Rajiv Gandhi University of Health Sciences, Karnataka

Curriculum Development Cell

CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration No

Name of the Candidate : Ms.Eswaralakshmi.N

Address D/o T. Nadesan

Packiavilai street,
Avaraikulam,
Nelai (D.T)-627105

Name of the Institution

: Goldfinch college of nursing
Course of Study and Subject : M.Sc Nursing in
Medical Surgical Nursing

Date of Admission to Course : 20-06-2009

Title of the Topic : To assess the effectiveness of music `

therapy on pain management
Among post operative CABG
Patients in selected
hospital at Bangalore.

Brief resume of the intended work Attached

Signature of the student

Guide Name : Mr. prof. Paulraj.s

Remark of the Guide :

Signature of the Guide :

Co-Guide Name :
Signature of the Co-Guide :

HOD Name : Mr. prof. Paulraj.s

Signature of the HOD :

Principal Name : Mr. prof. Paulraj.s

Principal Mobile No : 9986555383

Principal E-mail ID : paulraj777@yahoo.com

Remarks of the Principal :

Principal Signature :

GOLD FINCH COLLEGE OF NURSING –BANGALORE

RESEARCH PROPOSAL

A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC

THERAPY ON PAIN MANAGEMENT AMONG POST-
OPERATIVE CABG PATIENTS IN A SELECTED HOSPITAL
AT BANGALORE

SUBMITTED BY

MS. ESWARALAKSHMI.N
M.Sc (N) 1st YEAR
GOLDFINCH COLLEGE OF NURSING

BANGALORE-

GUIDER
PROF. PAUL RAJ. S
PRINCIPAL,

GOLDFINCH COLLEGE OF NURSING

BANGALORE-92
RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

PROFORMA SYNAPSIS REGISTRATION OF SUBJECTS

FOR DISSERTATION TITLE

TOPIC: A STUDY TO ASSESS THE EFFECTIVENESS OF

MUSIC THERAPY ON PAIN MANAGEMENT AMONG
POST- OPERATIVE CABG PATIENTS IN A SELECTED
HOSPITAL AT BANGALORE

SUBMITTED BY

MS. ESWARALAKSHMI.N
M.Sc (N) 1st YEAR
GOLDFINCH COLLEGE OF NURSING

BANGALORE-92
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION

1
NAME OF THE CANDIDATE AND MS. ESWARALAKSMI. N
ADDRESS D/O T. NADESAN
PACKIAVILAI STREET,
AVARAIKVLAM, NELAI(D.T)
PIN – 627105
TAMILNADU.

2 NAME OF THE
INSTITUTION GOLDFINCH COLLEGE OF
NURSING, BANGALORE -92
3
COURSE OF STUDY AND 1ST YEAR M.Sc [N],

SUBJECT MEDICAL AND SURGICAL

NURSING DISSERTATION
PROTOCOL
4 DATE OF ADMISSION TO
COURSE 20-06-2009

5. TITLE OF THE TOPIC:

A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON

PAIN –MANAGEMENT AMONG POST-OPERATIVE CABG PATIENTS
IN A SELECTED HOSPITAL AT BANGALORE.

6. BREIF RESUME OF INTENDED WORK

 INTRODUCTION :

The present day social brings storm and stress to all human
beings. Illness with chronic pain goes on and on for months or even
years. Experts say that the first step in treating post operative pain is to
identify the source of pain, if possible. Pain after CABG procedure is such
an illness where most of the patients experience sever pain and
eliminating the source of pain is a challenge. Music has been shown to
have excellent potential as a conditional relaxation technique.

The understanding of the effectiveness of music therapy upon

pain, anxiety and selected physiological variables of pain after CABG
surgery patients can help nurses to design successful interventions to
reduce pain, anxiety and promote healthy adaptation.

Additional sources for reimbursement and financing of music

therapy services include: many state departments of mental health, state
departments of mental retardation/developmental disabilities, state adoption
subsidy programs, private auto insurance, employee worker’s compensation,
county boards of mental retardation/developmental disabilities, IDEA Part
B related services funds, foundations, grants, and private pay.

