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Music Therapy Example
Music Therapy Example
Music Therapy Example
ABSTRACT
Music Therapy is one of the many Complementary and Alternative Medicine (CAM)
treatments that are used in conjunction with pharmacological pain management to
decrease postoperative pain. CAM has grown to become a globally accepted intervention
in the medical field. Pain control in the postoperative period is important in preventing
negative patient outcomes and promoting healing. The purpose of this study is to analyze
the effect of a nurse-directed music therapy intervention on postoperative pain in adults
who have had abdominal surgery. A 3-month randomized quasi-experimental
intervention study will be performed using convenience sample of 100 participants who
will be randomized to groups. Participants will be recruited from three large teaching
hospitals on Long Island, New York. Ages will range from 18 to 90 years old. The
intervention group will receive traditional postoperative pharmacological pain
management and 30 minutes of Relaxation or Classical music to listen to via headphones
and a CD player. The control group will receive standard postoperative pain
management. It is anticipated that pain scores will be decreased in the intervention
group. Pain scors will be collected once the patient is out of the operating room then 30
minutes and 60 minutes in the PACU. Both the sensory and affective aspects of pain will
be assessed using the Visual Analogue Scale (VAS) with zero for no pain and 10 for the
worst thinkable pain. Demographic data will be analyzed using descriptive statistics and
pain scores will be collected from both groups and compared using independent t tests
and MANCOVA.
I NT R ODUC T I ON
Pr oblem Statement
Acute postoperative pain can be challenging for both patients and nurses.
Sometimes the sole use of pain medication is not enough to keep patients comfortable.
The use of CAM offers an adjunctive alternative and alternative method of pain relief. It
is the duty and responsibility of the nurse to regularly assess and treat patients’ pain;
significance of using music therapy to decrease postoperative pain is that it provides the
The independent variable in the proposed study is the music therapy intervention.
According to the American Music Therapy Association (2010), “Music Therapy is the
approved music therapy program”. Activation of the anterior cingulated cortex and
thalamus, which are integral components of the auditory pathway, affect the emotional
aspect of the patients’ pain experience (Shertzer & Keck, 2001). According to Good,
gates, which are diverse points in the central nervous system where the transmission of
physical, cognitive, and emotional factors” (p. 241). The amygdala and the
hypothalamus have an effect on the anxiety and distress associated with pain (Shertzer &
Keck, 2001). According to Shetzer & Keck (2001), “The sensory component of pain is
mediated in part through inhibitory neurons in the spinal cord and thalamus” (p. 92).
There are also distraction and relaxation components at work when patients listen to
Surgical pain is defined as “a complex response to tissue trauma during surgery that
Adequate pain relief is one of the primary focuses of nurses caring for postoperative
patients because it has proven to improve patient outcomes (Shertzer & Keck, 2001).
Inadequate pain management activates the human stress response which results in
The Effect of Music on Postoperative Pain 4
gastrointestinal, renal, neuroendocrine, and autonomic nervous systems are all examples
The theory that provides this study with its conceptual framework is called the
gate control theory (Good et al., 2005). Good et al. (2005) states that, “the perception of
pain is decreased by gates, which are diverse points in the central nervous system where
the transmission of noxious impulses to the cortex is repeatedly modulated, filtered, and
science and must be cognizant of all pain management options available to patients.
What works for some patients will not necessarily work for another. According to Good
et al. (2001), “The sensory component of pain is the unpleasant, physical perception of
hurt, measured with the visual analogue scale (VAS) sensation of pain scale. The
experienced with the sensation” (p. 211). Pain has both sensory and affective aspects and
There are not many articles found addressing music therapy and pain control in
abdominal surgery patients. Some studies only provided patients with one type of music.
This neglects to provide variety and music preference to the participants in the study.
Many studies included the effects of music on other variables including anxiety, nausea
and vomiting, and vital signs (Ikonomidou, Rehnstrom, & Naesh, 2004; Good et al.,
2001). Further studies are needed that solely focus on the effects of music on
The Effect of Music on Postoperative Pain 5
postoperative pain and not other variables. Some studies included other interventions,
such as environmental changes and relaxation techniques, which makes it difficult to say
how much of the results are from music therapy (Good et al, 2001; Shertzer & Keck,
2001).
therapy intervention on postoperative pain in adults who have had abdominal surgery.
H ypothesis
R esear ch Question
The proposed research question is, “What is the effect of a nurse-directed music
abdominal surgery?”
