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In patients undergoing surgery, does the use of music therapy as a nursing intervention reduce anxiety and physiologic responses to stress in the

perioperative setting compared to only offering pharmacological interventions? Nora VanderPal, BSN

VITERBO UNIVERSITY

Clinical Practice Recommendations

Patients undergoing surgery and other significant medical procedures have high levels of stress and anxiety related to several different factors. These feelings and their corresponding physiologic responses may be caused by the surgical experience, coping with acute pain, treatment regimens, financial burdens of care, and disruptions of their personal and professional lives. Traditional methods of reducing anxiety in presurgical patients have been focused primarily on the use of pharmacologic interventions. However, such interventions may result in delayed awakening and subsequent late discharge from postoperative care and sometimes even an adverse reaction to the medication itself. Moreover, unrelieved postoperative pain can lead to complications, such as ineffective breathing patterns and delayed ambulation resulting in increased postoperative morbidity, delayed recovery and reduced patient satisfaction. Music listening is a non-pharmacological method that can focus attention, facilitate breathing, and stimulate the relaxation response.

Summary of Findings

Limitations

Abstract

Search for Evidence Evidence Based Practice nursing research articles were found using CINAHL

Plus with Full Text from EBSCOhost.

Music is a non-invasive low cost intervention that can easily be implemented in the perioperative setting of any healthcare facility. •  Music therapy should be offered to patients in the

preoperative setting. •  Music acts as an anxiolytic diversion from negative

stimuli and an integrated hypothalamic relaxation response resulting in reduced heart rate and blood pressure.

•  Music therapy provides distraction, promotes relaxation, and decreases anxiety

•  Music therapy should be offered to patients in the postoperative setting. •  Distraction from negative experiences through the

use of music therapy can increase satisfaction, enhance pain management and decrease anxiety in patients recovering from surgery.

Research indicates that music therapy provides distraction, promotes relaxation, and decreases anxiety. Music therapy has a beneficial effect on a patient’s perceived pain, relaxation, respiratory rate, self-reported anxiety level, and the amount of analgesia required for effective pain management. When used in conjunction with pharmacologic pain management strategies, music therapy promotes a sense of well-being and an overall positive experience. Although there was minor evidence suggesting that music has a significant influence on physiologic parameters indicative of stress and anxiety, such as heart rate and blood pressures alone, when used in conjunction , music therapy can produce positive effects on individuals experiencing stress and medically-induced anxiety. Evaluation of the long term effects of music therapy during the perioperative period include a significantly lower respiratory rate and a decrease in mean arterial pressure. Several participants receiving music volunteered comments postoperatively about how much they enjoyed hearing the music and that it provided comfort to them. As healthcare providers search for ways to provide services to their clients that can produce greater satisfaction, perioperative music may be an efficacious and cost effective intervention.

1.  In some studies, participants knew their levels of pain and anxiety were being studied 2.  The 20 minute music intervention in one study may have been insufficient to produce

physiologically measurable effects. 3.  Music responses might have been more significant if subjects brought their own music

selections from home. 4.  The studies should be replicated with a larger sample size and with different patient

populations to validate findings.

Background

♫♪♬ Individuals in the perioperative setting experience high levels of anxiety and stress with consequent physiologic responses. Even patients with a low predisposition to anxiety may become apprehensive in this setting and show physical and psychological changes including increased heart rate, blood pressure, palpitations, vasoconstriction, nausea, vomiting and gastric stasis. Music as a therapeutic intervention has been recognized for its ability to modify the limbic system to provide pain relief, relaxation, and reduction in psychological stress. Therefore the question begs asking: Does the use of music therapy as a nursing intervention in conjunction with pharmacologic therapies effectively reduce anxiety and physiologic responses to stress in the perioperative setting?