. The American Music Therapy Association is the largest professional

association which represents over 5,000 music therapists, corporate
members and related associations worldwide. Founded in 1998, its mission
is the progressive development of the therapeutic use of music in
rehabilitation, special education, and community settings. AMTA sets the
education and clinical training standards for music therapists. Predecessors
to the American Music Therapy Association included the National
Association for Music Therapy founded in 1950 and the American
Association for Music Therapy founded in 1971.

6.1. NEED FOR THE STUDY

 In addition to the social support and coping resources, the
relaxation techniques reduces psychological disturbances and physiological
illness and buffers the deleterious effect of stress on physical and mental
health. Many investigators experimental on the effectiveness of various
relaxation technique either separately or in combination with other
techniques.

104 patients undergoing open hear t surgery were prospectively

randomized to receive pre operative music and postoperative music with
standard care. Hear t rate, systolic and diastolic blood pressure, and pain
and tension were measured preoperatively and as pre-tests and post-tests
during the postoperative period. Complications were abstracted from the
hospital record.

Virtually all patients in the music therapy group (95%) and 86% in
standard care completed the study. Heart rate and blood pressure patterns
were similar. Decreases in heart rate and systolic blood pressure in the
complementary therapies group were judged within the range of normal
values. Complication rates were very low and occurred with similar
frequency in both groups. Pretreatment and post treatment pain and tension
scores decreased significantly in the music therapies group on
postoperative days 1 (p < 0.01) and 2 (p < 0.038).

The aim of this study was to explore the effect of music therapy
on postoperative pain. Fifty-seven patients (24 females, 33 males; mean ±
SD age 39.9 ± 14.35 years [range 15 to 69 years] were matched for age
and sex and then non selectively assigned to either an experimental (n =
27) or a control (n = 30) group. Music was played intermittently to
members of the experimental group during the first 24 hour postoperative
period. Pain intensity was measured using the Pain Verbal Rating Scales
(VRS). Significant decreases in pain intensity over time were found in the
experimental group compared to the control group (p < 0.0001). In
addition, the experimental group had a lower systolic blood pressure and
heart rate, and took fewer oral analgesics for pain. These findings suggest
that music therapy is an effective non pharmacologic approach for
postoperative pain management for the CABG patients.

6.2.REVIEW OF LITERATURE.

An extensive review of literature and guidance by experts formed

the foundation to the development of tool. The review of related literature
was done on topics related to post operative CABG patients and
physiological variable in pain after CABG procedure music therapy in
general and music therapy for after CABG procedure.

In this study, Mitrovic and colleagues provide data on their

seven-year experience with using music therapy in patients with acute
coronary syndrome who had undergone revascularization. In total, 740
patients between April 1990 and January 2009 were included in the
analysis, with 370 patients receiving two sessions of music therapy for
12 minutes daily and 370 patients not listening to music.

A broadcast music system has evolved at Piedmont Hospital in

Atlanta, Georgia, that brings music into the intensive care units (ICUs),
operating rooms, perioperative areas, gastrointestinal lab, and labor and
delivery. A number of years ago, Piedmont Hospital extended its 10-
channel music system to the open-heart ICU area, and a pilot stud y using
headphone music was done on a convenience sample of 67 patients
admitted to this particular ICU area who recovered from coronary artery
bypass graft surgery (without valve repair). Patients receiving the treatment
(music) spent significantly less time in the ICU (1,357 minutes vs. 1,657
minutes, F = 4.29, p = .02). There was a trend for lower sedative charges
and ICU charges, but these were not significant. The financial cost of
incorporating music in the care of cardiac and cardiac surgery ICU
patients is relatively small compared to the potential economic benefits.

With use of an analysis of covariance (ANCOVA), subjects ' mood

ratings showed significant improvement in mood among subjects in the
“music intervention” group after the second intervention when controlling
for the pre intervention rating of mood, F(2, 87)=4.33, p=0.016. However,
no significant differences were reported for anxiety ratings as measured by
the NRS and state anxiety instruments. With use of repeated measures
analysis of variance (ANOVA), there were no significant interactions
between the intervention groups and time for any of the physiologic
variables. However, there were significant main effects over time for heart
rate and systolic and diastolic blood pressure, which indicated a generalized
physiologic relaxation response.

An experimental design was used. A total sample of 86 patients

(69.8% males) were randomized to 1 of 2 groups; 50 patients received 20
minutes of music (intervention), whereas 36 patients had 20 minutes of
rest in bed (control). Anxiety, pain, physiologic parameters, and opioid
consumption were measured before and after the 20-minute period.

