MUSIC AS DISTRACTION IN A PEDIATRIC

EMERGENCY DEPARTMENT

Authors: Tiffany Young, BSN, RN, Elizabeth Griffin, RN, BS, CPEN, Erin Phillips, BS, CCLS,and Erin Stanley, BS, CCLS, ITFS, Raleigh, NC

Section Editor: Susan McDaniel Hohenhaus, MA, RN, FAEN

Pain reduction methods are under-utilized in chil-dren, especially in emergency settings.1 After attend-ing a nursing conference where complementary

therapies such as music and humor were discussed, wedecided to explore non-pharmacological pain managementtechniques for our pediatric patients. This project, The iPodIntervention, describes what we believe is a best practice useof music as a distraction from pain and anxiety for childrenin emergency departments. Research has shown that musicis an effective distraction2; in addition, patients and inves-tigators report that music helps reduce pain.3

Background

The project was funded through a grant ($1300) from ourhospital volunteer board. This grant allowed us to pur-chase 4 iPod Nano models of different colors for eachage group (yellow for infants/toddlers, blue for preschoo-lers, green for school-aged children, and orange for adoles-cents), 4 sets of earphones, one “boom box” dockingstation with speakers that could be used as an alternativeto earphones, 1000 disposable sanitary ear phone covers,and an iTunes card to use in purchasing age-appropriatemusic. The iPod Nano model was chosen because itsvideo screen allowed for greater patient and parental con-trol of the music chosen.

Four staff guided the firstmonth ofThe iPod Intervention:2 child life specialists and 2 registered nurses.We chose to tar-get patients we believed would benefit the most: those withmoderate to severe pain, such as patients experiencing a sicklecell crisis, a fracture, or a migraine headache, and those whowould undergo a painful procedure such as an incision anddrainage, a laceration repair, intravenous line insertion, or alumbar puncture. Child life specialists (CLSs), our residentexperts on pediatric distraction, diversion, and coping, werelargely responsible for implementing The iPod Intervention.However, all children’s emergency department (CED) staffwere encouraged to refer patients who might benefit frommusic therapy. A log was designed to track the demographicsof patientswho used the intervention; this log also helped busystaff keep track of the equipment. Satisfaction with the inter-vention was evaluated using an investigator-designed 4-ques-tion survey that was available in both English and Spanish.

We piloted The iPod Intervention with 50 patients andtheir families over the course of a 4-week period. Eighty-sixpercent (n = 50) of the patients and families in our pilotgroup reported that listening to music via the iPod was“helpful” or “very helpful” in reducing their pain and/or dis-comfort. It was quickly discovered that the numbers ofpatients who could benefit from The iPod Intervention out-numbered the available equipment. The project had benefitsbeyond what we had planned or imagined because it notonly provided a welcome distraction from the patient’s painbut also reduced distress and anxiety in parents. For example,one father of a newborn undergoing a “septic workup” wasvisibly distraught. An iPod was offered to the family, and thefather decided to use the boom box docking station to playmusic by his favorite band. Not only did this help him relax,but his infant daughter fell asleep because, according to thefather, “She’s used to hearing that all the time in my car.”

Other families expressed their appreciation of simplybeing offered the iPod as a comfort measure for their child,whether or not they accepted it. Thus a secondary benefit ofThe iPod Intervention has been improved customer service,which was reflected in an increase in our scores on pain man-agement and overall quality of care. Onemother summarizedher feelings this way: “The option to listen tomusic and to beeasily distracted from the scary procedures was priceless. TheiPod was a great idea...I hope this program continues!”

Tiffany Young is Supervisor/Educator, Children’s Emergency Department,WakeMed Health & Hospitals, Raleigh, NC.

Elizabeth Griffin is Staff Nurse III, Children’s Emergency Department,WakeMed Health & Hospitals, Raleigh, NC.

Erin Phillips is Child Life Specialist, Children’s Emergency Department,WakeMed Health & Hospitals, Raleigh, NC.

Erin Stanley is Child Life Specialist, Children’s Emergency Department,WakeMed Health & Hospitals, Raleigh, NC.

For correspondence, write: Elizabeth Griffin, RN, BS, CPEN, Children’sEmergency Department, WakeMed Health & Hospitals, 3000 New BernAve, Raleigh, NC, 27610; E-mail: elgriffin@wakemed.org.

J Emerg Nurs 2010;36:472-2.

Available online 17 June 2010.