M ethod
Study Design
Wood & Haber, 2010) is needed due to the study’s circumstances. Participants are to be
the effect music therapy has on postoperative pain. This study focuses primarily on the
effect music therapy has on postoperative pain. An advantage to this design is that no
other variables are included that could possibly confound the study. Based on the data
The Effect of Music on Postoperative Pain 6
collected from the demographic questionnaire statistical analysis can pinpoint whether or
not there is a variation among age groups and postoperative pain scores.
knowledge, beliefs and values may or may not affect his or her willingness and ability to
accurately report postoperative pain scores, possibly affecting internal validity. Also,
participants involved in the study may have a pre-existing interest in CAM or music
therapy prior to participating in the study. This may be a potential threat to internal
validity. External validity can be affected by the Hawthorne effect, which is when
“subjects may respond to the investigator not because of the study procedures, but merely
Sample
appropriate number of participants. The sample will consist ideally of 100 participants.
There will be 50 participants in the control group and 50 participants in the experimental
I nclusion cr iter ia. Included in the study will be adults who are immediately
post-abdominal surgery who have the ability to hear, speak and read in English. Ages of
E xclusion cr iter ia. Patients excluded from this study are those with hearing
regime, patients with psychiatric disorders, and patients that cannot read, write or speak
English.
The Effect of Music on Postoperative Pain 7
assigned to the experimental group will first be assessed for pain, then provided with a
time. Their pain level will be assessed after listening to the music selection of their
choice for 30 minutes and then reassessed once more at 60 minutes. The CD player and
headphones will be all the same make and model and approved by bio-med prior to the
start of the study. Standard infection control will be practiced and a protocol will
the control group will be assessed for pain, then provided with a blank CD, a CD player
with headphones, and thirty minutes of listening time. After listening to the blank CD
for 30 minutes their pain level will be assessed and then reassessed once more at 60
minutes. The CD player and headphones will be all the same make and model and
approved by the bio-med department prior to the start of the study. Standard infection
control protocol will be practiced and policy will be implemented to maintain equipment
cleanliness.
Setting
Participants will be recruited from three local teaching hospitals in Long Island,
New York. Trained registered nurses in the pre-surgical testing area at each hospital will
be instructed on the recruitment process and will attempt to recruit participants Monday
through Friday when patients come in for preoperative screening. Patients will be
interviewed to make sure that they are eligible for the study and will be asked about their
music preference between relaxation and classical music at this time. Informed consent
The Effect of Music on Postoperative Pain 8
will also be obtained. They will be advised that they may or may not be listening to
music via the provided CD player with headphones post-operatively depending on what
I nstr uments
questionnaire (Appendix A). Participants will be provided with hard copy and a pen to
fill out during pre-operative testing. Patients will be advised that any questions can be
answered by the research nurse. The questionnaire will be collected and reviewed by the
same research nurse, then given by the research nurse to the research conductors.
on Postoperative Pain). Approval from the Investigational Review Board of each of the
participating in the study will be required to attend the same three hour in-service. Both
research nurses working in the pre-surgical screening area and in the PACU will be
required to obtain training and demonstrate competency. Nurses located in the pre-
surgical testing area will be responsible for recruiting the appropriate participants,
obtaining informed consent and assisting with the demographic questionnaire. They will
also educate the patient on the VAS pain scale and CD player and ensure proper use of
tool and equipment. Each, patients’ desired volume level will be determined and
be handed by the pre-surgical testing nurses to the research study conductors. Then
participants will be put into a computer database which will randomly assign them to
The Effect of Music on Postoperative Pain 9
either the control or experimental groups. The correct CD will be inserted into the CD
player by the researcher and then given to the PACU nurses to provide the participants
with the appropriate music selections or blank CD (depending on which group they
belong to). The PACU nurses will not be able to identify which group the participants
belong to. The CD players will be labeled A, B, and C and the PACU nurses will refer to
participants and at what volume level. The list will be placed in a binder labeled
The PACU nurses will be responsible for delivery of the actual music therapy
intervention. Patients’ pain will be assessed immediately upon arrival to the PACU with
the VAS pain scale as discussed previously. Then the PACU research nurses will place
decided level and press play on the CD player. After 30 minutes the PACU research
nurse will reassess patients’ pain level using the VAS. Pain level will be reassessed a
final time 60 minutes after arrival to PACU. Throughout this study pharmacological
means of pain control will not be withheld. This study is testing the ability of music
The instrument used to measure patients’ post-operative pain is the VAS pain
scale. The scale consists of a continuum from 0 to 10. The sensory aspect of pain is
assessed on the continuum as none (0), annoying (1-2), uncomfortable (3-4), dreadful (5-
6), horrible (7-8), agonizing (9-10). The affective aspect is assessed on the continuum
from 0 being no distress to 10 being unbearable distress. Patients will be shown the VAS
The Effect of Music on Postoperative Pain 10
analogue scale and asked to verbally report both sensory and affective pain levels. The
research nurse will be responsible for recording this number. The VAS scale is used in
most hospitals to assess patient pain. The validity of the McGill Pain Questionnaire’s
Pain Rating Scale has been proven in numerous studies. (Good et al., 2001) The VAS
pain scale has proven to have concurrent validity (Good et al., 2001) Based upon the
questionnaire filled out and collected during the pre-surgical testing areas. Pain scores
will be documented and collected by the research nurses stationed in the PACU. A
baseline pain score will be collected upon arrival to the PACU prior to placing
E xper imental gr oup. Data collected from the experimental group includes
C ontr ol gr oup. The data collected and data collection method in the control
Data A nalysis
statistics. Age, gender and music preference must be analyzed using mean, median and
I nfer ential statistics. All other data will be analyzed using inferential statistics.