A significant reduction in anxiety (P ≤ .001) and pain (P = .009) was

demonstrated in the group that received music compared with the control
group, but no difference was observed in systolic blood pressure (P = .17),
diastolic blood pressure (P = .11), or heart rate (P = .76). There was no
reduction in opioid usage in the 2 groups.: Patients recovering from
cardiac surgery may benefit from music therapy.

STUDIES RELATED TO MUSIC THERAPY

 Music therapy can be used to reduce postoperative pain and improve
sleep particularly for patients who have had recent coronary artery bypass graft
surgery. The patient's willingness to listen to music and the patient's preference
for music type should be determined. Music that is best suited for sleep and
promotion of relaxation is that which has a tempo of approximately 60 beats per
minute with low tones played predominantly with a stringed instrument.
Diseases

.
Everyone is not this side of the Herring Pond was convinced by the 66+% claim
for pain relief. A spokeswoman for the Arthritis Research Campaign said:
“Music can be very soothing and relaxing, and may take your mind off your
pain for a little while. As a coping strategy music may have its place, along with
the likes of relaxation and aromatherapy. However, to suggest that it can reduce
the pain of osteoarthritis by 50% stretches credulity a little and should not be
taken terribly seriously.” 39 Well, given that perhaps the research was not totally
perfect, a likely response to that level of skepticism by sufferers could well be
that even 33% of pain relief is worth the non-effort of sitting and listening to
pleasant soothing music for 20 minutes a day! “Try it, you’ll like it!”

In 2001, one American researcher went one step closer for arthritic
sufferers to get ‘good vibrations’ first hand. In a small case study of four older
adults, the purpose was to examine the effects of keyboard playing on the
management of hand osteoarthritis.40 Apart from the fun of maybe learning to
do something new and using brain/body co-ordination, this was a serious piece
of research. The four participants, diagnosed with hand osteoarthritis, met the
investigator 4 days a week, for approximately 30minutes for 4 weeks. 41 They
played folk and big band melodies for 20 minutes at each session. 42 Participants
enjoyed the treatment and there were additional benefits, which included
improved structure of leisure time and increased socialization for older adults
who tend to isolate themselves due to disease deterioration.

Results indicated that ‘finger pinch meter’ and range of motion were
positively increased by keyboard playing. Two of the participants recorded
significant decreases in arthritic discomfort after playing, while three showed
significant improvement in finger speed and hence, finger strength/dexterity
due to treatment43 - not a bad result for indulging in a fun time.

More research results are in the pipeline. At the end of last month, it was
announced that US researchers tested the effect of music on 60 patients who
had endured years of chronic pain.44 The study participants were recruited form
pain and chiropractic clinics and had been suffering from conditions such as
osteoarthritis, disc problems and rheumatoid arthritis for an average of six-and-
a-half years. Most were affected in more than one part of their body, and pain
was continuous.45 Within the parameters of the study, those who listened to
music reported a cut in pain levels up to 21%, and in associated depression of
up to 25%, compared with those who did not listen.46

A researcher said: “Our results show that listening to music had a

statistically significant effect on the two experimental groups, reducing pain,
depression and disability and increasing feelings of power. Non-malignant pain
remains a major health problem and suffers continue to report high levels of
unrelieved pain despite using medication. So anything that can provide relief is
to be welcomed.”47
 A previous piece of research found listening to soft music for 45 minutes
before going to bed can improve sleep by more than a third (33%).49 Nor are
music therapy applications in any way a domain of the elderly. This month
Israeli research has shown that ‘background’ music stimulation provides
significant benefits to pre-term infants.50 Although live music therapy had no
significant effect on physiological and behavioral parameters during the 30-
minute therapy; at the 30-minute interval after the therapy ended it significantly
reduced heart rate and improved the behavioral score. Recorded music did not
hit the spot.51

