plan was effective, RN facilitator aligned to the mission, values, and primary goals of Legacy health care center. The mission for Legacy health care center care focused on the provision of outweighing care services regarding the health of community persons. A task is vital as it results in the facilitation of adequate standards of health to all in a society (Mirvis, Googins, & Kinnicutt, 2010). With a well-defined purpose, then the achievement of ABC's vision was evident and depended as a core factor for effective plan implementation. Legacy health care center implemented determination value, respect value, integrity value, vision value, excellence value, and nurturing value. The determination was to boost, respect the needs of patients, show integrity through the persistence of addressing issues, implement EBP through visions, excellently focus on care for patients, and nurture their ecosystems for more exceptional outcomes.

The integration of the aspects in Legacy health care center was, as a result of earlier successful projects which applied the same technique in the implementation plan. An EBP had been implemented earlier in the Legacy health care center regarding acupressure/acupuncture methods to relieve pain. This non-pharmacological therapy involves the managing of pain in different patients (Abraham, 2008). However, the implementation plan for the EBP was effective due to the coordination and following aspects of values, mission, and vision of Legacy health care center. Despite this, strategies and techniques were considered as an incentive to help implement plans for non-pharmacological interventions.

Barriers to Implementation of EBP

The RN facilitator was aware of the potential primary obstacles facing the Legacy health care center, like the lack of policies to coordinate administration of non-pharmacological interventions. Besides, lack of expertise and inadequate pieces of equipment to facilitate physical therapies were recognized. The barriers went further to limit the desire to grab the opportunities of implementing or exercising the project proposals. The RN facilitator stated that the efforts to eliminate the obstacles could not be reflected. According to Dyeson (2005), obstacles in the EBP plan for implementation arise due to assumptions of fewer impacts on the same being too high.

The clinical officers could not easily cope with the sudden dynamics in the Legacy health care center; thus, taking more time to adapt to the new ecosystem. Although efforts and strategies were later put in place to eliminate the barriers, this took an extended time than expected. Conditioning the mind and body to new activities require time to master the practices (Kleinbongard et al., 2017). The RN facilitator (Abbigail) and his assisting nurses in Legacy health care center were the most connected with the barriers.

Facilitation Strategies for EBP Implementation

The RN facilitator discussed the strategies to be applied in the plan, among them the establishment of a control system or technique that is mutual to all clinicians in monitoring adult patients in the Legacy health care center. As Klingbeil, & Gibson (2018) would argue, a system act as a reminder to the officials to consistently follow on the adult patients’ non-pharmacological interventions, enabling them in pain relief. Despite monitoring, the system would allow gaining patient's feedback based on the outcome (therapies). The system was introduced after a review of earlier feedbacks and intended to improve the EBP implementation plan.

The team persuaded to offer support was to be guided on the bases of clinical guidelines. This was to assist in following the role of the project by maintaining but not veering off the course. Individuals involved were allowed to acquire skills and knowledgeable experience from EBP projects that had previously occurred. The majority of the stakeholders speculated and believed they would witness the success of the implementation plan. As a result, the RN facilitator encouraged the division of labor in which duties would be delegated according to the unique skills of clinicians. According to Kizza & Muliira (2015), this enabled each stakeholder to participated and operated within his or her domain. Through these strategies, the RN facilitator was satisfied that stakeholders involved were convinced to work on implementing the EBP project.

Resources Needed

In full project implementation, the RN facilitator requested for specific resources. As a resource, the cooperation of society around the Legacy health care center was more significant. Kleinbongard et al. (2017) say the peace of mind when associated is a vital requirement in the project implementation. Financial support could not be omitted in the project since acquiring training, and reading facilities demanded finances. Besides the technological gathering of information, the project was backed by funds. Kizza & Muliira (2015) agrees that time resources are much be appreciated when visiting and spending time with the patients. Therefore, balancing time became essential to make sure that all the requirements were attended to at a higher rate. The people's cooperation and trust were earned by letting them know the importance of this project. Additionally, the RN facilitator deliberately suggested that time could be gathered by strictly being in the right place when required.

Table 2

Estimated Timetable Blueprint for Implementation

Task	Estimated Date of Start	Estimated Date of Completion	Person/s Responsible
Considering the acceptance of the RN facilitator in the EBP project before start-up.	05/01/2020(1 week)	05/06/2020	· Adult patients therapy team · RN facilitator · Clinical top executives
Allocation of support team roles. Reviewing the roles depending on support team potentials.	05/08/2020 (1 week)	05/14/2020	· Adult patients therapy team · RN facilitator · Clinical top executives
Allocation of stakeholders to enable adjustment of possible requirements when moving forward.	05/15/2020 (2 weeks)	05/28/2020	· Adult patients therapy team · Clinical top executives
Evaluating the capability of the support team before implementation.	06/02/2020 (1 week)	06/10/2020	· Adult patients therapy team · RN facilitator · Clinical top executives
Countercheck and approval of the evidence to be considered in project implementation.	06/16/2020 (1 week)	06/23/2020	· RN facilitator
Analyzing possible modifications that can fit new strategies in the EBP project.	06/25/2020 (1 week)	07/01/2020	· Adult patients therapy team · RN facilitator · Clinical top executives
Determine the appropriate approach to acquiring clinical materials. Prioritizing the most useful sources.	07/07/2020 (2 Consistent weeks)	07/21/2020	· Adult patients therapy team
Clinical guidelines allocation before Extracting important materials.	07/29/2020 (1 week)	08/06/2020	· Adult patients therapy team
Visitation of adult patients undergoing therapies to explain the essentiality of non-pharmacological interventions.	08/11/2020(4 weeks)	09/10/2020	· Adult patients therapy team · Clinical top executives
Guidance of less-skilled stakeholders. Especially the primary stakeholders.	09/14/2020 (2weeks)	09/29/2020	· Clinical top executives

