Music for heart patients during invasive procedures
Article by Specialist nurse Bitten Gøtzsche, Cardiology Laboratory, Aalborg University Hospital
Article by Specialist nurse Bitten Gøtzsche, Cardiology Laboratory, Aalborg University Hospital
In Cardiology Laboratory, Aalborg (1), we have since 2002 used music to patients in the invasive procedures. The starting point of our practice were two studies from 2001 and 2003, which focused on the efficacy of music to patients in relation to CAG (koronararteriografi - study of coronary arteries) and PCI (percutaneous absorption coronary intervention - angioplasty and stent treatment of narrowed coronary arteries in the heart).
In the first music study, the patients were divided into two groups - a music group and a basic group. For both groups the basic sound environment was the same – i.e. the sounds, which is common in the ward for invasive treatment (patient's heartbeat in speakers, opening of disposable utensils, x-ray tubes movements, phones, staff communication, etc.), and these sounds were not modified during the project.
For the music group the basic sounds were the same, but added were selected acoustic music played through loudspeakers (2). Volume was predefined, and the music was just audible and not dominant. Patients were not made aware of the music in the room or asked if they wanted the music or not.
After the procedure we asked patients about their experience of the sound environment in the ward (on a scale from "very pleasant" to "very unpleasant"), which sounds they had observed in particular (spontaneous statements from the patient), and finally how patients perceived the music that was played for them (from "liked the music very much" to "did not like music"). More than 60% had noticed and heard the music, and more than 80% liked the music, although they had no influence on the choice of music and might not otherwise have listened to this genre of music at home. Among other remarks the patients stated that the music had been calming and soothing, and helped take their thoughts away from what they might be worried about.
In the second music study, we had focused on the periods before and after the stay in the Cardiology Laboratory - then the waiting time before and after the procedure, spent in the bedding department (3). Patients were also this time subdivided into two groups - a music-group and a basic group (control). Basic group did not listen to music before and after the procedure, and the music-group listened to specially composed music (i.e. "Heartbeat" by Niels Eje composed especially for this study) through headphones and discman.
The music group listened to the music about one hour before procedure start, and after the procedure, for as long as they wanted to do it (an average of one hour). Both groups listened to our usual music during the procedure. Also in this study, it appeared that the music group had an amazingly positive experience with music, and more than 80% again liked the music composed especially for this study. Patients stated again that the effect was calming, a sanitation and good pastime in a period which otherwise may be filled with anxiety and restlessness.
Both studies confirmed our assumptions that the music has a positive effect on patients in relation to cardiac investigations and treatments. In both studies the patients said that music made them relax, think about other things (other than the ‘unpleasantness’ of the procedure itself, and what they otherwise were afraid of) and that the music gave them a good feeling.
We have since used the music every day of Cardiology Laboratory, and we strive to constantly expand our knowledge and experience through literature search and monitoring of other studies. In addition, we are working to further develop the quality of current practice with music to our patients.
We have appointed two nurses in the department (4), which is key persons for future development of practice and to keep the focus on music as an essential element in the treatment of patients and staff working environment. These two nurses follow the literature available are investigate new and suitable music for the department, and they ensure that there is relevant additions to our CD collection, so there is a process of renewal of the music in the various treatment rooms.
In addition, we are experimenting with new sound sources. In our two studies, we played music through speakers build in the ceiling in the procedure rooms and via discman in the bed wards. We still primarily play music through speakers in the invasive area and there is a good common experience around music for both patients and staff. In connection with the special procedures (5), where the music might disturb the staff - because they use headsets as an internal communications tool during the procedure - we have through the last six months used a so-called ‘music bar’ - a specially developed ‘pillow application’ music player (called “Maysound Music Player” distributed by Tempur) (6).
This music player is positioned at the head of the patient and the patients listens to music through the speakers, but are not aurally isolated because the speakers are located approx. 10 cm from the patient's ears. This enables the necessary communication between the practitioner team and patient, while the patient may doze, sleep and listen to music when his presence and ability to communicate is not required in relation to treatment. The music can clearly be heard by the patient, but are hardly audible for the staff.
We have planned a scientific study of the effect of the music player. We will examine how the patient experiences the treatment of cardiac fibrillation (atrial fibrillation ablation) with sedation (7) and music (8) and compare it with the patient's experience of the treatment when it takes place (according to our current practice) in full anesthesia (9). We will measure the patient’s pain experience (VAS score) and patient's ability to relax during the procedure.
Treatment of cardiac fibrillation without anesthesia can be a painful and unpleasant experience. Previous and ongoing studies at GentofteHospital shows this (10). On the other hand, it is not completely safe and hardly always necessary that the patient is fully sedated for this intervention. Therefore it would be an appropriate and patient-friendly alternative to offer treatment without anesthetic, where the patient has a good and pleasant experience.
We have already good experience with the use of this music player and we look forward to seeing evidence of our assumptions about music's positive effects for this patient group as well.
Use of music to heart patients is a useful and effective tool to increase patient comfort in relation to cardiac investigations and treatments. We carry out surveys, which we know the patient fear or at least cares about, and the use of music can alleviate patient anxiety and unrest, and at he same time give the patient a good experience.
Our results can certainly be transferred to other categories of patients and other departments, and we would very much like to share and pass on our knowledge and experience in this field.
Specialist Nurse Bitten Gøtzsche, Cardiac Laboratory, Department of Cardiology Aalborg Hospital & Aarhus University Hospital. E-mail: bitgo@rn.dk
- Cardiology Laboratory is part of the Head and Heart Centre at Aalborg Hospital - a part of Aarhus University Hospital
- Ceiling suspended speakers, which give a good sound in every part of the room
- Bed ward S2 participated in the music study
- Nurses Tove Boye Brunsgaard and Gitte Højer Wilhelmsen
- Radio frequency ablation (heat) of atrial fibrillation
- The company Tempur (TempurMed) is distributor of the Maysound Music Player Tempurmed
- Sedation with inj. Morphine p.n. and inj. Dormicum p.n.
- Music by composer Niels Eje www.musicure.com
- Development nurses Anne Boesgaard, Department of Cardiology P, Gentofte Hospital