.
Twenty-three trials (1461 participants) were included. Music listening
was the main intervention used, and 21 of the studies did not include a trained
music therapist.
1 Music for stress and anxiety reduction in coronary heart disease patients
(Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley &
Sons, Ltd.
Results indicated that music listening has a moderate effect on anxiety in
patients with CHD, however results were inconsistent across studies. This
review did not find strong evidence for reduction of psychological distress.
Findings indicated that listening to music reduces heart rate, respiratory rate and
blood pressure. Studies that included two or more music sessions led to a small
and consistent pain-reducing effect.
.
Twenty-three studies with a total of 1461 participants were included.
These studies examined the effects of music on psychological,
physiological, and physical outcomes in patients undergoing
cardiac surgery and procedures (11 studies, 941 participants), myocardial
infarction patients (MI) (9 studies, 389 participants), and cardiac rehabilitation
patients (3 studies, 131 participants). The large majority of the participants
included in these studies were male (67%). The average age of the participants
was 63.3 years. For 13 trials, ethnicity of the participants was not reported. For
those studies that did report on ethnicity, the majority of the participant sere
Caucasian (average of 85%). Several studies lumped on-Caucasian ethnic
groups together under “other” making it hard to estimate the percentage of other
specific ethnic groups
represented in these trials. Trial sample size ranged from30 to 196participants.

Not all studies measured all outcomes identified for this review. For
studies with more than one intervention group, only data of the participants in
the music group and the standard care group were used.

Twenty-one studies used parallel group designs whereas two

studies(Davis-Rollans 1987; Emery 2003) used cross-over designs. For these
cross-over trials, only data of the first phase (i.e. before the cross-over) of the
trials were used in the meta-analysis.

Ten studies provided detailed information about the music that was used
(composition title and composer). Eleven studies stated only the different styles
of music that were offered to the subjects(e.g. jazz, easy listening, country and
western, classical Music)without any composition or performance-specific
information. Only two studies provided composition title, composer, and tempo
information.
 Fourteen studies used patient-selected music, whereas nine studies used
researcher-selected music.

The studies were conducted in six different countries: USA (15studies),

Canada (2 studies), Australia (1 study), Denmark (1study), Germany (1 study),
and Hong Kong (1 study).

Four studies examined the effects of music listening on psychological

distress by use of the Profile of Mood States (POMS) (Cadigan2001, Hormel
2005, School 2008) or Brief Symptom Inventory(BSI) (Mandel 2007a). Their
pooled estimate indicated no strong evidence of effect of the music intervention
(SMD = -0.23, 95%confidence interval (CI) -0.48 to 0.02, P = 0.07) (Analysis
1.1).Seventeen studies examined the effects of music on anxiety, ten of which
reported mean state anxiety as measured by the SpielbergerState-raitAnxiety
Inventory (STAI). Seven studies reported mean anxiety measured by other
scales such as numeric rating scale and
visual analogue scale.

The standardized mean difference (SMD) of those studies

studies) that reported posttest anxiety scores, regardless of the scale used,
revealed a moderate (Cohen 1988) effect favoring music interventions (SMD =
-0.49, 95% CI -0.83 to -0.15, P = .004),but results were inconsistent between
studies (Chi² = 46.91,P<0.00001, I² = 77%). Grouping the studies by patient
type (myocardial infarction (MI) patients, rgical/procedural patients,
rehabilitation patients) (Analysis 1.2) or music preference did not resolve this
heterogeneity (Analysis 1.3).

When pooling studies that only used STAI State Anxiety form(STAI-S) to
measure state anxiety, significantly lower state anxiety was found in
participants who received standard care combined with music listening than
those who received standard care alone (mean difference (MD) = -3.78, 95% CI
-6.31 to -1.24; P =0.003). However, considerable statistical heterogeneity
remained(Chi² = 53.51, P < 0.00001, I² = 83%). After grouping the STAI studies
by type of patients (MI; surgical/procedural), heterogeneity was greatly reduced
(Analysis 1.4)

Interventions are effective in reducing anxiety (as measured by TAI-S) in

MI patients: MI patients exposed to music had 5.72units (on a possible score
range of 20 to 80) less anxiety than unexposed patients (7 studies, 95% CI -7.67
to -3.78, P < 0.00001;Chi² = 11.33, P = 0.08, I² = 47%). No anxiety-reducing
effect was found for surgical/procedural patients (3 studies, MD = 0.0, 95%CI
-1.48 to 1.49; Chi² = 1.53, P = 0.47, I² = 0%). It is important to point out that in
surgical or procedural patients, anxiety levels dropped to within normal range
(low anxiety) in both the intervention
and the standard care groups after the procedure regardless
of the intervention. Two studies reported on the effects of music on anxiety in
rehabilitation patients. Emery 2003 reported no significant difference between
the two groups on the tension-anxiety scale of the Profile of Moods Scale
(POMS). Mandel 2007a compared the two groups on the outcome of trait
anxiety (STAI Trait Anxiety form(STAI-T)) and found no significant difference
at the end of the treatment period. At 4-month follow-up, a significant
difference was found (p = 0.03),

