Music therapy as a nursing intervention for patients supported by mechanical ventilation

Music-based interventions and theoretical mechanisms in post-ICU survivors: A critical narrative synthesis

BACKGROUND

Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear.

AIM

This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions.

METHOD

We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence.

RESULTS

Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood.

CONCLUSION

Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions.

IMPLICATION TO PRACTICE

1. Music interventions help in post-ICU patients' recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain. 2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life. 3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.

Efficacy and safety of music therapy for the treatment of anxiety and delirium in ICU patients: a meta-analysis and systematic review of randomized controlled trials

INTRODUCTION

The medical application of music therapy (MT) has received widespread attention in recent years and some researchers have attempted to apply MT to the treatment of patients with anxiety and delirium in ICU.

EVIDENCE ACQUISITION

Relevant randomized controlled trials (randomized controlled trials s) were searched in databases, such as Web of Science, PubMed, Embase, Cochrane Library, Medline, Scopus, and CINAHL. Researchers performed literature screening, data extraction, literature quality assessment, and heterogeneity analysis among RCTs.

EVIDENCE SYNTHESIS

Fourteen studies met the inclusion criteria. In general, we included RCTs with low risk of bias, and the primary outcome indicators, including the Chinese version of the State-Trait Anxiety Inventory (C-STAI), Visual Analogue Scale for Anxiety Measurement (VAS-A), and Facial Anxiety Scale (FAS), with a recommended level of evidence of "strong". The pooled results indicated that MT was effective in alleviating the anxiety state of ICU patients (95% CI, SMD=-1.09 [-1.52, -0.67], P<0.05) and could reduce mental and physical fatigue in patients with anxious delirium in ICU (95% CI, WMD=-2.35 [-3.37, -1.33], P <0.05). There were significant differences in the therapeutic effects of MT with different intervention durations. Both 15-minute and 30-minute MT were effective in reducing anxiety levels in patients with anxiety disorders in the ICU (15min: 95%CI, SMD=-1.70[-2.15, -1.24], P<0.05; 30min: 95%CI, SMD=-0.73[-1.16, - 0.29], P<0.05). However, when the duration of MT exceeded 45 min, the overtreatment of MT instead interfered with patient rest and failed to produce a positive therapeutic effect (95% CI, SMD=-1.04 [-3.06, 0.97], P=0.31). In addition, a meta-analysis of physiological outcomes found that MT was effective in maintaining the stabilization of heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) in ICU patients with anxiety (P<0.05), but did not affect patients' oxygen saturation, mean arterial pressure and diastolic blood pressure (P>0.05). No adverse events occurred during MT treatment in the reports of included 14 studies.

CONCLUSIONS

MT can safely and effectively reduce the anxiety level of patients with anxiety and delirium in ICU and relieve their psychological and physical fatigue. And MT was able to maintain the stability of HR, RR, and SBP in ICU patients.

Quality of Life and Stress Levels in Patients under Home Mechanical Ventilation: What Can We Do to Improve Functioning Patients at Home? A Survey Study

BACKGROUND

Home mechanical ventilation (HMV) is becoming more widely available in many countries.

OBJECTIVES

The aim of this study was to measure the health-related quality of life and stress levels of patients ventilated mechanically at home. The relation between quality of life and stress levels was investigated including multiple regression analysis.

METHODS

100 patients treated with HMV in Poland were surveyed with the WHOQOL-BREF questionnaire and Perceived Stress Scale (PSS-10).

RESULTS

26% of patients assessed their quality of life as bad or very bad and 34% as good or very good. Stress levels measured with PSS-10 Scale were high level. For the group of patients with neurological disorders, stress levels were significantly higher than for the group of patients with pulmonological disorders.

CONCLUSIONS

The higher the stress levels of patients, the lower the quality of life in particular domains. Improving the living conditions of HMV patients can influence improving their quality of life.

