Music therapy is an evidence-based practice that can affect changes in physical, psychological, social and cognitive domains. Many scientists and researchers have examined music treatment and its ability to reduce anxiety in a variety health care settings and patients. The soothing effects of music have been demonstrated in patients undergoing chemotherapy or elective surgery under local or regional anesthesia. These effects also have been found in preoperative and postoperative patients, patients receiving assistance from a ventilator or undergoing flexible sigmoidoscopy, and women in labor (Standley, 1992, Marley, 1984, Mckinney, 1990 and Barnason et al, 1995 cited in Mok and Wong, 2003).
Project objectives
Providing high-quality, cost-effective perioperative evaluation and nursing care of surgical patients is a key issue in perioperative management. As surgical staffs make efforts to reduce anxiety which is this normal predictable response is seen, is our big task. Music is an easily administered, non-threatening, non-invasive, and inexpensive tool to calm preoperative anxiety. This project objective is to evaluate the effect of music on perioperative level of anxiety in the surgical patient.
Literature Review
Johnston (1980) used the State-Trait Anxiety Inventory (STAI) in studies involving 136 surgical patients to examine the natural course of anxiety before and after surgery. The results suggested that high levels of anxiety were experienced before admission to hospital, between admission, surgery and following surgery, and such phenomena were not restricted to the immediate pre-operative period. These results have implications for those planning interventions to alleviate anxiety associated with surgery and for those studying surgical stress as a model for other naturally occurring stresses.
Augustin and Hains (1996) in their study found that familiar music can affect patients’ hospitalization experiences and have a positive effect on their physiological responses to surgery. Music blocks out background noise and may inhibit patients’ ability to engage in negative self-talk or magnify the significance of undergoing surgery.
Lukas (n.d.) said that offering music listening as therapy to patients can be a low cost and effective tool. In this study, 31 surgical patients selected music from a set of CD recording and listened to music preoperatively, intraoperatively, and postoperatively. A 10-item survey was administered to participants in orthopedic patients approximately 24 hours following their dismissal from the surgery centre. Study results indicated that participants overwhelmingly felt that music listening was a positive addition to traditional pain and anxiety management.
(Ikonomidou el at, 2004 ) the study points to an anxiety reducing effect of a period of peaceful rest both before and after surgery. The addition of music therapy in the perioperative period thus stands out more as a complementary measure for improved patient comfort and satisfaction, although an opioid-sparing effect seems to be attainable with the use of postoperative music therapy.
Methodology
Study design
I, myself will be, the leader of the research team and 4 more volunteers of operating theatre nurses will have to be recruited for this research. All facility nurses who participated in the study are possessing knowledge in the surgical operations and will be given 30 minutes orientation of study description. The role of facility nurses in the study is cleared outlined. All questions regarding study methods will be added prior to commencing the study.
For this study, researchers assess the effectiveness of music as a relaxation modality by measuring patients’ vital signs and self-reported anxiety before and after surgery. The study design requires the use of the Chinese version of the Spielberger State-Trait Anxiety Inventory (C-STAI) as a principle measure and a physiological measure of procedure-related anxiety. This study also is designed to learn about the broader effects of music by asking patients their perception of listening to music before, during and after surgery. The goals of this study are to examine whether music can reduce patients’ perioperatively anxiety and sense of isolation effectively and be considered an alternative nursing intervention when planning patient care in ambulatory surgery service centre.
This study is designed as an experimental quantitative design comparing anxiety, blood pressure, and heart rate in two groups of patients – control group and experimental group. The purpose of the study is to determine the effects of music on patients’ anxiety levels before, during minor surgery with local anesthesia and after surgery. More specifically, the objectives are to
- determine whether music has an effect on lowering patients’ subjective level of anxiety when undergoing minor surgery with local anesthesia,
- determine whether music has an effect on lowering patients’ blood pressure and heart rate when undergoing minor surgery with local anesthesia,
- explore the patients’ perceptions of music during their surgical procedure.
Hypothesis
The hypothesis of this study is that
- patients who listen to relaxing music perioperatively would have significantly lower anxiety levels than those who just listen to ambient operating room noise.
- patients who listen to their choice of music perioperatively would have significantly lower blood pressure and heart rate levels than patients who does not listen to music.
Study Sample
A convenience sample of 80 surgical patients will be chosen. Patients will be divided into two groups by random. The patients will be assigned to either experimental group or control group by drawing an envelope. 80 envelopes will be prepared for the patients to choose at random. Half of the surgical patients selected will be the control group and the rest will be the experimental group. They are all going to have excision of breast lump under local anesthesia, which group of patients will be chosen because it is a relatively large sample in our hospital.
Participant Inclusions and Exclusion
In this study, the patients (study sample), the patients are selected based on inclusive criteria, including the followings if the patient:
- is 18 year old or older;
- is willing to participate in the study;
- has a cognitive ability without a hearing impairment;
- is able to comprehend oral and written instructions;
- is not with premedication prescribed before operation, otherwise which will alter the patient’s vital signs or level of consciousness;
- has no cardiac disease and history of hypertension, If not, which will affect the data.
In addition, a patient who recently has undergone or is scheduled for surgery on an ear, face and head is excluded because listening to music requires headphones.
Human Subject Protections
This study will be conducted in Ambulatory Day Surgery Centre, in hospital of HA, HK. Approvals for the study will be obtained from the Hospital Research Ethics Committee, Hospital Authority and Department of manager (DOM OT) of the hospital. Patient participation in this research study must be voluntary. All applicable human subject protections will be provided. The purpose of the study will be fully explained to patients before surgery one to two weeks prior to surgery. Sufficient time will be also given for patients to ask questions. Written informed consents will be obtained from all willing participants during the preoperative visits, being two to three days prior to surgery.
