1. Presented by: Carol Lewallen BSN, RN, BC
Does Listening to Music Improve the Recovery Experience of Adolescent Same Day Surgery Patients Age years old?
Presented by:
Carol Lewallen BSN, RN, BC
This is my son Chris. He is graduating from High School on May 15th. He is the inspiration for my study. A year and a half ago, when my son was 16 years old, we discovered he had a Coarctation of the Aorta. He had open heart surgery. He listens to music all the time and I could not help but wonder if music would help this age group in particular who were having surgery.

2. Introduction It is well known that:
Surgical procedures may cause patients to experience pain and anxiety.
Music has the ability to affect moods and emotions.
Adolescents listen to music as a form of relaxation.

3. Statement of the Problem
There is a direct correlation between preoperative anxiety, postoperative pain, and increased risk of infection.
- Vaughn et al, (2007)
There are many negative side effects to taking pain medications.
Pain can increase lengths of stay and increase costs.
Limited research is available related to adolescent pain.

4. Purpose of the Study
To improve the recovery experience for adolescent same day surgery patients age

5. Research Question
Does Listening to Music Improve the Recovery Experience of Adolescent Same Day Surgery Patients Age years old?

6. Significance Decreased post-operative pain Decreases risk of infection
Decreases the need pain medications
Decreases costs
Improves satisfaction
Postoperative pain may increase the risk of infection through poor nutrition and dehydration, constriction of vessels leading to decreased circulation, and the inability to maintain an environment free from infection causing bacteria.
Postoperative pain increases the need for narcotic pain medications which can cause nausea/vomiting, hypotension, decreased consciousness, and respiratory depression that can lead to airway concerns— including aspiration and the need to be re-ventilated.
Pain can cause an increased length of stay which increases costs to patients and facilities.
Pain is a main dissatisfier for patients, families and nurses.
(Vaugh 2007)

7. Literature Review Music was used an early nursing intervention.
- McCaffey & Locsin (2002)
Music diverts feelings of anxiety, fear, and pain.
- Cooke et al (2005)
Music relieves postoperative pain.
- Engwall & Duppils (2009)
Florence Nightingale used music as a nursing intervention as part of the healing process for wounded soldiers of the Crimean War. Music was considered part of the environment and Nightingale felt that nursing should control the environment to put the patient in the best place for healing to occur (McCaffrey & Locsin, 2002).
In 2005, Cooke et al reported that “the auditory stimulation of music occupies a number of neurotransmitters thereby diverting feelings of anxiety, fear and pain resulting in a more positive perceptual experience”.
Engwall & Duppils, 2009 conducted a systematic review of quantitative studies to examine the effects of music on postoperative pain. 15 out of 18 studies confirmed that music had a significant positive effect on postoperative pain. They concluded that music can be used as an effective adjuvant for the relief of postoperative pain.

8. Literature Review Cont.
Music reduces the need for medications.
-Nilsson (2008)
Music offers comfort and familiarity.
- McCaffrey & Good (2000)
Music reduces the effects of stress in adolescents.
- Yahaw and Cohen (2008)
Respecting musical choice needs to be considered Wong & Mok (2003)
In a systematic review of 42 randomized controlled trials, Nilsson 2008, found music intervention reduced the use of sedatives and analgesics. The review reported that music had a positive effect on reducing pain and anxiety in half of the reviewed studies.
McCaffrey & Good conducted a qualitative study with 8 participants who listened to music while recovering from surgery. Evaluating findings from a phenomenological perspective, the themes that emerged included: comfort from a discomforting condition, familiarity in a strange environment, and distraction from fear, pain, and anxiety.
In a RCT of 255 adolescents. Yahaw and Cohen, 2008, undertook a study to evaluate the effect of a cognitive-behavioral, biofeedback-assisted intervention to impart skills for coping with stressful encounters. It was found that listening to music as a form of distraction is an effective coping strategy that is used by adolescents to help reduce the effects of stress.
During an experimental study by Wong & Mok, 2003, a choice of music was given to the 20 non-randomized patients undergoing surgery. They were given a choice of musical categories to listen to during surgery which included classical music, contemporary popular music, or Chinese popular music. Patients listening to music had significantly lower anxiety, blood pressure, and heart rate levels than those who did not listen to music. Patients were given an evaluation questionnaire following their surgical experience, it was found that listening to music was a patient satisfier and found to be helpful, but respecting musical choice should be given more consideration.