Effectiveness of Music-Based Intervention in Improving Uncomfortable Symptoms in ICU Patients: An Umbrella Review

Background: Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using music-based intervention, a nondrug treatment. This umbrella review aims to combine the data of systematic reviews and/or meta-analyses to evaluate the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients. Methods: A comprehensive literature search was performed on the PubMed, Embase, Cochrane Library, Airiti Library, CINAHL, ProQuest, and Web of Science databases, and Epistemonikos. The search had no language restrictions, and articles on the improvement of symptoms using music-based intervention in adult ICU patients were included. This review protocol was registered on PROSPERO (CRD42021240327). Results: This umbrella review retrieved 5 systematic reviews and 41 original studies, including 39 randomized controlled trials, and 2 nonrandomized controlled trials. Diverse music was the most common music type used for music-based intervention, the intervention music was typically decided by the study participants (61%), and most subjects underwent one intervention session (78%). Furthermore, most music intervention sessions lasted for 30 min (44%). The positive results included decreased anxiety, decreased pain, decreased agitation, decreased anesthesia dose and sedative use, decreased chances of delirium, decreased feelings of uncomfort, and improved sleep quality. Conclusions: A systematic review on the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients revealed that 20–30 min intervention sessions showed the best improvement in the uncomfortable symptoms in patients. This study provides a basis for using music-based intervention to relieve the uncomfortable symptoms in critically ill ICU patients, and a reference for empirical clinical practice.

Self-Achievement Through Creativity in Critical Care

Art in nursing is present in various forms and there is ample literature exploring creativity, including journaling for clinicians, intensive care unit diaries for patients and providers, and music therapy for patients. Illness narratives, depictions of the sick, or the effects of disease are commonly represented in media. This article highlights how creativity and various mediums of artistic expressions may can be used as a self-care practice and aid in boosting empathy in health care providers. Theories on empathy are presented as well as selected representations of nursing as creative expressions and the importance of promoting creativity and empathy.

Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses

Music interventions are used for stress reduction in a variety of settings because of the positive effects of music listening on both physiological arousal (e.g., heart rate, blood pressure, and hormonal levels) and psychological stress experiences (e.g., restlessness, anxiety, and nervousness). To summarize the growing body of empirical research, two multilevel meta-analyses of 104 RCTs, containing 327 effect sizes and 9,617 participants, were performed to assess the strength of the effects of music interventions on both physiological and psychological stress-related outcomes, and to test the potential moderators of the intervention effects. Results showed that music interventions had an overall significant effect on stress reduction in both physiological (d = .380) and psychological (d = .545) outcomes. Further, moderator analyses showed that the type of outcome assessment moderated the effects of music interventions on stress-related outcomes. Larger effects were found on heart rate (d = .456), compared to blood pressure (d = .343) and hormone levels (d = .349). Implications for stress-reducing music interventions are discussed.

Music as Medicine: The Therapeutic Potential of Music for Acute Stroke Patients

Nurses caring for patients with acute stroke are likely to administer both music and medication with therapeutic intent. The administration of medication is based on accumulated scientific evidence and tailored to the needs of each patient. However, the therapeutic use of music is generally based on good intentions and anecdotal evidence. This review summarizes and examines the current literature regarding the effectiveness of music in the treatment of critically ill patients and the use of music in neurologically injured patients. The rationale for hypothesis-driven research to explore therapeutic music intervention in acute stroke is compelling.

Relaxation - Induced by Vibroacoustic Stimulation via a Body Monochord and via Relaxation Music - Is Associated with a Decrease in Tonic Electrodermal Activity and an Increase of the Salivary Cortisol Level in Patients with Psychosomatic Disorders

Vibroacoustic stimulation by a Body Monochord can induce relaxation states of various emotional valence. The skin conductance level (SCL) of the tonic electrodermal activity is an indicator of sympathetic arousal of the autonomic nervous system and thus an indicator of the relaxation response. Salivary cortisol is considered to be a stress indicator of the HPA-axis. The effects of the treatment with a Body Monochord and listening to relaxation music (randomized chronological presentation) on SCL and salivary cortisol in relation to the emotional valence of the experience were examined in patients with psychosomatic disorders (N = 42). Salivary cortisol samples were collected immediately before and after the expositions. Subjective experience was measured via self-rating scales. Overall, both the exposure to the Body Monochord as well as the exposure to the relaxation music induced an improvement of patients' mood and caused a highly significant reduction of SCL. A more emotionally positive experience of relaxation correlated with a slightly stronger reduction of the SCL. Both treatment conditions caused a slight increase in salivary cortisol, which was significant after exposure to the first treatment. The increase of salivary cortisol during a relaxation state is contrary to previous findings. It is possible that the relaxation state was experienced as an emotional challenge, due to inner images and uncommon sensations that might have occurred.

