Effects of music on patient anxiety - Research

AORN Journal,  Feb, 2003  by Esther Mok,  Kwai-Yiu Wong

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Anxiety is defined as state anxiety, which has been described as a transitory state of uneasiness or apprehension. It is ephemeral, occurs in response to a stimulus, and is likely to vary in intensity as a function of the stimulus. (20) The subjective measure of anxiety was determined by the Chinese version of the Spielberger State-Trait Anxiety Inventory (STAI), and the objective measure of anxiety was determined by patients' blood pressure and heart rate.

Minor surgery is surgery on a small scale in which minimally invasive techniques and less extensive cutting are involved. Using local anesthesia reduces the patient's trauma to a tolerable level. Minor surgery usually is much shorter in duration than major surgery. In this study, the time span for each surgery was no longer than 45 minutes. In addition, 1% xylocaine with adrenaline (1:200,000) was used for local anesthesia. The adrenaline added can have a vasoconstricting property in the area injected. It delays the rate of absorption of the local anesthetic agent and reduces the incidence of toxicity. Routine preoperative instruction consisted of explaining the surgical procedure to patients.

Patients' perceptions about music during minor surgery were obtained through an attitudinal scale and interview responses. Ethical committees from both the Hong Kong Polytechnic University and Tuen Mun Hospital, Hong Kong, approved the study. The study was conducted for five months from September 1999 to February 2000. Before proceeding to the main study, a pilot study including 12 patients was performed, and a medium effect size resulted. The results of the pilot study indicated that an 80% power at the 0.05 level of significance would require at least 26 participants in each group.

Study sample. The study took place in an acute care hospital in Hong Kong. The study sample consisted of 80 patients from a day surgery ward who were scheduled for minor surgery under local anesthesia. Subjects were selected based on inclusive criteria, including whether the patient

* was 18 years of age or older;

* was willing to participate in the study;

* was able to comprehend oral and written instruction;

* had no hearing impairment;

* had not received any preoperative sedative, which can affect vital signs and mask anxiety;

* had no cardiac disease; and

* had no history of hypertension.

In addition, patients who recently had undergone or were scheduled for surgery on an ear, the face, or the head were excluded because listening to music requires headphones.

Procedure for sampling. Patient participation in the research study was voluntary. The purpose of the investigation was explained to patients before surgery, and their written informed consent was obtained. One hundred six patients were approached to participate in the study, but only 80 patients participated (ie, 75%). Some individuals did not participate because they did not like music or felt uncomfortable with the headphones. Some did not like the choices of music available. Approximately 40 minor surgeries were performed per month. The OR schedule usually is composed of three minor surgical procedure sessions per week with about four minor surgeries per session.