Based on prior studies, pain scores collected from both groups should be compared and
The Effect of Music on Postoperative Pain 11
analyzed using independent t-tests and MANCOVA (Shertzer & Keck, 2001; Good et al.,
2001; Good et al., 2005). Standard deviation must be looked at to determine variation
between pain scores. These statistics have been chosen due to the design of the study.
L imitations of Study
This study consists of a one time exposure to the music intervention. Also, pain
scores are only reflected in the immediate post-operative period. A more longitudinal
study, where music is played more than once, and pain scores are assessed at more
Another limitation is that the study depends upon patients self reports of pain. A
number of individual aspects may interfere with accurate reporting, including culture and
past pain experiences. Pain medication is not standardized and may result in varying
levels of pain.
C onclusions
This study is of importance due to its potential implications for nurses and
patients. Music Therapy is a low risk intervention and is generally affordable. Adequate
pain control in the post-operative period provides patients with an overall positive
Nurses in the field can benefit from the findings of this study and previous
studies. Since music preference can vary and be age-specific, patients can be encouraged
to listen to their own music in an attempt to alleviate pain. One concern may include the
fact that nurses may or may not be open to a nurse-directed music intervention. Based on
difficult. Research needs to be done in order to determine the best way to implement a
new policy.
and classes must be provided for all and competency must be assessed. A designated
resource person must be available for staff at all times to facilitate a smooth transition.
up-to-date information. Further research must be done to determine the best way to
implemented if equipment is utilized between one patient to the next. All equipment
music therapy and post-operative pain. A possible outcome of this study is that music
therapy will decrease pain after surgery. Music therapy may also be helpful in
minimizing use of pain medication and benzodiazepines. Just like with other methods of
pain management, what works for some people may not necessarily work for others,
The Effect of Music on Postoperative Pain 13
including music therapy. Culture, age, socioeconomic status and religion will affect
music preferences and must be taken into account. Findings from this research may not
be generalizable to all populations since the sample used was one of convenience and the
References
Ebneshahidi, A. & Mohseni, M. (2008). The effect of patient selected music on early
Good, M., Anderson, G. C., Ahn, S., Cong, X. & Stanton-Hicks, M. (2005). Relaxation
and music reduce pain following intestinal surgery. Research in Nursing and
Good, M., Stanton-Hicks, M., Grass, J., Anderson, G. C., Lai, H., Roykulcharoen, V. &
Ikonomidou, E., Rehnstrom, A. & Naesh, O. (2004). Effect of music on vital signs and
80(2), 269-278.
LoBiondo-Wood, G., & Haber, J. (2010). Nursing research: Methods and critical
appraisal for evidenced based practice. (7th ed.). St. Louis: C.V. Mosby.
http://www.surgeryencyclopedia.com/Pa-St/Post-Surgical-Pain.html
Shertzer, K. & Keck, J. (2001). Music and the PACU environment. Journal of
1. Gender:
a. Male
b. Female
2. Age
a. 18-30
b. 31-50
c. 51-70
d. 71-90
3. Ethnicity
a. Caucasian
The Effect of Music on Postoperative Pain 15
b. African-American
c. Asian
d. Other
4. Race
a. White
b. Hispanic/Latino
c. Not Hispanic/Latino
d. Other
5. Music preference
a. Relaxing (calm/meditation)
b. Classical
a. yes
b. no
a. yes
b. no
a. yes
b. no
a. yes
b. no
The Effect of Music on Postoperative Pain 16
a. yes
b. no
a. yes
b. no
Appendix B
The Effect of Music on Postoperative Pain 17
Appendix C