Music listening alleviates anxiety and physiological responses in patients receiving spinal anesthesia

OBJECTIVE

The aim of this study was to explore the effects of listening to music on the anxiety levels and physiological responses of surgical patients receiving spinal anesthesia.

METHODS

An experimental design was used in the study with an experimental group (n=50) and a control group (n=50). The experimental group received 30min of musical intervention and routine nursing care in the Post-Anesthesia Care Unit (PACU) while the control group received only routine nursing care.

RESULTS

The study found significant differences in both anxiety and physiological indices between the two groups. The mean score of the State-Trait Anxiety Inventory (STAI) in the study group decreased from a pre-test score of 59.0 to a post-test score of 31.20 (t=28.63, p<0.001). Physiological indices such as heart rate (t=2.61, p=0.012), respiration rate (t=2.29, p=0.026), systolic blood pressure (t=2.30, p=0.026), and diastolic blood pressure (t=3.02, p=0.004) decreased significantly as well. Control group was not seeing significant changes from pre-op values.

CONCLUSION

Listening to music while in the recovery room may decrease the level of anxiety in surgical patients receiving spinal anesthesia. The results of this study can serve as a reference for PACU nurses in utilizing music listening programs to achieve the goal of holistic care.

Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention ( n = 41) or control group ( n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures ( p < .02) and pre–post differences ( p < .03) except for diastolic blood pressure. Because of music intervention’s low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient’s mood should be monitored after the music intervention.

Therapeutic Use of Music and Television in Neurocritical Care: A Practice Survey

INTRODUCTION

Although health care providers often play music via radio, or play television, to calm and soothe patients, limited research is available to guide practice.

METHOD

This study used a 17-item practice survey that was distributed electronically to neurocritical care society members in July 2014. Responses were collated and analyzed using SAS (Version 9.3).

RESULTS

There were 118 completed responses, including from 71 attending physicians, 9 resident or fellow physicians, 30 nurses, and 8 affiliate professional members. The majority of respondents sometimes or always play music (65%) and agree that music is therapeutic (70%). However, there was no clear practice pattern regarding when or why music or TV should be used as an intervention in the neurocritical care unit.

CONCLUSION

The use of music and TV is a common intervention in the neurocritical care unit but lacks a strong scientific foundation and is associated with a high practice variance.

Music interventions for mechanically ventilated patients

BACKGROUND

Mechanical ventilation often causes major distress and anxiety in patients. The sensation of breathlessness, frequent suctioning, inability to talk, uncertainty regarding surroundings or condition, discomfort, isolation from others, and fear contribute to high levels of anxiety. Side effects of analgesia and sedation may lead to the prolongation of mechanical ventilation and, subsequently, to a longer length of hospitalization and increased cost. Therefore, non-pharmacological interventions should be considered for anxiety and stress management. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however, their efficacy for mechanically ventilated patients needs to be evaluated. This review was originally published in 2010 and was updated in 2014.

OBJECTIVES

To update the previously published review that examined the effects of music therapy or music medicine interventions (as defined by the authors) on anxiety and other outcomes in mechanically ventilated patients. Specifically, the following objectives are addressed in this review.1. To conduct a meta-analysis to compare the effects of participation in standard care combined with music therapy or music medicine interventions with standard care alone.2. To compare the effects of patient-selected music with researcher-selected music.3. To compare the effects of different types of music interventions (e.g., music therapy versus music medicine).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 2), MEDLINE (1950 to March 2014), CINAHL (1980 to March 2014), EMBASE (1980 to March 2014), PsycINFO (1967 to March 2014), LILACS (1982 to March 2014), Science Citation Index (1980 to March 2014), www.musictherapyworld.net (1 March 2008) (database is no longer functional), CAIRSS for Music (to March 2014), Proquest Digital Dissertations (1980 to March 2014), ClinicalTrials.gov (2000 to March 2014), Current Controlled Trials (1998 to March 2014), the National Research Register (2000 to September 2007), and NIH CRISP (all to March 2014). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction. The original search was performed in January 2010.

SELECTION CRITERIA

We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data and assessed the methodological quality of included studies. We contacted authors to obtain missing data where needed. Where possible, results for continuous outcomes were presented in meta-analyses using mean differences and standardized mean differences. Post-test scores were used. In cases of significant baseline difference, we used change scores. For dichotomous outcomes, we presented the results as risk ratios.