We then explored whether music preference affected the outcome of state

anxiety as measured by STAI-S. The pooled estimate of studies that allowed
patients to select music from music selection offered by the researcher was
smaller anymore heterogeneous withed = -2.73 (95% CI -3.95 to -1.50, P <
0.0001; Chi² = 31.83,P < 0.00001, I² = 87%) than those who used researcher-
selected music (MD = -5.16, 95% CI -6.54 to -3.79, P < 0.00001; Chi² =14.92,
P = 0.005, I² = 73%) (Analysis 1.5).

The pooled estimate for studies that measured anxiety by scales other
than the STAI-S indicated that patients who listened to music had greater
anxiety reduction than those who did not (7studies, SMD= -0.34, 95% CI -0.74
to 0.06, P = 0.09). Here too, results were statistically heterogeneous (Chi² =
20.33, P = 0.002,I² = 70%). Grouping the studies by type of patients did not
reduce the heterogeneity for the surgical/procedural patients. Two studies with
MI and rehabilitation patients did obtain a homogeneous
effect but this effect did not reach statistical significance (SMD =0.15, 95% CI
-0.32 to 0.63, P = 0.53; Chi² = 0.07, P = 0.80, I²= 0%) (Analysis 1.6).

Four studies included depression as an outcome. Their pooled estimate

indicated that participants who listened to music did not significantly differ in
their reported levels of depression from those participants who received
standard care (SMD = -0.12, 95% CI-0.42 to 0.18, P = 0.44) (Analysis 1.7).

Two studies used a numeric rating scale to measure the effects of music
on mood. Their pooled estimate indicated that participants who listened to
music reported significantly more mood enhancement than those receiving
standard care (SMD = 0.85, 95% CI0.43 to 1.28, P < 0.0001), however, there
was disagreement between the two studies about the size of the effect (Chi² =
5.02, P= 0.03, I² = 80%) (Analysis 1.8). Therefore, the results are
inconclusive.1.9).

A subgroup analysis by patient-selected versus researcher-selected music

produced interesting results. The pooling of studies that used researcher-
selected music (5 studies) resulted in a smaller but homogeneous effect size
(MD = -2.74, 95%CI -4.69 to -0.79, P =0.006; Chi² = 2.89, P = 0.58, I² = 0%).
The use of patient-selected music (9 studies) resulted in a larger effect size (MD
= -6.44, 95%CI -7.94 to -4.94, P < 0.00001), however, the results were highly
inconsistent between studies (Chi² = 46.38, P < 0.00001, I² =
83%) (Analysis 1.10)
.
Two studies included heart rate variability as an outcome with Impatiens.
Their pooled estimate suggests that music has no effect on heart rate variability
(MD = 0.00, 95% CI -0.25 to 0.26, P =0.97) (Analysis 1.11).

Music helps in the treatment of actual diseases in the following manners :-

1. One obvious use of music is that of a sedative. It can replace the

administration of tranquillizers, or at least reduce the dosage of tranquillizers.

2. Music increases the metabolic activities within the human body. It accelerates
the respiration , influence the internal secretion, improves the muscular
activities and as such affects the "Central Nervous System " and Circulatory
System of the listener and the performer.

PRINCIPLES OF MUSIC THERAPY;

Music Therapy is not the subject of an article only . The entire subject is Now
in the experimental and implementation stage , and data are rapidly
accumulating . And the ancient system is gradually being transformed in to a
modern science . Since -1993, I am a practitioner of Music Therapy. After, more
then five thousands patients , I have observed that - India classical 'Ragas' have
been acclaimed to have healing effects .They stimulate the brain, ease tension
and remove fatigue. The effect of Music Therapy may be immediate or slow,
depending upon number of factors like the subject, his mental condition ,
environment and the type of Music, selected for having the desired effect.

A STUDIES RELATED TO MUSIC THERAPY AND ANXIETY

AFTER HEART SURGERY.

