ORIGINAL ARTICLES

Perioperative Music or Headsets to DecreaseAnxiety

Brenda Johnson, BSN, RN, CPAN, Shirley Raymond, BSN, RN, CPAN, Judith Goss, BSN, RN

The ambient noise of monitors, other patients, and staff in the post-

Brenda Johnson

Shirley Raymond,

and Judith Goss, B

Hospital, Cincinna

Conflict of intere

Address corresp

Christ Hospital, 21

e-mail address: Bre

� 2012 by Ame

1089-9472/$36.

doi:10.1016/j.jo

146

anesthesia care unit/operating room may elevate levels of anxiety. The

purpose of our study was to determine the effect of music versus noise-

blocking headphones on the level of anxiety in women undergoing gyne-

cologic same-day surgery. Institutional Review Board approval was

obtained. The women were approached for consent and randomized to

usual care, music with headphones, or headphones only. Preoperative

and postoperative anxiety was rated on a scale of 0 to 10. Music/head-

phones were continued throughout surgery and removed when Aldrete

level of consciousness equaled 2. The 119 women had a mean age of

38.8 (standard deviation5 2.2) years. Of interest, 51 (45%) reported

very low preoperative anxiety (0-3/10) and were excluded. All groups ex-

perienced a drop in anxiety from pre- to postoperative status, but the

usual care group had the least improvement (P, .05). The music group

experienced the lowest postoperative anxiety scores; the headphone

group had a greater change overall. Music is a relatively inexpensive in-

tervention, easy to administer, and noninvasive.

Keywords: music therapy, anxiety, perioperative care, research, music,

perianesthesia.

� 2012 by American Society of PeriAnesthesia Nurses

PREOPERATIVE PATIENTS FREQUENTLYexpe-

rience anxiety. Surgery itself is stressful. Patients

may worry about the outcomes of surgery or the

possibility of complications. In a prospective study

of patients scheduled for outpatient surgery, it was

found that 57% did not feel calm. This number in-creased to 65% when only women were studied.1

Furthermore, the ambient noise of monitors, other

patients, and staff in the same-day surgery (SDS),

, BSN, RN, CPAN, is a Staff Nurse, PACU;

BSN, RN, CPAN, is a Staff Nurse, PACU;

SN, RN, is a Staff Nurse, PACU, The Christ

ti, OH.

st: None to report.

ondence to Brenda Johnson, PACU, The

39 Auburn Avenue, Cincinnati, OH 45219;

nda.Johnson@thechristhospital.com.

rican Society of PeriAnesthesia Nurses

00

pan.2012.03.001

Jou

operating room (OR), and postanesthesia care

unit (PACU) may elevate levels of anxiety.2

A review of the literature indicated support for mu-

sic therapy in reduction of preoperative stress and

anxiety. However, randomized control studiescould not be found that incorporated the use of

music during the entire perioperative period.

Also, studies conducted did not differentiate bet-

ween whether anxiety reduction was because of

music or blocking environmental noise.

Literature Review

Music therapy is the process of bringing about

changes from undesirable, unhealthy, and uncom-

fortable conditions to more pleasant ones by the

deliberate use of music.3 Music has played an im-

portant role in health care and healing since thebeginning of recorded history. Mothers have

sung lullabies to soothe their children. Florence

rnal of PeriAnesthesia Nursing, Vol 27, No 3 (June), 2012: pp 146-154

PERIOPERATIVE MUSIC 147

Nightingale stated, ‘‘Unnecessary noise is that

which hurts a patient’’ in her Notes on Nursing

in 1859.2 She goes on to write about the noise of

a whispered conversation creating more harm

than a louder noise. The strain of the sick patientlistening to a conversation that may be concerning

them was considered the worst of offenses. Today,

we need to remember that as more advanced tech-

nology is being used, noise levels also increase.

Music and noise-blocking headphones can be help-

ful tools. Studies have been conducted to validate

the use of music as a therapeutic tool (Table 1).

Three studies in the literature examined the effects

ofmusic on anxiety andpain.4-6Heiser et al4 studied

a group of patients undergoing a microdiscectomy.

Patientswere randomly assigned tomusic or nomu-

sic, intraoperatively and postoperatively. Pain and

anxiety were measured using a visual analog scale

(VAS). The sample group of 10 used in the study

by Heiser et al was not large enough for statisticaldifference. However, all in the music group com-

mented very positively, stating how relaxing the

music was and they would like to listen again.

Nilsson et al5 looked at 75 subjects undergoing

open inguinal hernia repair. Subjects were ran-

domized into three groups, intraoperative music,

postoperative music, and a control group, withsham CD players. Stress response was assessed

during and after surgery using cortisol and blood

glucose levels. The postoperative music group ex-

hibited decreased anxiety (P, .05) and pain

(P, .01). The intraoperative group experienced

decreased pain postoperatively compared with

the control group (P, .05).