MAIN RESULTS

We identified six new trials for this update. In total, the evidence for this review rests on 14 trials (805 participants). Music listening was the main intervention used, and 13 of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients. Specifically, music listening resulted, on average, in an anxiety reduction that was 1.11 standard deviation units greater (95% CI -1.75 to -0.47, P = 0.0006) than in the standard care group. This is considered a large and clinically significant effect. Findings indicated that listening to music consistently reduced respiratory rate and systolic blood pressure, suggesting a relaxation response. Furthermore, one large-scale study reported greater reductions in sedative and analgesic intake in the music listening group compared to the control group, and two other studies reported trends for reduction in sedative and analgesic intake for the music group. One study found significantly higher sedation scores in the music listening group compared to the control group.No strong evidence was found for reduction in diastolic blood pressure and mean arterial pressure. Furthermore, inconsistent results were found for reduction in heart rate with seven studies reporting greater heart rate reductions in the music listening group and one study a slightly greater reduction in the control group. Music listening did not improve oxygen saturation levels.Four studies examined the effects of music listening on hormone levels but the results were mixed and no conclusions could be drawn.No strong evidence was found for an effect of music listening on mortality rate but this evidence rested on only two trials.Most trials were assessed to be at high risk of bias because of lack of blinding. Blinding of outcome assessors is often impossible in music therapy and music medicine studies that use subjective outcomes, unless the music intervention is compared to another treatment intervention. Because of the high risk of bias, these results need to be interpreted with caution.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, or cost-effectiveness. No adverse events were identified.

AUTHORS' CONCLUSIONS

This updated systematic review indicates that music listening may have a beneficial effect on anxiety in mechanically ventilated patients. These findings are consistent with the findings of three other Cochrane systematic reviews on the use of music interventions for anxiety reduction in medical patients. The review furthermore suggests that music listening consistently reduces respiratory rate and systolic blood pressure. Finally, results indicate a possible beneficial impact on the consumption of sedatives and analgesics. Therefore, we conclude that music interventions may provide a viable anxiety management option to mechanically ventilated patients.

Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial

IMPORTANCE

Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.

OBJECTIVE

To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.

DESIGN, SETTING, AND PATIENTS

Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.

INTERVENTIONS

Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).

MAIN OUTCOMES AND MEASURES

Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).

RESULTS

Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, -32.2 to -6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by -0.18 (95% CI, -0.36 to -0.004) points/day (P = .05) and had reduced frequency by -0.21 (95% CI, -0.37 to -0.05) points/day (P = .01). The PDM group had reduced sedation frequency by -0.18 (95% CI, -0.36 to -0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.

CONCLUSIONS AND RELEVANCE

Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00440700.

The Effect of Music Therapy on Hospitalized Psychiatric Patients’ Anxiety, Finger Temperature, and Electroencephalography

Purpose: This study aimed to explore the effectiveness of music therapy in reducing anxiety in hospitalized psychiatric patients.

Methodology: The authors used a randomized clinical trial design and randomly allocated the 24 enrolled participants to the experimental or the control group. Patients in the experimental group received music therapy in a therapy room at a set time for 30 min each morning for 11 days. The authors administered the Beck Anxiety Inventory (BAI) and measured skin temperature and brain waves to determine anxiety level before, during, and after music therapy. Results: Experimental group participants had lower scores on the BAI than control participants, after the music therapy ( z = −2.0, p < .05) and at 1-week follow-up ( z = −2.2, p < .05), indicating that they were experiencing significantly less anxiety. The mean BAI anxiety score fell in the experimental group from 23.9 ( SD = 9.9) at baseline to 13.9 ( SD = 8.8), after music therapy, and 12.7. ( SD = 10.5) at follow-up. The experimental group demonstrated a significant elevation in the average alpha electroencephalographic (EEG) percentage (from 38.1% to 46.7%) and a reduction in the average beta EEG percentage (from 61.9% to 53.4%) after the music therapy. After adjusting for change in patient finger temperature on the first day, mean change in finger temperature did not differ significantly between the experimental and control groups. Conclusions: Music therapy can relieve anxiety in hospitalized psychiatric patients and help them achieve a state of relaxation.

