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Background
Our Lady of the Lake Regional
Medical Center (OLOLRMC) is a
Magnet-designated, DAISY Hospital Partner with surgical volume of
11,270 cases annually. Postoperatively, patients are admitted primarily to the inpatient surgical unit
(SURG). SURG is a 27-bed inpatient
unit with two wings (A hall=ll beds;
B hall=16 beds). Its staff manages
care of patients after planned surgical procedures, predominately abdominal, vascular, and oncology
diagnoses. In fiscal year 2010, 2,191
patients were discharged ftom SURG
with an average length of stay of
3.57 days.
Literature Review
The review of literature was conducted ufilizing the following databases: Cumulafive Index to Nursing and
Allied Health Literature (CINAHL)
Tressa Comeaux, APRN, FNP-C, CEN, is CICU Staff Nurse, Our Lady of the Lake Regional
Medical Center, Patient Care Services, Baton Rouge, LA.
Susan Steele-Moses, DNS, APRN-CNS, AOCN, is Research Director, Our Lady of the Lake
Regional Medical Center, Academic Affairs, Baton Rouge, LA.
Theoretical Model
As part of the professional model
of care at OLOLRMC, principles
inherent to Relationship-Based Care
MEDSURG
Acknowledgments: This study was funded by a non-restricted grant from the DAISY Foundation:
JPB-021-A. The authors wish to thank Angela Dykes, BSN, RN; Sandra Wade, MN, APRN-CNS;
and Yvette Robson, RN-BC, who conducted the ongoing study on the SURG unit at Our Lady of
the Lake Regional Medical Center, Baton Rouge, LA.
313
Method
A quasi-experimental non-equivalent control group design was used in this study
with participants assigned based on room assignment rather than randomly. The
control group, which consisted of participants admitted to the A hallway, received
the standard of care. The intervention group, which consisted of participants
admitted to the B hallway, received complementary music therapy in the form of
pre-programmed MP3 players, in addition to the standard of care. Based on the
premise of a non-equivalent control design, neither analgesia type nor route was
controlled. Each participant was enrolled for a total of 3 days or until discharge,
whichever came first. Outcome measures were collected upon enrollment (Time
One) and for the next 2 consecutive days (Time Two and Time Three). Participants
in the intervention group were encouraged to listen to a selection of non-lyrical
low decibel (less than 60 db) pre-programmed music, for at least 30 minutes via
a MP3 player after their prescribed analgesia was administered. Non-lyrical low
decibel music was chosen for this study because previous research supported its
effectiveness. State trait anxiety as well as pain and environmental noise satisfaction were assessed using the State-Trait Anxiety Inventory and two standardized
questions from the Press Ganey survey.
Findings
Before the intervention was implemented, both groups were the same related to
their average level of state and trait anxiety, pain, and noise perception. The
patient's state anxiety, pain perception, and noise perception were measured 1
day after the intervention was in place. A significant difference was found from
Time One to Time Two in pain management (t=3.938, p<0.001 ) and environmental noise satisfaction (t=3.457, p=0.001), while there was no change in state anxiety (t=0.373, p=0.7n). The intervention group experienced improved pain management (t=7.385, p<0.011) and environmental noise satisfaction over time
(t=4.371; p<0.001); however, there was no improvement in state anxiety (t=1.47;
p=0.159). The findings suggest music therapy decreases pain and environmental
noise perception, although there was no effect on state anxiety.
Conclusions
Use of music therapy improves patients' postoperative experience by increasing
their pain management and white noise satisfaction. Because the intervention was
tested on a busy post-surgical unit with a short inpatient stay (mean=3.57), the
effect of music therapy over more than 2 days could not be measured. This intervention was inexpensive and easy to implement in the clinical setting, and therefore recommended to improve postoperative outcomes in other facilities. It is recommended the study be replicated with a larger sample size and different patient
populations to validate these findings.
314
3SrX7Xl
September-October 2013 Vol. 22/No. S M E D S U
RG s
IISTG.
The Effect of Complementary Music Therapy on the Patient's Postoperative State Anxiety, Pain Control, and Environmental Noise Satisfaction
TABLE 1.
Demographic Data by Croup
Environmental Noise
Reduction
Environmental noise is a significant barrier to sleep for hospitalized
patients; research supports sleep as
therapeutic to overall health, wound
healing, and recovery (Gardner,
Collins, Osborne, Henderson, &
Eastwood, 2009). Noise in and
around the nurses' station can be
especially problematic (Haupt, 2012).
Music therapy functions as a distracter ftom hospital noise, thereby
reducing emotional anxiety and
pain (Gardner et al., 2009). To promote relaxation, music should: (a) be
non-lyrical, (ti) have predominantly
low tones, (c) have minimal brass
and percussion, and (d) have a maximum decibel volume of 60 db
(Nilsson, 2008).
Method
The first 41 data sets collected to
test the efficacy and feasibility of the
study methods are reported here.