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A few other stories illustrate the many different waysthat The iPod Intervention has helped our pediatric patients:

• An 8-year-old girl with sickle cell anemia rated her painas “8/10.” However, 10 minutes later, she was taken toradiology singing a Taylor Swift song aloud while lis-tening to the iPod. She was in her own little world!

• A 13-year-old boy arrived from school via EMS with anobvious shoulder dislocation; he was in significant pain.The CLS helped him situate the iPod, and he was veryexcited to find that his favorite music was available. Thepatient used his “good” arm to work the iPod, and hewas visibly calmed even before receiving pain medica-tion. He also used the iPod to distract him during x-raysand intravenous line placement, and he continued touse it while he was sedated for shoulder reduction.

• An active 18-month-old girl was under observation inthe CED for 6 hours following an ingestion. Her par-ents had tried everything to distract and entertain her,including toys, books, and walks in the hallway. OurCLS offered the family the preschool iPod with theboom box. She helped the parents select age appropri-ate “fun” music that the patient danced to, and latershe helped them find calm music that soothed the childto sleep. The parents were grateful!

• A 7-year-old developmentally delayed boy came to theCED after a seizure. When the CLS first entered hisroom, the patient was very withdrawn. The patient’smother was excited to learn The iPod Interventionbecause she said that her son loved classical music. Thusclassical music was played using the “boom box” in thechild’s room, and his flat affect turned into an elatedsmile. He sat up straight, turned his face toward themusic, and stared to sway. An intern, observing thistransition, said it “it was like a flower turning to seethe sun.” During their reassessment, the physician wasso struck by the change in the child that he called theresident in to see it as well. It was a beautiful and movingexperience for all persons involved in his care.

• An 11-year-old girl presented to the CED with burnsto her right leg. She seemed to be coping well but wasin such pain that our CLS offered her the iPod as adistraction. The patient had the iPod with while herburns were cleaned and debrided, and she used itthroughout her ED stay. Her mother commented,“Finally a hospital gets it right in dealing with kids.Kids need music to help them cope!”

The two primary challenges of The iPod Interventionhave been the selection of appropriate music and the pre-vention of theft. Selecting music was especially challengingbecause pop culture music tends to have controversial con-

tent. We had to be vigilant about selecting music thatwould not be considered offensive to our patients or theirfamilies. Fortunately, we detected and corrected most ofour “errors” before our patients had access to the iPods.

Our security plan included keeping the iPods in a cen-trally located cabinet, with keys only available to the 4 staffsponsoring the project. Parents and staff had to sign the logbook, and we placed bright laminated signs on the roomdoors when an iPod was in use. Even with this close control,we lost an iPod when a patient was discharged withoutappropriate follow-up by the staff. This was a valuable lessonfor us and resulted in an increased awareness among all staff.

We are in the process of developing an iPod SuperUser group within the CED in an effort to ensure thatiPods are always available. We also are analyzing how tobest distribute the playlists among the iPods in order tomeet the demographics of our most frequent users. Forexample, patients in the 11- to 17-year-old age group areour highest users, so we are considering dedicating addi-tional iPods for them.

Because of the success of this program, we believe thatThe iPod Intervention is an initiative that holds promise forevery patient in every setting. One of the foremost authori-ties on working with children in pain, Leora Kuttner, PhD,says, “Music is a wonderful way to bring the child’s worldharmoniously into the medical setting, supporting thewell-being of the child and making long periods of time feelshorter, or at least more interesting…. It can be a fine aid inshifting attention away from pain and onto a very pleasantalternative. Music needs to be included more often in thetreatment and recovery process for children.”4 We agree.

Acknowledgment

We give special thanks to Dr Betty Woodard for her guidance in every step ofthis project. We also thank the Board of Directors of the Volunteers atWakeMed Raleigh Campus for their generosity in funding The iPod Interven-tion for our patients.

REFERENCES1. Ramponi D. Reducing pain in pediatric procedures in the emergency

department. J Emerg Nurs. 2009;35:379-82.

2. Berlin B. Music therapy with children during invasive procedures: ouremergency department’s experience. J Emerg Nurs. 1998;24:607-8.

3. Stubenrauch JM. Striving for distraction: two nurses are honored for researchon an innovative approach to pain management. Am J Nurs. 2007;107:94-5.

4. Kuttner L. A Child in Pain: How to Help, What to Do. Vancouver, BC:Hartley & Marks; 1996.

Submissions to this column are encouraged and may be sent toSusan McDaniel Hohenhaus, MA, RN, FAENshohenha@ptd.net

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