9. Clinical Research Project
IRB approval through Briar Cliff University and Spencer Hospital
Experimental project – 8 participants and 8 controls
Parental consent and adolescent assent obtained
Similar outpatient surgical procedures
Both groups were injected with Marcaine or Ropivicaine in OR by the surgeon.
Setting was the surgical services area at Spencer Hospital.
The participant group listened to music postoperatively, although, each participant had the choice to listen preoperatively as well as in the OR while being anesthetized.
Both groups had similar surgical procedures including: knee ACL repairs, lateral releases, or meniscal repairs.

10. Clinical Research Project
Research measures:
Amount of time in recovery (PACU and SDS).
Pain rating 0/10 scale (1st, highest, DC scores)
Postop medication requirements.

11. Clinical Research Project
Control Group
Participant Group
5 females, 3 males ages
2 of 8 had femoral nerve blocks. 7 of 8 had pain med in the OR.
Information was obtained through retrospective chart audits.
6 females, 2 males ages
3 of 8 had femoral nerve blocks. 7 of 8 had pain med in OR.
Information was gathered during the patient’s flow through the recovery process.
Average time listening to music = min.
Participants listened to self selected music on an ipod in PACU. Average length of time listening in PACU was minutes.
Some participants chose to continue to listen to their music after PACU, during the SDS recovery period. l

12. Results -Medication Requirements
Control Group
Participant Group
7 of 8 = 88% were administered additional pain medication in PACU.
3 of 8 = 38% were administered additional pain medication in PACU.

13. Results for Recovery Times
The recovery times were less overall in PACU and on SDS.

14. Statistical Significance
Two-tail t-test
PACU RECOVERY TIME
p = .15
SDS RECOVERY TIME
p = .27
Although the recovery times were less overall for the participant group. Results were not < .05 , we accept the null hypothesis

15. Results of Pain Scores
All pain scores were less overall in PACU and on SDS.

16. Statistical Significance
Two-tail t-test
PACU PAIN SCORES
1st score--- p= .12
high score ---p=.037, (p<.05)
DC score--- p= .09
SDS PAIN SCORES
1st score--- p=.15
high score--- p=.06
DC score--- p=.058
1. A two-tail t-test was completed on the pain score data
PACU pain “high score” was <.05
Several other scores were very close to .05, we can probably infer that listening to music does make a significant difference in decreasing pain scores.

17. References
Canon Communications LLC (2008). Nearly half of teen activities are driven by technology. Retrieved November 25, 2008, from
Cooke, M., Chaboyer, W., & Hiratos, M. A. (2005). Music and its effect on anxiety in short waiting periods: A critical appraisal. Journal of Clinical Nursing, 14(2), McCaffrey, R., & Locsin, R. C. (2002). Music listening as a nursing intervention: A symphony of practice. Holistic Nursing Practice, 16(3),
Engwall, M. & Duppils, G. (2009). Music as a nursing intervention for postoperative pain: A systematic review. Journal of Perianesthesia Nursing, 24(6),

18. References
Kemper, K. & Danhauer, S. (2005). Music as Therapy. Southern Medical Journal, 98(3),
Maranets, I., & Kain, Z. N. (1999). Preoperative anxiety and intraoperative anesthetic requirements. Anesthesia Analgesia, 89(6),
Mitchell, M. (2003). Patient anxiety and modern elective surgery: a literature review. Journal of Clinical Nursing, 12(6),
Mok, E., & Wong, K. (2003). Effects of music on patient anxiety. Association of Perioperative Registered Nurses (AORN) Journal, 77(2), 401-4, 406.

19. References
Nilsson, U. (2008). The anxiety and pain reducing effects of music interventions: A systematic review. Association of Perioperative Registered Nurses (AORN) Journal, 87(4), 780, 782, ,
Parris, W., Matt, D., Jamison, R. N., & Maxon, W. (1988). Anxiety and postoperative recovery in ambulatory surgery patients. Anesthesia Progress, 35(2),
Yahaw, R., & Cohen, M. (2008). Evaluation of a cognitive-behavioral intervention for adolescents. International Journal of Stress Management, 15(2),