Researchers at the Bryan Memorial Hospital, Lincoln, USA recently

investigated the influence of music therapy on mood and anxiety of patients
undergoing heart surgery.

Ninety-six patients who underwent elective, heart bypass surgery at the

cardiovascular intensive care and progressive care units of a Midwestern
community hospital participated in the study. The mean age of the patients was
67 years, with an age range of 37 to 84 years. 68% of the patients were men and
32% were women

A STUDIES RELATED TO MUSIC THERAPY AND PAIN

MANAGEMENT :

Japanese researchers have assessed the potential role of music therapy in

the field of pain management. The researchers decided to analyses the effects of
music on pain associated with having to keep a compulsory posture. Classical
music were chosen in this study. Five healthy adult females kept a supine
position for two hours without music. Complaints, and variations of heart beat
and respiration were observed in each subject during the two hour experiment.
After five days or more, these subjects had the same experience, but this time
with music. Frequency and intensity of complaints were found to be
significantly diminished by music.

Although heart rate was not changed by music, frequency of irregular

respiration was found to be significantly decreased by the music. There was
therefore a positive correlation between frequency of irregular respiration and
number of complaints in subjects kept without music. The researchers claimed
that their study demonstrated that music is effective to relieve a pain associated
with a compulsory posture and that music may play a significant role on pain
management in palliative therapy.

STUDIES RELATED TO CABG SURGERY

 . One hundred four patients undergoing open heart surgery were
prospectively randomized to receive either complementary therapy
(preoperative guided imagery training with gentle touch or light massage and
postoperative music with gentle touch or light massage and guided imagery) or
standard care. Heart rate, systolic and diastolic blood pressure, and pain and
tension were measured preoperatively and as pre-tests and post-tests during the
postoperative period. Complications were abstracted from the hospital record.

Virtually all patients in the complementary therapy group (95%) and 86%
in standard care completed the study. Heart rate and blood pressure patterns
were similar. Decreases in heart rate and systolic blood pressure in the
complementary therapies group were judged within the range of normal values.
Complication rates were very low and occurred with similar frequency in both
groups. Pretreatment and post treatment pain and tension scores decreased
significantly in the complementary alternative medical therapies group on
postoperative days 1 (p < 0.01) and 2 (p < 0.038).

: The complementary medical therapies protocol was implemented with

ease in a busy critical care setting and was acceptable to the vast majority of
patients studied. Complementary medical therapy was not associated with safety
concerns and appeared to reduce pain and tension during early recovery from
open heart surgery.

6.3 STATEMENT OF THE PROBLEM

 A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC
THERAPY ON PAIN MANAGEMENT AMONG POST-OPERATIVE
CABG PATIENTS IN A SELECTED HOSPITAL AT BANGALORE.

6.4 OBJECTIVES OF THE STUDY :

1. To assess the effectiveness of music therapy on pain management among

post – operative patient after CABG procedure through pre – test
assessment.

2. To assess the effectiveness of music therapy on pain management among

post operative patient after CABG procedure through post – test
assessment.

3. To assess the effectiveness of music therapy upon the selected

physiological variables of pain management among post-operative
patients after CABG procedure through pre and post assessment.

4. To associate effectiveness of music therapy upon the pain management

among post – operative patients after CABG procedure.

5. To find out the association between select demographic variables and

level of pain after CABG procedure followed by music therapy.

6.5 HYPOTHESIS :
HO1 : There will be no significant difference in the pain management among
post – operative patients after CABG procedure, before and after music therapy.

HO2 : There will be no significant change in the physiological variables of pan

management among post operative patients after CABG procedure before and
after each session of music therapy.

HO3 : There will be no significant association between select demographical

variable and levels of pain in post operative patients after CABG procedure
after music therapy.

6.6 OPERATIONAL DEFINITIONS:

1. Assessment :
The critical analysis and valuation or judgment of the statues of a
particular condition situation or either subject of appraisal.

2. Effectiveness :

It refers to the desired change brought by the measurement in terms of

significant knowledge gain in the mean post test scenes.

3. Music Therapy:
 Music therapy is the clinical and evidence-based use of music
interventions to accomplish individualized goals within a therapeutic
relationship by a credentialed professional who has completed an
approved music therapy programme.

