 Hello and welcome to Fairfield University's Innovative Research Symposium Spotlight. I'm Dr. Sally Gerard and today I have the pleasure of introducing Brianna Mann. Over the past semester, Brianna has been working on the research topic of use of complementary and alternative medicine in perioperative care at the Egan School of Nursing and Health Science. Thank you for joining us today. Thank you so much. I'm happy to be here. Brianna, we're very proud of the work that you have to share with us today. Let's start with a presentation of your research and then we'll follow up with some conversation. So I would like to begin with introducing my topic, use of complementary and alternative medicine in perioperative care. This is a topic that I have been very passionate about for the majority of my time here in the Egan School. I found that in my practice personally, both professionally and within the academic setting, I found many examples of how this is such a budding field in especially the treatment of perioperative care. So something that really drew my attention from a very early stage in nursing school was the designation of pain as the fifth vital sign. In 2001, the Joint Commission developed a pain management standard because they felt that basically pain was being under-treated and under-reported. So of course, as nurses, we're always taught to rate pain on a scale of 0 to 10. So that's something that I was very, very interested in from a very early age and I was lucky enough to do my capstone research in the post-anesthesia care unit where I was able to work hands-on and see for myself the prescription and the administration of these narcotics, especially in the hospital setting and in the outpatient setting. So a little bit of rationale from my project. Narcotic use is a largely linked precursor to drug overdose, misuse, and abuse. We give these drugs to people who don't have the education that we as nurses have or doctors and this has the potential to cause accidents, maybe not on purpose, but we're sending these people home with these drug prescriptions. So that was something that I kind of saw from the beginning as just a little interesting. The aim of the research is to link complementary and alternative medicine, which I abbreviate as CAM, to increase in patient comfort and better patient outcomes. I hope that this link could help decrease the use of narcotics in the perioperative practice because I feel that when combined with the standard of care practices such as pharmacology that we use, I feel that it could cause a more controlled, improved outcome in patient symptom management. So let's jump into it. We have a couple learning needs that I want to highlight. We have a knowledge gap among healthcare professionals who care for clients who are prescribed these opioid analgesia in the hospital setting. Us as practitioners are given information to relay to our patients, but where does the knowledge gap occur? I wanted to look into this in my research. Furthermore, in my research, I discovered that perioperative care physicians including anesthesia staff, doctors, and nurses have a need for more research in order to implement these practices in their own practice. Complementary and alternative medicine is a blanket term, and they can include things such as acupuncture, Chinese medicine, aromatherapy, guided imagery, Reiki, reflexology, and homeopathy and naturopathy. Cam has been clinically indicated to improve things such as postoperative nausea, pain, and anxiety both after and before the surgical setting. So in my research, I found that evidence-based literature observed a greater symptom reduction in groups of people receiving both CAM and standard of care procedures. These include standard pharmacological implementation that we see today. Basically what happened was, one of three CAM interventions such as guided imagery, acupuncture, and reflexology were implemented in each patient case. Basically, there was a group of an experimental group who selected the use of this CAM therapy in addition to standard of care, and then there was a control group that only received the standard of care. And basically what was observed is when giving them a scale from 0 to 10, the group that received the CAM therapy were statistically significantly more content with their treatment and symptom management. I feel that this is significant because it is such a simple implementation that can be done relatively free of danger, of course, with the permission of the doctor. Certain CAM interventions have also been linked to specific outcomes. For example, acupuncture and acupressure have been clinically proven to reduce pain nausea vomiting. And it actually, in a specific subgroup of patients who are experiencing GI abnormalities, it's been linked with improved passing of flaches and bowels at an earlier time, which of course is very important in our post-operative patients. Aromatherapy has been linked to reduced post-operative pain, and music therapy has been linked with improved rest sleep cycles and decreased anxiety. Anxiety is an important topic because so many of our patients who are going into the operative setting feel a great influx of knowledge deficit, worry, uncertainty, and that of course hinders the experience for both our patient and our staff. Greater understanding of relief for anxiety using CAM therapies in the perioperative period can supplement conventional medicine and that will allow perioperative nurses in anesthesia to basically provide better care to their patients at a more tailored, specific setting. Nurses who receive separate education are narcotic youth, display a higher education competency than nurses who do not. This doesn't have any impact related to age, education level. It's really just what we provide our nurses with to then again relay to their patients. I structured my development and implementation of my project around the research that I've completed. I found something very interesting. Anesthesia staff, comparatively to surgeons, in addition to nursing staff, have a stronger interest in CAM practice, which I feel is very interesting. I feel like it's because these people have a more hands-on