The larger study, which is still ongoing, consists of three groups: (a) control, (b) music therapy, and (c) white
noise therapy. The pilot study and
the larger study were provided
exempt status by both the Nursing
Research Council and Clinical Research Steering Committee of OLOLRMC. An implied consent process
was used because a wriften consent
would have tied the participant to
the study, thereby precluding
exempt criteria definition. Providing
complementary music therapy via
pre-programmed MP3 players was
an inexpensive intervention that
was implemented easily to enhance
the patient's postoperative experience.
MEDSURG
Variable
Gender (A/=41)
Standard of Care
Intervention
Male (n=27)
14 (34.2%)
13 (31.7%)
8 (19.5%)
6 (14.6%)
13 (31.7%)
12 (29.3%)
8 (19.5%)
7 (17.1%)
1 (2.4%)
Female (n=14)
Race (/V=41)
Caucasian (n=25)
Measures
The State-Trait Anxiety Inventory
(STAI) was used to evaluate anxiety.
The STAI is divided into the two subscales: STAI Form Y-1 and STAI Form
Y-2. The 20-item STAI Form Y-1
(Chronbach's alpha = 0.62) was used
to measure state anxiety (Spielberger,
Gorsuch, & Luschene, 1970). The
STAI Form Y-1 (range score 20-80)
measures the participant's current
emotional feeling, such as calm or
316
TABLE 2.
Difference between Groups per Study Variable, Time One (N=4^)
Variable
M'
State Anxiety
Music
19
9.63
Control
22
36.05
Trait Anxiety
Music
19
37.42
Control
22
32.81
19
2.42
Control
22
2.73
Music
19
2.74
Control
22
3.14
t
1.112
P
0.273
1.448
0.156
1.694
0.098
1.864
0.070
TABLE 3.
Difference between Croups per Study Variable, Time Two (/y/=41)
State Anxiety
0.373
Music
19
37.11
Control
22
35.68
3.938 <0.001
Music
19
3.47
Control
22
2.77
3.457
Music
19
3.53
Control
22
3.05
Findings
At Time One, no significant differenee existed in state anxiety, trait
anxiety, or pain management or
environmental noise satisfaetion
between groups (see Table 2). The
partieipant's state anxiety, pain management satisfaetion, and noise satisfaetion were measured again 1 day
after the intervenfion was in plaee
(Time Two). At Time Two, a signifieant inerease was found in pain
management (t=3.938; p<0.001) and
environmental noise satisfaetion
(t=3.457; p=0.001), while no ehange
was found in state anxiety (t=0.373;
p=0.711)(seeTable3).
The efteetiveness of the intervenfion was analyzed over time. For the
0.711
0.001
Discussion
Both groups expressed average
levels of general anxiety (trait) and
situational anxiety (state) at the
The Effect of Complementary Music Therapy on the Patient's Postoperative State Anxiety, Pain Control, and Environmental Noise Satisfaction
TABLE 4.
Difference within Group from Time One to Time Two, Controi (N=22)
State Anxiety
Time One
0.149
0.883
0.237
0.815
0.568
0.576
36.05
Time Two
35.68
2.73
Time Two
2.77
3.14
Time Two
3.05
TABLE 5.
Difference within Group from Time One to Time Two, Music (N=19)
State Anxiety
Music
39.63
1.47
Control
37.11
7.385 <0.001
Music
2.42
Control
3.47
4.371
Music
2.74
Control
3.53
MEDSURG
0.159
<0.001
Nursing Implications
In this study, use of music therapy
improved pain management and
environmental noise satisfaction
when used as a complementary therapy. Therefore, distraction from negative experiences through use of
music therapy can increase satisfaction in patients recovering from surgery. This intervention was inexpensive and easy to implement in the
clinical setting, and therefore recommended for use to improve postoperative outcomes. MP3 player technology decreased in cost, providing a
viable option for hospitals. The players can be cleaned easily, patients
can be given their own ear buds to
keep, and music discs are a one-time
purchase. Nurse leaders may consider purchasing MP3 players inscribed
with their hospital logo for the
patients to keep, thus promoting the
intervention after discharge.
Findings ftom this study can be
incorporated easily into the nurse's
practice. The medical-surgical nurse
could encourage family members to
bring the patient's favorite music
ftom home to augment analgesia.
Portable CD players, MP3 players,
and cell phones are all viable portable options to provide music.
Family members also should be
reminded to bring earphones or ear
buds to prevent disrupting other
patients. The nurse can encourage
the patient to listen to the music
immediately after analgesia administration for a period of at least 30
minutes. Not only will the patient's
favorite music decrease anxiety, but
it also masks routine hospital noise
that patients often find annojng.
Limitations and
Recommendations for
Future Research
Preliminary analysis identified
some limitations in the study. First,
patients were not assigned randomly to the intervention; although
room assignments were non-predictive, they were not random. In addition, use of personal distraction may
have confounded the findings of
this study. Patients in the control
group also reported listening to
music. Patients may have brought
their own music with them or listened to music provided on the television network. Because no manipulation occurred to change usual
317
Conclusion
Findings of this study suggest
music therapy improves the postoperative experience through enhanced pain management and environmental noise satisfaction. The
intervention was inexpensive and
easy to implement in the clinical set-
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continued from page 312
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Agitation Management
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