Abstract and Introduction
Abstract
The aim of this study was to investigate the effect of listening to personal choice of music on self-report of pain intensity and the physiologic parameters in patients who have undergone open heart surgery. The study design was quasiexperimental. Patients were selected through convenience sampling in the Cardiovascular Surgery Intensive Care Unit at a university hospital. The study was conducted with a total of 87 patients who underwent open heart surgery: 44 in the music group, 43 in the control group, ages between 18 and 78 years. Through pretest-posttest design, postoperative first-day data were collected. First, physiologic parameters (blood pressure, heart rate, oxygen saturation, and respiratory rate) were recorded and a unidimensional verbal pain intensity scale applied to all participants. Later, the control group had a rest in their beds while the music group listened to their choice of music for 30 minutes. Physiologic data were then collected and the pain intensity scale applied once more. In the music group, there was a statistically significant increase in oxygen saturation (p = .001) and a lower pain score (p = .001) than in the control group. There was no difference between the groups in the other physiologic parameters. Results of this research provide evidence to support the use of music. Music might be a simple, safe, and effective method of reducing potentially harmful physiologic responses arising from pain in patients after open heart surgery.
Introduction
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Although pain is a predictable part of the postoperative experience, inadequate management of pain is common and can have profound implications. Unrelieved postoperative pain may result in clinical and psychologic changes that increase morbidity, mortality, and costs and decrease the quality of life (Apfelbaum, Chen, Mentha, & Gan, 2003; Tse, Chan, & Benzie, 2005). Moreover, negative clinical outcomes resulting from ineffective postoperative pain management include deep vein thrombosis, pulmonary embolism, coronary ischemia, myocardial infarction, pneumonia, poor wound healing, insomnia, and demoralization (Apfelbaum, Chen, Mentha, & Gan, 2003). Moderate to severe postoperative pain is experienced by >80% of patients having surgery (Allred, Byers, & Sole, 2010).
Pain has also been reported as one of the primary sources of concern for cardiac surgery patients, and postoperative pain management is important owing to the increasing number of patients undergoing open heart surgery (Mueller et al., 2000, Sendelbach et al., 2006, Twiss et al., 2006, Voss et al., 2004). Postoperative pain for the cardiac surgery patients has many facets. Pain can be caused by incisions, intraoperative tissue retraction and dissection, multiple intravascular cannulations, chest tubes left after surgery, and multiple invasive procedures that patients undergo as part of their therapeutic regimen (Mueller et al., 2000). In one study, patients reported chest incision pain as a problem after coronary artery bypass graft (CABG) surgery (Puntillo & Weiss, 1994). Because of pain, patients cannot take deep breaths, cough, or start moving around as soon as they should, and this delays their recovery. Poorly controlled pain also contributes to hemodynamic instability, which can lead to myocardial ischemia (D'Arcy, 1999). Associated with these complications are economic and medical implications, such as extended lengths of stay and patient dissatisfaction with medical care (Apfelbaum et al., 2003). It is proposed that effective management of postoperative pain in patients who have undergone CABG surgery can be an important factor in overall recovery. Pharmacologic management should continue to be the cornerstone of the treatment of postoperative pain (Zimmerman, Nieveen, Barnason, & Schmaderer, 1996); however, nonpharmacologic methods of pain management are advantageous, in part because they can enhance the effect of pain-relieving medications. In addition, these techniques can help patients achieve a sense of control over pain (VanKooten, 1999).
Nurses spend more time with patients experiencing pain than any other health care professional and are therefore in an ideal position to consider other pain-relieving strategies to complement the analgesics currently used (Dunn, 2004). Cognitive-behavioral intervention, such as music, for pain management is recommended by the Agency for Healthcare Research and Quality (Sendelbach et al., 2006). The commonly accepted theory explaining the pain-, anxiety-, and stress-reducing effects of music is that music acts as a distracter, focusing the patient's attention away from negative stimuli to something pleasant and encouraging. Music also occupies the patient's mind with something familiar and soothing, which allows the patient to escape into his or her own world (Nilsson, 2008). Additionally, Watkins (1997) indicated that music exerts its effect through the entrainment of body rhythms. Entrainment is defined as the tendency for two oscillating bodies to lock into phase and thus vibrate in harmony (Chlan, 1998); this is like individual pulsing heart muscle cells, which, when they are brought close together, begin pulsing in synchrony (Watkins, 1997).
Listening to music is theorized to release endorphins and to reduce catecholamine levels, thereby resulting in lower blood pressure and a decreased need for analgesics. In addition, heart rate and respiratory rate are improved and oxygen consumption decreases (Chan et al., 2006, Twiss et al., 2006).
Additional advantages of using music therapy in pain relief are that it is not harmful to patients, it has minimal risks, and its costs are low, which means that music therapy has great potential to reduce suffering (Chan et al., 2006). As a specific nursing intervention, music was found to be advantageous, particularly owing to its lack of adverse reactions and as a noninvasive therapy, its relative inexpensiveness, and its ease of administration (Lim & Locsin, 2006). Therefore, it can be said that music therapy is important to relieve pain and improve (balance) some physiologic parameters, such as blood pressure, heart rate, respiratory rate, and oxygen saturation in the postoperative period.
In examining the effects of music on patients who have undergone CABG surgery, a number of studies have demonstrated decreases in postoperative pain (Aragon, Farris & Byers. 2002; Sendelbach et al., 2006, Voss et al., 2004, Zimmerman et al., 1996), whereas Nilsson (2009) found no difference in pain. In researching the effect of music intervention on physiologic parameters, some studies have indicated that music intervention improves some physiologic parameters, such as systolic blood pressure, diastolic blood pressure, or heart rate (Aragon et al., 2002, Byers and Smyth, 1997), whereas others showed that music has no effect on these parameters (Nilsson, 2009, Sendelbach et al., 2006).
Due to the differences in these study findings (Aragon et al., 2002, Byers and Smyth, 1997, Nilsson, 2009, Sendelbach et al., 2006), further studies are necessary to investigate the effectiveness of music to alter physiologic parameters and control pain. In addition, there are minimal studies investigating the effect of music on patients who have undergone open heart surgery (Aragon et al., 2002; Byers & Smyth, 1997; Nilsson, 2009, Sendelbach et al., 2006) and there is no descriptive and experimental study that investigates the effect of music on these patients in Turkey. This underpinned the need for the present study.
The aim of this study was to investigate the effect of listening to personal choice of music on self-report of pain intensity and the physiologic parameters in patients who have undergone open heart surgery.