Music Listening Intervention
A variety of music from four different categories will be offered, including easy listening, classical music, popular contemporary music and Chinese music. The music is deemed relaxing and has regular rhythms.
After admission and the preoperative teaching, participants will be given uninterrupted, music listening time prior to entering the preoperative holding area. The participants will be allowed to choose from the music selections available. Each participant will be given a CD player, headphones and a CD of their own music selection when they are admitted to the preoperative holding area. The CD players used in the study will be inspected by E&M department and approved for patient usage. Participants placed the headphones on themselves and will be asked to set the volume control on the CD player to a comfortable level. The volume control is taped in place to avoid accidental change while the CD player is in use. When participants are being transported to the surgical suite, they continue listening to music intraoperatively. Postoperatively, the participants listen to music throughout their stays in the PACU.
Pilot Study
Prior to the main study, a pilot study including 12 patients will be conducted to examine the validity of the experimental procedures and to allow a better preparation for the main study. Having finished the pilot study, we will finalize and standardize the protocol and we will ensure all the experimental group patients will receive the same and adequate information. After the pilot study, data collection of this research will start immediately.
Procedure for sampling
Patients will be assigned to the experimental group or the control group via an alternate session arrangement. There are two whole day sessions for this surgical operation – excision of breast lump - per week performed by a same doctor. For example, patients who come in one session will be assigned to the experimental group, and patients who come in the next session will be assigned to the control group. This assigning process will be repeated until each group has 40 patients completed surgical operations.
Data Collection
To ensure consistency in data collection, only one research will collect the data.
Patients in the experimental group and the control group will be the same to be taken to the operating theatre as usual. During admission, patient’s demographic data, baseline assessments of blood pressure and heart rate will be obtained. Each of them will also be asked to complete the C-STAI pretest to assess the anxiety level, after which nurses performed routine admission procedures and conducted preoperative teaching. A period of 5 to 15 minutes preoperative teaching will be given to participants depending on patients’ knowledge of the planned surgical procedure and previous hospital experience. In both group, 2% Xylocaine with 1:100,000 adrenaline used as local anesthesia is prescribed by surgeon.
Data Collection for Experimental Group
Each of the patients will be given a selection of CD music to listen to through headphones. After admission and the preoperative teaching, patients put on the headphones to listen to their selected music. During the surgical procedure, three readings of patients’ blood pressure and heart rate will be recorded respectively, and the mean reading will be obtained for calculation. In addition, music selected, the amount of local anesthesia given, and the duration of the procedure will also be recorded.
Immediately after the surgical procedure, the nurses remeasure patients’ vital signs and the patients will be asked to rate items on the state portion of the C-STAI posttest retrospectively, including what they think about their emotional states during the surgical procedure in PACU. Patients also will be asked to comment on their impressions during the surgical procedure by completing an evaluation questionnaire.
Data collection for Control Group
Patients in the control group will not be offered CD music. Their vital signs will be taken before, during and after surgery. These patients will also complete the state portion of the C-STAI before and immediately after the procedure. Meanwhile the amount of local anesthesia given and the duration of the procedure will also be recorded but the patients will not be required to fill out the evaluation questionnaires.
Data Analysis
The data obtained from experimental group and the control group will be compared to determine the possibility of differences among the individual pretreatment variables, which can affect treatment outcomes.
Demographic descriptive and subject variation data will be collected from patients in the control group and the experimental group, including data on age, sex, marital status, education level, previous surgical experience, duration of procedure and amount of local anesthesia used for purposes of assessing comparability between two groups. These data will further be analyzed with χ2 test (chi-square test).
A two-sample t-test for independent groups will be performed to detect any baseline differences in each of the pre-assessment variables (i.e., STAI scores, physical measures - systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate. And a dependent sample t-test design will be used to compare pretest and posttest variables for both groups.
Timeframe
Estimated Cost
- Staff (Volunteer recruited) NA
- Music CD $ 500
- Audio equipments: (a) CD player x 3 $3000 (b) Headphone $ 500
(c) Hi Fi (Hospital build-in equipment) NA
- Research materials: Copy of questionnaires $ 100
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Total Estimated Cost $ 4100
Limitations of this study include
- not everyone considers listening to music a relaxing experience. Some patients may prefer watching television, reading or talking with friends or relatives before operation rather than listening music for relaxation.
- using a small sample size and all data will be collected in only one hospital.
- not accounting for the impact that the patient is accompanied by friends or relatives; and
- operations of the experimental group and the control group are not conducted separately, certain subject interactions are not the same as a result.
Project Contributions
This study is used to assess of patients’ anxiety level in relation to music intervention. If such kind of nursing intervention (i.e. perioperatively providing relaxing music to patients as background sound) is useful to alleviate patients’ anxieties, this intervention can be extended to the other types of operation. Patients may have lower anxiety level, and therefore will decrease their needs of using dosage of anesthesia and pain killers. As a result, the complications of their operations will be decreased and wound recovery will be improved. Those are to promote patients’ comfort and shorten their hospitalization period. The overall medical costs can also be reduced. Last but not least, this program will be beneficial to both the patients and the hospitals.
References
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Standley J M (1992) Clinical applications of music and chemotherapy: the effects on nausea and emesis. Music therapy perspectives, 10(1), 27-35.
Advanced Research Design