Friday, November 2, 2007

Research: Chapter 5: The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

Chapter V


The results of the present study support the hypothesis that preferred, sedative music decreases the amount of self-reported anxiety in adult male patients undergoing heart catheterization or pacemaker implantation. The data in this study are comparable to the data in those studies which also implemented preferred music (Augustine & Hains, 1996; Hanser, 1985; Robb, et al.). Before discussing the implications of this study, it is necessary to briefly consider some of the variables which were not controlled for that may have influenced the results.

One of the uncontrolled variables relates to the tone which may have been set by doctors’ comments to the patients during or immediately after surgery. Since all of the patients were awake during the procedure, it was common practice for the doctors to verbally update the patients on the progress of the procedure. Although more formal reports to the patient and family about the results of the procedure were conducted after the patient left the operating room, some indication of the condition of the patient’s heart and circulatory system was given to the patient by the physician either during or immediately following the procedure. It is possible that positive or negative prognosis remarks would have affected the subject’s state level of anxiety.

Other variables not controlled for in this study were the number of times a patient had undergone the same procedure before and how much time elapsed between the pre-operative anxiety assessment and the exact time the doctor began the procedure. In a similar study using pediatric patients undergoing catheterizations, Gettel (1985), found that the difference in number of previous catheterizations and hospitalizations was not significant between experimental and control groups. Controlling for the time delay between the first anxiety assessment and the actual commencement of surgery is much more difficult given the dynamic and fluid workings of a hospital operating room. Doctors work at their own pace and leisure. In this study, there was never a delay long enough to necessitate another dose of sedative medication before surgery.

The present study has contributed additional evidence that the use of preferred, sedative music is a means of reducing anxiety in medical procedures that take place while patients are awake. The data presented add to the research that has shown music as a means of reducing patient anxiety in other out-patient procedures such as dental operations.

Practical implications for using the methods presented in this study include using preferred, sedative music to reduce anxiety in patients undergoing blood vessel angioplasty or implantable cardiac defibrillator devices. Both of these procedures are similar to the pacemaker implants and heart catheterizations described in this study, the exceptions including higher procedural risk factors and longer surgical time periods. Patients in these longer surgeries, with more at risk, may have higher state anxiety levels and could benefit from efforts to reduce their anxiety.

Wider implications of the results presented in this study extend to using preferred, sedative music during other portions of a patient’s admission to the hospital. Patients could benefit from lower anxiety during waiting times in pre-operative holding and overnight hospital stays. The ramifications of reduced patient anxiety levels may have a positive impact on patient satisfaction with their medical service providers. This can be a very important factor in advocating for music therapy programs in hospital environments.

Preferred, sedative music appears to be beneficial in decreasing a patient’s self-reported state anxiety during pacemaker implant and heart catheterization. Further research is warranted to refine methods and increase the effectiveness of music assisted relaxation. Such studies might utilize new technologies such as “compact disc writeable” capabilities to compile music group listening selections with digital quality sound. A larger study with more time and subjects could pre-assess incoming patients music preferences and create custom compact discs from a list of sedative music.

In future studies, assessment of observed behaviors can be compared with self-reported behavior. Other useful comparisons could be made between female versus male anxiety responses to preferred, sedative music. There is also a need to study the effects of recorded, sedative music on the anxiety of pediatric patients. All of this future research will be helpful in refining the protocols for using music to decrease anxiety during catheterizations and pacemaker implants. Related research in the future will also assist music therapists in generalizing the findings presented in this study to larger populations.

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