section 4

Plan for Evaluation

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Table 3

EBP Evaluation Plan

Outcome(s)	Measures/Measurement	Time of Collection/Person Responsible

section 5

Conclusions, Recommendations and Implications

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References

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Bucci, S., Berry, K., Barrowclough, C., & Haddock, G. (2016). Family interventions in psychosis: a review of the evidence and barriers to implementation. Australian Psychologist, 51(1), 62-68.

Connors, M. H., Quinto, L., McKeith, I., Brodaty, H., Allan, L., Bamford, C., & O'Brien, J. T. (2018). Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychological medicine, 48(11), 1749-1758.

Carr, D., Elissa Charbonneau, D. O., Tedra Cleveland, M. S. H. A., Senelick, R. C., & Stillo, J. (2019). Non-Pharmacological Pain Management Interventions. Birmingham: Encompass Health Corporation. 1241-1428.

Ceballos-Laita, L., Estébanez-de-Miguel, E., Martín-Nieto, G., Bueno-Gracia, E., Fortún-Agúd, M., & Jiménez-del-Barrio, S. (2019). Effects of non-pharmacological conservative treatment on pain, range of motion and physical function in patients with mild to moderate hip osteoarthritis. A systematic review. Complementary therapies in medicine, 42, 214-222.

Cintoli, S., Radicchi, C., Noale, M., Maggi, S., Meucci, G., Tognoni, G., & Maffei, L. (2019). Effects of combined training on neuropsychiatric symptoms and quality of life in patients with cognitive decline. Aging clinical and experimental research, 1-9.

Cheung, A. (2019). The Importance of Non-Pharmacological Pain Management in Pediatric Palliative Care (Doctoral dissertation, Azusa Pacific University). 358-711.

Chiasson, A., Brooks, A., Ricker, M., Lebensohn, P., Chen, M. K., & Maizes, V. (2020). Educating Physicians in Family Medicine Residencies about Nonpharmacologic Approaches to Pain: Results of an Online Integrative Course. Family Medicine, 52(3), 189-197.

Dyeson, T. B. (2005). Home health social work: Obstacles to evidence-based practice. Home Health Care Management & Practice, 17(4), 316-319.

Edmond, S. N., Becker, W. C., Driscoll, M. A., Decker, S. E., Higgins, D. M., Mattocks, K. M., & Haskell, S. G. (2018). Use of non-pharmacological pain treatment modalities among veterans with chronic pain: results from a cross-sectional survey. Journal of general internal medicine, 33(1), 54-60.

Kizza, I. B., & Muliira, J. K. (2015). Nurses' pain assessment practices with critically ill adult patients. International nursing review, 62(4), 573-582.

Karabulut, N., Gürçayır, D., & Aktaş, Y. Y. (2016). Non-pharmacological interventions for pain management used by nursing students in Turkey. Kontakt, 18(1), e22-e29.

Kleinbongard, P., Gedik, N., Stoian, L., Frey, U., Zandi, A., Thielmann, M., & Heusch, G. (2017). Cardioprotection by Remote Ischemic Conditioning in Humans: Improved Contractile Function and Mitochondrial Respiration of Atrial Trabeculae. Circulation, 136(suppl_1), A15363-A15363.

Klingbeil, C., & Gibson, C. (2018). The teach back project: a system-wide evidence based practice implementation. Journal of pediatric nursing, 42, 81-85.

Mirvis, P., Googins, B., & Kinnicutt, S. (2010). Vision, mission, values. Organizational Dynamics, 39(4), 316.

Rycroft-Malone, J. (2010). Promoting action on research implementation in health services (PARIHS). Models and frameworks for implementing evidence-based practice: linking evidence to action, 109, 135.

Stetler, C. B., Damschroder, L. J., Helfrich, C. D., & Hagedorn, H. J. (2011). A guide for applying a revised version of the PARIHS framework for implementation. Implementation Science, 6(1), 99.

Theleritis, C., Siarkos, K., Politis, A. A., Katirtzoglou, E., & Politis, A. (2018). A systematic review of non‐pharmacological treatments for apathy in dementia. International journal of geriatric psychiatry, 33(2), e177-e192.

Vancampfort, D., Firth, J., Correll, C. U., Solmi, M., Siskind, D., De Hert, M., & Stubbs, B. (2019). The impact of pharmacological and non‐pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐review of meta‐analyses of randomized controlled trials. World Psychiatry, 18(1), 53-66.

Ward, M. M., Baloh, J., Zhu, X., & Stewart, G. L. (2017). Promoting Action on Research Implementation in Health Services framework applied to Team STEPPS implementation in small rural hospitals. Health care management review, 42(1), 2.

Wexler, B. E. (2017). Non-pharmacologic interventions for the management of cognitive symptoms. Johns Hopkins Advanced Studies in Medicine, 7(3), 79-83.

APPENDICES

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