Mental health implications of music: insight from neuroscientific and clinical studies

Neuroscientific and clinical studies of music over the past two decades have substantially increased our understanding of its use as a means of therapy. The authors briefly review current literature related to music's effect on people with different mental illnesses, and examine several neurobiological theories that may explain its effectiveness or lack thereof in treating psychiatric disorders. Neuroscientific studies have shown music to be an agent capable of influencing complex neurobiological processes in the brain and suggest that it can potentially play an important role in treatment. Clinical studies provide some evidence that music therapy can be used as an alternative therapy in treating depression, autism, schizophrenia, and dementia, as well as problems of agitation, anxiety, sleeplessness, and substance misuse, though whether it can actually replace other modes of treatment remains undetermined. Future research should include translational studies involving both neuroscience and clinical medicine that investigate the long-term effects of music intervention and that lead to the development of new strategies for music therapy.

Music interventions for mechanically ventilated patients

BACKGROUND

Mechanical ventilation often causes major distress and anxiety in patients. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for mechanically ventilated patients needs to be evaluated.

OBJECTIVES

To examine the effects of music interventions with standard care versus standard care alone on anxiety and physiological responses in mechanically ventilated patients.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE, CINAHL, AMED, EMBASE, PsycINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the National Research Register, and NIH CRISP (all to January 2010). We handsearched music therapy journals and reference lists and contacted relevant experts to identify unpublished manuscripts. There was no language restriction.

SELECTION CRITERIA

We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data and assessed the methodological quality. Additional information was sought from the trial researchers, when necessary. Results were presented using mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Post-test scores were used. In cases of significant baseline difference, we used change scores.

MAIN RESULTS

We included eight trials (213 participants). Music listening was the main intervention used, and seven of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients; however, these results need to be interpreted with caution due to the small sample size. Findings indicated that listening to music consistently reduced heart rate and respiratory rate, suggesting a relaxation response. No strong evidence was found for blood pressure reduction.Music listening did not improve oxygen saturation level.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, mortality, or cost-effectiveness.

AUTHORS' CONCLUSIONS

Music listening may have a beneficial effect on heart rate, respiratory rate, and anxiety in mechanically ventilated patients. However, the quality of the evidence is not strong. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.

Interventions for anxiety in the critically ill: a guide for nurses and families

Anxiety is a common feeling for patients and families during the critical care experience. As anxiety for critically ill patients presents increased risks for morbidity and mortality, it is imperative that nurses strive to identify unrelieved anxiety early to prevent adverse events. Alleviating anxiety experienced by families as a result of the critical care experience involves providing assurance, allowing them to remain near the patient, providing accurate and current information, providing for their comfort, and projecting a supportive attitude. As constant care providers, nurses can have the greatest impact on creating an environment that is safe, healing, and humane for critically ill patients and their families.

Effects of music intervention on physiological stress response and anxiety level of mechanically ventilated patients in China: a randomised controlled trial

AIM

To examine the effects of music intervention on the physiological stress response and the anxiety level among mechanically ventilated patients in intensive care unit.

BACKGROUND

Despite the fact that previous studies have found music interventions to be effective in stress and anxiety reduction, effects of music on the Chinese population are inconclusive and warranted systematic study to evaluate its effect fully for a different Asian culture.

DESIGN

A randomised placebo-controlled trial.

METHODS

A total of 137 patients receiving mechanical ventilation were randomly assigned to either music listening group, headphone group or control group. Outcome measures included the Chinese version of Spielberger State-Trait Anxiety Scale and physiological parameters (heart rate, respiratory rate, saturation of oxygen and blood pressure).

RESULTS

Comparison of mean differences (pretest score-posttest score) showed significant differences in heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure as well as the Chinese version of Spielberger State-Trait Anxiety Scale, but not in SaO(2) among the three groups (ranging from p < 0.001 to p = 0.007), of which greater mean differences were found in music listening group. A significant reduction in physiological stress response (heart rate and respiratory rate) over time was found in music listening group (p < 0.001 for both variables) and a significant increase in heart rate and respiratory rate over time in control group (p < 0.001 and p = 0.032), with no significant change over time in headphone group. Within group pretest-posttest comparison of the Chinese version of Spielberger State-Trait Anxiety Scale demonstrated a significant reduction in anxiety for the music listening group (p < 0.001) and headphone group (p < 0.001) but not the control group.

CONCLUSIONS

Our findings confirm that short-term therapeutic effects of music listening results in substantial reduction in physiological stress responses arising from anxiety in mechanically ventilated patients.