4. Pain :

Pain is whatever patient experiencing post operatively says it is, existing

whenever he says it does .

5. CABG – CORANARY ARTERY BYPASS GRAFT :

This surgery consists of the construction of new conduits between the

aorta & arteries beyond the obstructed coronary arteries. This procedure
provides blood flow beyond the stenosis, so that myocardium receive
blood supply to function.

post operative:

Following surgery, the patient who is in the post operative unit. It lasts
hours to days, depending on the extent of surgery & the patients
response.

ASSUMPTIONS :
 1. The patient who is in CCU after CABG surgery will have interest to
participate in this study.

2. The patient who has adequate knowledge regarding effects of music

will give good post test scores.

3. The effect of music therapy on pain in a coronary unit following CABG

surgery in conjunctions with standard care by investigate both
objectively & subjectively.

4. The patient may actively engage the healing process.

5. Music therapy may induce relaxation & facilitate recovery by listen to

relaxing music.

6. Music therapy is distracted the patient from unpleasant symptoms.

7. It may reduces the tension, pain intensity, anxiety & stress by evoking
the relaxation response.

DELIMITATIONS :

The study is delimited to ;

1. The patients who has pain intensity, tension & anxiety after CABG
surgery.

2. Those who are available at the time of data collection

 3. Patient who has highly interested to participate music therapy.

4. Patients those who would live to know more about music therapy
which is provide safe, feasible compare with the standard care.

5. Activity engage the PT in healing process .

PROJECTED OUTCOME :

Post operative pain after CABG procedure has profound impact on the
psychobiological health of the patient. Anticipation of prognosis is an
anxiety – provoking event.. The present study was designed to evaluate the
effectiveness of music therapy as the best means of non-pharmacological
management for pain, anxiety and selected physiological variables among
patients with post operative pain after CABG surgery. The findings of the
study can be attributed to the effectiveness of music therapy on reduction in
the level of pain ,anxiety and selected physiological variables among
patients with post-operative pain after CABG procedure.

Music has been shown to have excellent potential as a conditional relaxation

technique. The understanding of the effectiveness of music therapy upon
pain, anxiety and selected physiological variables of patient’s pain after
CABG procedure can help nurses to design successful
 intervention to reduce pain, anxiety and promote healthy
adaptation.

6. Materials & Methods

: S o u rc e O F D a t a
Post operative patient those who have pain after
C A B G s u rg e r y i n s e l e c t e d h o s p i t a l a t B a n g a l o r e .

R e s e a rc h d e s i g n & a p p ro a c h

Quasi experimental design ( pretest & post test design )

Settings :

Individual patients in ICCU

7.1.3. population :

pain among post operative patients after CABG

S U R G E RY

M E T H O D S O F C O L L E C T I O N O F D ATA
S a m p l i n g p ro c e d u re :
.
Purposive sampling procedure.

Va r i a b l e s u n d e r t h e s t u d y.

D e p e n d e n t Va r i a b l e :

E ff e c t s o f m u s i c t h e r a p y .

Independent variable:

planned teaching programme

Attributed variables:

personal characteristics which include post

operative pain management.

7.2.3 SAMPLE SIZE: 50 ICCU Patients.

7.2.4 Durations of study : 6weeks.

7.2.5 Inclusive criteria for sampling :

 1 . P o s t – o p e r a t i v e p a t i e n t s a f t e r C A B G s u rg e r y t h o s e
w h o w i l l i n g t o p a r t i c i p a t e i n t h i s s t u d y.

2 . P a t i e n t t h o s e w h o i s u n d e rg o n e C A B G s u rg e r y.

3. Patient those who are present during the time of date

collection.

7.2.6 Exclusive criteria for sampling

1. Patient those who are not willing to participate

2. Post operative patients those who are other than CABG

s u rg e r y.

3. Patient those who are not present during the time of

data collection.

7.2.7 I N S RT U M E N T I N T E N D E D TO B E U S E D :

Planned teaching programme will be used to assess

t h e k n o w l e d g e r e g a r d i n g e ff e c t s o f m u s i c t h e r a p y o n p a i n
management among post-operative patients after CABG
s u rg e r y.