approach to patient care when it comes to the perioperative setting. Discussing CAM alternatives between the staff and the clients obviously increases comfort level and I think it's something that we should offer our clients. Improve relief of anxiety with CAM in addition to standard of care aids this whole process of communication between the patient and the staff. Symptom reduction is optimized when, of course, the standard of care is supplemented with the CAM interventions. An important thing that I want to underscore is I'm not suggesting use of CAM and not standard of care. I think that it's optimized when both are used in conjunction with one another. The effect on patient practice in reviewed experimental studies CAM in addition to standard of care procedures improve patient outcome and satisfaction. The benefit of using CAM is twofold. We have the objective improvement in symptom management that these treatments offer. In addition to the fact that since these are non-pharmacological, patient-controlled component of pain is improved. We see these in implementations with narcotics already. Patient-controlled analgesia pumps, PCA pumps is something that I observed in the PACU first hand. Of course, this delivers narcotics but this use of non-pharmacological interventions puts the control back in the patient's hands and with something as subjective as pain I feel that this is very important and we give our patients the say in their treatment approach. In nursing school we always talk about how we want to tailor the experience individual to the patient. This is something that is going to bridge that link. Improved patient satisfaction and outcomes have a significance in hospitals being successful as businesses because obviously as doctors and nurses, as healthcare professionals, we want to provide the best care but we also work for businesses and these will improve the satisfaction. PCAM is a popular new trend in healthcare. All supporting literature suggests that more evidence-based research is needed. So that is basically the final takeaway that I took from my research. We really do need improved evidence-based research in order to implement this in the hospital. That's not to say that hasn't been done already. I have personally seen in my own practice this in the perioperative setting, even in the postoperative on inpatient units. I have patients who receive aromatherapy starting in the PACU and I've seen the effects that it has and I like what I saw. So that was something that also pushed me to be passionate about this project. I think it can be important to patient care because PCAM, as I said before, can be implemented relatively with limited risk of serious side effects. We're not putting anything really into the body. That's kind of something that is just a very subjective process. Nurses should communicate to patients and families about the availability of these treatments because it has such a profound possibility for symptom reduction in this period. And it also has been linked with increased willingness to alternative practices that the patient may not even been aware of. Benefits, challenges, and lessons learned. As I discussed before, I think the evidence-based realm is the most promising point that we can jump off of CAM therapy. I think that objective success of CAM interventions, however, is slightly more difficult to measure because of the subjectivity of pain. Patient knowledge of NARN pharmacological modalities for persistent pain management influences the willingness to try such alternatives. This is basically us being advocates for our patients, providing them with the knowledge that they might not necessarily have. When somebody comes into surgery, we have to realize as healthcare professionals that they do not have the skill sets and the knowledge that we have as professionals. And I think it's very important for us to provide them with the information and, furthermore, the community access to such modalities. And that should be facilitated by case management in order to assist this process. So that's basically a summary of what I have conducted in my own research. Thank you so much, Brianna. That was a great summary of this topic. So tell me a little bit more about what experience that you brought with you into this critical setting that helped you to focus on this topic and share the research with the staff. I kind of delved into it before, but I will also reiterate that I worked as a patient care associate at a local hospital, and I worked on a postoperative orthopedic floor where we dealt with patients who have hip replacements, knee replacements, joint replacements. And I saw a lot of my patients came up from the PACU with these little like squares of, and it has like lavender images on it or like orange, orange images on it, and I was like, what's that? And I asked one of my patients and they told me, oh, I don't know. They gave it to me in the PACU. It always smelled so good to me. And then I realized upon my own research that it was aromatherapy being implemented in the patient recovery period. I found this really interesting because it was something that I had never seen before. I didn't know that it was something that we did in the hospital. And that was basically the point that I jumped off onto my own research and interest into this topic. Great. Thank you. And so how would you say this project supported your professional growth as you start in on your nursing career? My whole career at the Egan School, I have been introduced to the field of evidence-based practice. This was my ability to take my own creative license into this field of evidence-based research. And I felt that it was a nice bridge between the learning portion of nursing school into my own personal practice. And I feel that it bridged that connection between nursing school and the real life. That's wonderful. That's wonderful. Thank you so much. So in closing, I want to thank you, Brianna, for joining us here today and for sharing this really interesting research and your perspectives on this evidence. And on behalf of Fairfield University and the Egan School, I'd like to thank you all for watching. Thank you so much.