RELEVANCE TO CLINICAL PRACTICE

Music as a non-pharmacological nursing intervention can be used as complementary adjunct in the care of patients with low-energy states who tire easily, such as those requiring mechanical ventilator support.

The effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients

AIMS AND OBJECTIVES

A pilot study designed as future randomised controlled trial was carried out to determine the effects of music on physiological responses and sedation scores in sedated, mechanically ventilated patients.

BACKGROUND

Mechanically ventilated ICU patients, even when receiving intravenous sedatives, may experience stress and anxiety. One possible intervention to reduce stress and anxiety is listening to music.

DESIGN

A randomised controlled trial design with repeated measures was used.

METHODS

Data were collected over a six-month period in 2006. Twenty subjects were randomly assigned to either the experimental or control group. Subjects in the experimental group listened to music three times for 30 minutes over two days; subjects in the control group undertook three 30 minute rest periods. Physiological effects of music on systolic, diastolic and mean arterial blood pressure and heart and respiratory rate were assessed. Sedation scores were also measured.

RESULTS

Physiological parameters did not show a significant difference between the groups. Patients in the experimental group showed significantly higher Ramsay (sedation) scores than patients in the control group after the first session. The higher scores indicate that patients were less responsive to external stimuli.

CONCLUSION

Our results suggest that listening to music leads to higher sedation scores in sedated, mechanically ventilated ICU patients. No significant decreases in physiological parameters were observed. Listening to music showed no negative changes in the condition of these patients. Future research should focus on the use of other measures, such as stress hormones, to assess stress in sedated, mechanically ventilated ICU patients.

RELEVANCE TO CLINICAL PRACTICE

For the sedated, mechanically ventilated ICU patient, the benefit of music may lie in the associated (deeper) level of sedation that is achieved, which in turn may make the patient less susceptible to stress and anxiety.

Practice guidelines for music interventions with hospitalized pediatric patients

Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy interventions be aligned with evidence-based information and that accepted standards be established by the music therapy discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design pediatric practice guidelines in the application of music therapy.

Harmonic sounds: complementary medicine for the critically ill

Anxiety is a common phenomenon among hospitalized patients, and over the past few decades there has been a growing interest in using music as an anxiolytic agent on patients in intensive care undergoing ventilation. Critically ill patients experience both anxiety and pain related to their illness and injury, but the implementation of music can help provide a supportive role for relief of symptoms that interfere with the healing process. This article aims to review music therapy as an aid to reducing anxiety and pain levels within an intensive care unit setting. By observing the literature, music therapy as a non-pharmacological intervention will be discussed and the benefit of promoting a healing environment for patients will be addressed.

Therapies to reduce stress and anxiety

Creativity in meeting patients' needs is required daily by the staff in acute and critical care environments. For critical care patients, many alternative and complementary therapies including aromatherapy, hydrotherapy, humor, imagery, massage, music, and relaxation can be used successfully as adjunct therapies to help decrease stress.

Shaping the future of complementary and alternative therapies for critical care nursing

Nurses from across the country gathered at the Nursing Summit to consider nurses' roles in providing complementary and alternative therapies (CAT) to achieve optimal patient outcomes. The implications to critical care nurses and recommendations for action are discussed.

Using complementary and alternative therapies to promote comfort at end of life

Dying is a journey for all involved. We have been fortunate to work in a hospital with both an ICU and a palliative care/hospice unit. We have transferred patients for whom care was withdrawn and who were still alive on the next day to the palliative care unit and have found the transfer to work to maximize comfort in dying. For many patients and families who have developed relationships with the staff in their ICU, the combination of established relationships, traditional therapies, and CAT maximizes the comfort during the dying process.

Clinical management of stressors perceived by patients on mechanical ventilation

Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both.

Music therapy--a complementary treatment for mechanically ventilated intensive care patients

The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients' experiences of the music therapy. In the study both quantitative and qualitative measurements were applied. Twenty patients were included using consecutive selection. It became apparent that the patients remembered very little of their time in ICU. The analysis of the quantitative data showed a significant fall in systolic and diastolic blood pressure during the music therapy session and a corresponding rise after cessation of treatment. All changes were found to be statistically significant. The conclusion was that intensive care nursing staff can beneficially apply music therapy as a non-pharmacological intervention.