7.2.8 M E T H O D S O F D ATA C O L L E C T I O N
 Questionnaire

7.2.9 L I M I TAT I O N S :

1 . I t i s n o t e ff e c t i v e f o r a l l t h e p a t i e n t s
c o n s i d e r a b l y.
2. patient who is not interested to listen music.
3. Patient those who are not available at the time of
data collection.
4. patient those who has pre occupied wrong
c o n c e p t s a b o u t m u s i c t h e r a p y.

7.2.10 .PILOT STUDY PLAN :

Prior permission should get from the concerned

authorities and subjects. A brief instruction will be given
to the subjects about the self and the study .The level of
post operative pain after CABG procedure will be
assessed before and after music therapy and
physiological variables will be assessed before and after
e a c h s e s s i o n o f m u s i c t h e r a p y. M u s i c t h e r a p y w i l l b e
given through head phone for 30 minutes of 2 session on
each day with an intervals of four hours between each
session for 5 consecutive days. The study will be
conducted by 10 samples.
7 . 2 . 11 Plan for analysis:

Statistical methods used for analysis

Descriptive Statistics :

Mean, median, mode, frequency & distribution of socio

demographic variables.
I n f e re n t i a l s t a t i s t i c s :

- Paired ‘t’ test to compare pretest

- Post test findings
- Student ‘t’ test to compare with post test assessment
- Chi-square test to find association between findings of
study & selected demographic variables.

7.3 DOES THE STUDY REQUIRS ANY

I N V E S T I G AT I O N O R I N T E RV E N T I O N TO B E
C O N D U C T E D O N PAT I E N T S O R O T H E R H U M A N S O R
A N I M A L S ? I F S O P L E A S E D E S C R I B E B R I E F LY.

Ye s : A s s e s s m e n t o n e ff e c t o f m u s i c t h e r a p y w i l l b e d o n e f o r
p a i n a m o n g p o s t o p e r a t i v e p a t i e n t s a f t e r C A B G s u rg e r y b y
giving structured interview method

7.4 ETHICAL CLEARENCE :

 - Confidential & anonymity of the subjects will be
maintained.
- Consent will be obtained from the patients before
c o n d u c t i n g t h e s t u d y.
- A written permission from the institutional authority
will be obtained.

8. LIST OF REFERENCES :

1.cardiovascular reactivity among surgeons. journal of the American Medical

Association, 2008; 272: 882–884.

2.coronary heart disease (Protocol). Cochrane Database of Systematic Reviews,

2009; (3). Art. No. CD006577.

3.Integrating complementary therapies and healing practices into the care of

cardiovascular patients. Progress in Cardiovascular Nursing, 2008; 17(2) : 73–80.

4.& Kummer B., Complementary alternative medical therapies for heart surgery
patients: Feasibility, safety, and impact. Annals of Thoracic Surgery 2006;
(81) : 201.

5.Tusek DL, CwynarR, & Cosgrove D M. Effect of guided imagery on length of

stay, pain and anxiety in cardiac surgery patients. Journal of Cardiovascular
Management. 1999; 10(2) : 22–28.
6.WhitworthJW, Burkhart A, & Oz M. Complementary therapy and cardiac
surgery. Heart & Lung The Journal of Critical Care. 1998; 12(4) : 87–94.

7.Lewis, Heitkemper & Dirksen. Medical Surgical Nursing Assessment and

Management of1. . 9th edition; Lippincott Raven Publishers; 2005 : p 325-
327.

8.John Luck Mann. Medical Surgical Nursing. 3rd edition; Philadelphia,

London: Saunders Company: 1987.

9.White L, Delmar Thomson , Medical Surgical Nursing: an integrated

approach. 2nd ed . Mosby publication (NK) : 2002.

INTERNET

1.CABG: Coronary Artery Bypass Graft: An Introduction to Heart Bypass

Surgery( home page from internet). Available from :| Suite101.com.
2.http://heartdiseasediabetes.suite101.com/article.cfm/cabg_coronary_artery_by
pass_graft#ixzz0ZIGd0VKw
3.The Institute for Music and Neurological Functioning( homepage from
internet). Available from: http://www.bethabe.org/About_the_Institute100.html.
4.The Center for Biomedical Research in Music(home page from internet).
Available from : http:/ /www.colostate.edu/depts/cbrm.
5.Florida State University's Center for Music Research(home page from
internet). Available from: http://www.music.fsu.edu/cmrbro.html.
6.WWW.music therapy.org.