The use of music and music therapy research surrounding surgical and procedural support has utilized primarily receptive methods. Music listening is an ideal intervention as it allows patients to choose what they want to listen to, when they want to listen, and how long they want to listen (Heiderscheit, Chlan, & Donley, 2011). This type of patient-directed approach also does not cause strain or require a great deal of energy. Music can be a comforting and calming stimulus for patients when they have low energy; are experiencing stress, discomfort, and pain; or have limited ability to focus (Heiderscheit, Chlan, & Donley, 2011).
Researchers have utilized music listening to assist patients in managing preoperative anxiety. Updike (1987) found that patients awaiting plastic surgery after listening to Bonny’s Music Rx programs for 30 minutes demonstrated significant decrease in blood pressure, heart rate, and mean arterial pressure. Patients also reported an emotional effect, indicating that they recognized that after listening to music, they experienced a more relaxed, calm state. Augustin and Hains (1996) found that patients listening to their preferred music as they awaited surgery helped to significantly reduce heart rate and demonstrated a positive impact on other vital signs as well. They concluded that a music listening intervention is more beneficial than preoperative instruction alone and encourage pre-op staff to offer music listening as an option for surgical patients.
Wang et al. (2002) found in a randomized controlled trial that patients who listened to 30 minutes of music via headphones experienced a 16% decrease in anxiety, when compared to the control group that had headphones and no music or white noise. Lee et al. (2004) discovered that patients who listened to music for 20 to 40 minutes reported significantly lower levels of anxiety than the control group
that rested quietly, watched television, or read prior to their surgery. Cooke et al. (2005) explored the use of music listening for surgical patients and found that patients who listened to 30 minutes of music reported significantly lower anxiety levels than the control group that utilized headphones with no music. While music has frequently been explored as a means of managing the preoperative anxiety that patients encounter, research has also explored the use of music intra- and postoperatively as well.
Lin et al. (2012) utilized music listening with older adults undergoing hemodialysis treatments three times a week. Patients in the music group listened to music from playlists they each created on their own, while patients in the control group received the usual care. After one week of music listening during each of the three hemodialysis treatments, patients demonstrated significant decreases in the frequency and severity of adverse reactions to dialysis. Patients also demonstrated decreased respiratory rates, increased finger temperature, and improved oxygen saturation.
Koch et al. (1998) implemented a music listening protocol for patients undergoing urologic surgery to identify what impact it may have on sedative and analgesic requirements. Patients in the experimental group were instructed to bring their preferred music for the surgical procedure, while patients in the control group received usual care. Researchers found that patients in the experimental group utilized significantly less propofol and opiod medication than the control group. Koelsh et al. (2011) also found that patients undergoing elective total hip replacement who listened to instrument music throughout the surgery demonstrated lower propofol consumption and lower cortisol levels than the control group. Steelman (1990) explored the effect of music listening on the anxiety and blood pressure of patients undergoing orthopedic surgery. Patients selected music from nine different prepared audio recordings. They began listening before skin preparation and continued to listen through surgery until the dressings were applied. The control group received routine care and staff utilized verbal distraction during skin preparation. The results indicated that music was comparable to verbal distraction in reducing anxiety, but demonstrated a significant decrease in blood pressure when distraction did not.
Dunn (2004), in a literature review of the use of music to reduce postoperative pain, found that after analyzing 10 studies, while the research methodology in the majority of the studies was poor and could not conclusively prove music effective, patients consistently reported listening to music as a positive experience. Dileo, Bradt, and Murphy (2008) completed a Cochrane Review of music for preoperative anxiety and reported that while many studies have utilized music listening as an intervention to manage anxiety and reduce sedation, there have been several factors that have contributed to the varied results. Studies have utilized small sample sizes, which contribute to difficulties in achieving statistical significance. Additionally, there are variances in study design, length of music listening, intervention method, and intensity of procedures, which contribute to varying results. While many studies have not achieved significance through a music listening intervention, there is still research that indicates a positive and significant impact of music in reducing anxiety and sedation for surgical patients.
Mechanical ventilation (MV) is a lifesaving measure utilized to treat respiratory failure stemming from a variety of causes. While MV is a common procedure in intensive care units (ICU), patients receiving MV experience a great deal of distress and anxiety as a result of the procedure. The distress and anxiety that patients experience can also pose greater risk for complications. Many researchers have explored the use of a music listening intervention to provide patients with a nonpharmacological means of managing their pain, discomfort, and anxiety.
Researchers have found that MV patients who listened to 30 minutes of preferred music experienced a significant decrease in state anxiety (Chlan, 1995, 1998; Wong et al., 2001). Some research has demonstrated that listening to music has significantly decreased heart rate, systolic and diastolic blood pressure, and respiratory rates (Almerud et al., 2003; Wong et al., 2001). Heiderscheit, Chlan, and Donley (2011) describe two cases from a randomized controlled trial utilizing a patient-directed music listening intervention. These two case illustrations provide greater detail regarding the process of assessing an MV patient’s preferred music, the successful implementation of a music listening
intervention, and how the intervention can be individualized based on patient needs. Chlan and Heiderscheit (2009) developed a music assessment tool (MAT) to utilize in assessing music preferences for patients. Hunter et al. (2010) reported that music therapy was successful in helping patients to manage their anxiety while weaning from MV. They also report high satisfaction rates among patients who received music therapy, as well as their nurses.
Bradt, Dileo, and Grocke (2010) completed a Cochrane Review on the use of music interventions with MV patients. Their review of the research included eight randomized and quasi-randomized controlled trials, which included a total of 213 patients. They reported that the findings of these studies suggest that a music listening intervention is a viable intervention for managing stress and anxiety and may positively impact heart rate, respiratory rate, and anxiety in MV patients. While the research does support the use of music as an effective method, the investigators do recommend that additional research is needed to further explore the effects of music listening with MV patients and that these interventions be provided by a trained or board-certified music therapist.
There are many other surgical and medical procedures with which researchers have explored the use of music and music interventions as a nonpharmacological method of symptom management. These include open heart surgery (Nilsson, 2009); abdominal surgery and hysterectomy (Good et al., 2001; Kain et al., 2000; Taylor et al., 1998); cataract surgery (Cruise et al., 1997); cerebral angiography (Schneider et al., 2001; Vanderboom et al., 2011); caesarean section (Laopaiboon et al., 2009); labor, birth, and delivery (Clark et al., 1981; Geden et al., 1989; Hanser et al., 1983; Kimber et al., 2008); colposcopy (Galaal et al., 2011); colonoscopy (Andrada et al., 2004; Smolen et al., 2002;); sigmoidoscopy (Chlan et al., 2000; Palakanis et al., 1994); and bronchoscopy (Colt et al., 1999; Dubois et al., 1995; Triller et al., 2006).
The research literature continues to grow regarding the effective use of music and music therapy during surgical and medical procedures. As a result, there are meta-analyses (Dileo & Bradt, 2005; Pelletier, 2004; Standley, 1986), reviews of evidence (Chlan, 2009), systematic reviews (Evans, 2002), and various Cochrane Reviews further exploring the effectiveness of music in these areas of medicine. Researchers and clinicians continue to explore how music can be implemented to improve patient care and the patient experience.
Although the current body of research literature utilizes receptive methods, this does not preclude other methods from being applicable in various areas of surgical and procedural support. It is important to note that many of the research studies were conducted by non–music therapists, and many did not employ a music therapist as a member of the research team. These two factors will limit the scope to which music can be utilized in surgery or during a procedure. Additionally, during procedures it may require the patient to be still or sedated, and this will also limit a patient’s level of engagement in music or music therapy.