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

Abstract

The purpose of this study was to examine the effect of patient preferred, sedative music on the state anxiety level of patients undergoing heart catheterization or pacemaker implant. Subjects were alternately assigned to experimental and control groups in order of admission to the operating room. Male subjects (N=22) in each group (N=11) completed a pre and post anxiety inventory in questionnaire format. Patients in the experimental group were allowed to choose from three different styles of sedative music to which to listen to during the surgical procedure. The change in anxiety levels between pre and post tests were compared between the control group and the experimental group using a one-way ANOVA test for two groups. Results indicated that patient preferred, sedative music significantly decreased state anxiety in patients who listened to preferred, sedative music during heart catheterization or pacemaker implant. Implications for clinical practice and further research are given.

Table of Contents

Page

Chapter I............................................ 1

Introduction..................................... 1

Heart Catheterization........................ 2

Patient Anxiety.............................. 4

Research Question............................ 6

Definitions.................................. 7

Chapter II........................................... 7

Literature Review................................ 7

Music to Reduce Anxiety...................... 8

Preferred Music.............................. 9

Studies Related to Using Music in Medical

Settings.................................. 10

Chapter III.......................................... 16

Methods and Procedures........................... 16

Participants................................. 16

Apparatus.................................... 16

Instrument................................... 17

Music........................................ 17

Procedures................................... 17

Data Analysis................................ 20

Chapter IV........................................... 21

Results.......................................... 21

Chapter V............................................ 23

Discussion....................................... 23

References........................................... 27

Table 1.............................................. 31

Appendices........................................... 32

Appendix A: Consent Form

Appendix B: Self-Evaluation Questionnaire

Appendix C: Music

Acknowledgments

I would like to express my gratitude to the following people, without whose assistance this thesis would not have been possible.

To my committee members, Dr. Alicia Ann Clair, Dr. Alice-Ann Darrow, and Dr. James Daugherty for their guidance, knowledge and encouragement.

To my father, Gary Tague, whose assistance and support was fundamental to this project. His time spent in gaining approval for the research and assistance during all parts of the research process deserves the greatest thanks.

To Michail Parekh, M.D., Ram Kolluru, M.D., Madhava Agusala, M.D., Sudhir Amaram, M.D., Suresh Gadasalli, M.D., and Shanti Neerukonda, M.D., whose interest in this project and sincere concern for their patients allowed this research to take place.

To the catheterization lab staff and nurses whose support and friendliness made this research possible.

To the patients who took part in this project and so willingly gave of themselves and their time.

And finally to my wife, who through all of my research and schooling has been my unbreakable foundation.

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

Chapter V

Discussion

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.

Research: Chapter 4: The Effect of Preferred Sedative Music on the Anxiety of Patients During Pacemaker Implant Surgery and Heart Catheterization

Chapter IV

Results

A one-way analysis of variance was conducted to evaluate the relationship between listening to preferred music during heart catheterization and pacemaker implantation and anxiety levels. The independent variable, the music listening factor, included two levels: no music or preferred music. The dependent variable was the change in the amount of anxiety from pre to post surgery. Four subjects, two from each level of the independent variable, were removed from the study. One subject did not receive any of the standard sedation. Another subject experienced a tape player malfunction which stopped his music listening. In the non-music listening group, one patient received double the amount of standard sedation, while another subject was not asked the STAI questions according to the proper procedure. Mean anxiety scores for the remaining subjects are shown in Table 1.

The ANOVA was significant, F (1,17) = 5.55, p = .032. The results of the one-way ANOVA supported the hypothesis that preferred, sedative music listening during heart catheterization and pacemaker implant surgery had an effect on state anxiety levels in male patients between the ages of 40 and 90 years.