|Author:||Chung, Siu-wai Anne|
|Title:||Music therapy : an intervention to reduce anxiety in mechanically ventilated patients|
|Subject:||Hong Kong Polytechnic University -- Dissertations|
Critically ill -- Psychology
|Department:||School of Nursing|
|Pages:||112 leaves : ill. ; 30 cm|
|Abstract:||Treatment in the intensive care unit (ICU) involves the use of sophisticated, high technology apparatus, medical tests and invasive procedures. Mechanical ventilation is a common, life-saving intervention employed in intensive care units worldwide. However, this treatment modality exerts an impact on patients' physiological and psychological responses. Patients undergoing mechanical ventilation will experience fear, anxiety and discomfort. In addition, noise pollution in the health care setting will influence patients' rest and sleep quality. Intrusive ICU noise levels lead to increased stress for patients and result in physiological changes (Baker, 1984). In order to overcome these problems in mechanically ventilated ICU patients, different strategies are implemented. First, in order to overcome the related distress of being mechanically ventilated, sedatives and anxiolytic agents are frequently used. These drugs, however, are costly and manifest various complications, both directly and indirectly. Other methods used to control the distress experienced by patients undergoing mechanical ventilation take the form of non-pharmacological devices, such as music therapy or personal social interaction with the patients by family and friends. Second, a reduction of the ambient noise level in the intensive care unit, combined with appropriate use of music is fundamental for improved health. The outcomes of the various attempts to improve the care environment for these patients have been mixed, despite numerous research studies on the efficacy of music in minimizing anxiety levels among these ventilated patients. The purpose of this study is, therefore, to determine whether or not music, when used as a therapeutic tool, has the ability to lower the levels of anxiety and the physiological parameters in mechanically ventilated ICU patients. A randomized controlled trial was conducted from April 2004 to January 2005 in the intensive care unit of an acute hospital. A pretest and posttest experimental design with repeated measures was performed to assess the effectiveness of music therapy on mechanically ventilated patients. A total of one hundred and forty seven subjects was randomly assigned to one of three groups: 30 minutes continuing current practice (control group); 30 minutes of music intervention (music group); or 30 minutes wearing headphones but without music (headphones without music group). The purpose of wearing the headphones (headphones but without music group) was to block out most of the extraneous environmental noise. The headphones did not provide any auditory stimuli. The Chinese version of the State Anxiety Inventory (C-STAI) scale was used to measure individual anxiety levels prior to and after the intervention period. Physiological status was calculated and compared between and within the three groups of subjects and resting behaviors were documented before and after the study for all three groups. In addition, the music intervention group's subjective response to the music was obtained at the end of the music intervention. The outcome showed a significant difference in the degree of reduction in anxiety level and blood pressure of mechanically ventilated patients in the 'headphones without music group' and the 'music group'. However, the music group' showed a more significant difference than the other two groups (control group & headphones without music group), as manifested by a marked decrease in physiological status, such as the patients having a reduction in blood pressure and state anxiety level. There was also an improvement in oxygen saturation among the 'music' and 'headphones without music group'. There was no improvement in measured values for the control group. This results indicated that music therapy and noise reduction produced a reduction in subjects' anxiety levels, improved their physiological status and promoted comfort, and suggested that other elements of the critically ill patient's environment should be investigated in the pathogenesis of ICU distress and sleep disruption. Thus, in addition to the use of music as an adjunct therapy to ventilated patients, it was also crucial for nurses to be aware of other environmental stressors in guiding the provision of comprehensive and effective nursing care.|
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