Chlan et al6 studied anxiety and pain in outpatients

undergoing flexible sigmoidoscopy. Spielberger

et al’s State Trait Anxiety Inventory (STAI)7 was

used to measure anxiety. The STAI measures an in-

dividual’s baseline trait anxiety as well as the tem-

porary state anxiety of a given situation. There are

20 statements in each of the state and trait por-

tions. The respondent evaluates each statementas not at all, somewhat, moderately so, or very

much so. Music was listened to during the proce-

dure. STAI was given preintervention to both

groups. The state portion was also administered

postintervention. A VAS with a rating scale of

0 to 10 was used to measure pain. There was a sig-

nificant difference between the music group and

control group in anxiety and pain (P5 .002 and

P5 .026, respectively).

Several studies examined only anxiety. Andrada

et al8 studied the anxiolytic effect of listening tomusic during colonoscopies. The STAI was given

30 minutes before the procedure and 30 minutes

after. There was a significant decrease in scores

in the experimental group with P, .01.

In the study of a group of 30 men undergoing trans-

urethral resectionof theprostatebyYunget al,9 anx-

ietywas reduced for themusicgroup, slightly for thenurse present group, and no reduction was seen in

the control group.Again,with the small groupof 30,

although a reduction in anxiety was found, the dif-

ference was not statistically significant.

As a means to reduce the ambulatory surgery pa-

tient’s preoperative anxiety, Augustin and Hains10

investigated music. STAI state portion was takenon arrival to the center and before surgery. The

music group listened tomusic 15 to 30minutes. Al-

though there was a slight reduction in anxiety

from pretest to posttest, the music group had a sta-

tistically significant reduction (P#.005).

Winter et al11 studied 62 women in the SDS gyne-

cology unit. STAIwas completedwhen they arrivedin the surgical holding area and again just before go-

ing to OR. Themusic group had a reduction of anx-

iety and stress after listening tomusic in theholding

area. The control group had an increase in anxiety

over the same period. The difference was signifi-

cant, P, .05. All patients recommended that mu-

sic be available for future patients.

Similarly, Hayes et al12 studied 198 subjects to see if

self-selected music would reduce preprocedure

anxiety for patients undergoing colonoscopies

and esophagogastroduodenoscopies. Patients lis-

tened to music 15 minutes before the procedure.

Those randomly assigned to the no music group

had 15 minutes of quiet time. STAI was completed

only postintervention and before the procedure.There was a significant difference in anxiety

(F5 7.5; P5 .007) between the two groups after

controlling for trait anxiety. In addition, patients

who listened to music were asked if they enjoyed

the music and if they felt relaxed after listening.

Ninety-seven percent enjoyed the music, and

89% stated that after listening they felt relaxed.

Table 1. A Review of Research Using Music to Improve Patient Outcomes of Surgery or Special Procedures

Author Study Description Population Sample Measurement Instrument Statistical Significance

Heiser et al4 Random, controlled experimental

study to test effects of music on

patients who listened to music

intraoperatively or

postoperatively

10 pts undergoing

microdiscectomies

VAS for pain and anxiety, pain

medication, questionnaireMusic group—NS

Questionnaire—very

positive responses

Control group—NS

Nilsson et al5 RCT using sham and regular music

CDs with headphones

intraoperatively or

postoperatively to test stress,

immunity, anxiety, and pain

response during and after

general anesthesia

75 pts undergoing open inguinal

hernia repair under general

anesthesia

Cortisol, blood glucose levels; NRS

for pain and anxiety; BP, HR,

SpO2

Intraoperative music group

Anxiety decreased (P, .05)

Pain decreased (P, .05)

Pain med decreased (P, .01)

Postoperative music group

Anxiety decreased (P, .05)

Pain decreased (P, .01)

Cortisol decreased (P, .05)

Pain med decreased (P, .05)

Chlan et al6 RCT to test the effects of music on

anxiety, discomfort, satisfaction,

and perceived compliance with

colon cancer screening

64 outpatients undergoing flexible

sigmoidoscopy

STAI; VAS for pain Music group

Anxiety decreased (P5 .002)

Pain decreased (P5 .026)

Control group

Anxiety increased

Andrada et al8 RCT using CDs with headphones

to assess the anxiolytic effect of

listening to music during

colonoscopies

118 pts receiving prescheduled

colonoscopies

STAI; BP, SpO2, HR Music group

STAI decreased (P, .01)

BP (NS)

SpO2 (NS)

HR (NS)

Yung et al9 Quasi-experimental study to assess

anxiolytic effect of music or

nurse presence pre-op

30 pts undergoing TURP State portion of the Chinese STAI Music group

SBP decreased (P, .01)

DBP decreased (P, .04)

HR decreased (P, .01)

Anxiety decreased (NS)

Nurse presence

SBP decreased (NS)

DBP increased (NS)

HR decreased (NS)

Anxiety decreased (NS)

148

JOHNSO

N,RAYMOND,AND

GOSS

Control group

SBP increased (P, .01)

DBP increased (NS)

HR increased (P, .01)

Anxiety increased (NS)

Augustin and

Hains10Quantitative experimental study to

investigate music reducing pre-

op anxiety

42 ambulatory pts VS; State portion of STAI Music group

Anxiety decreased (P, .005)

DBP decreased (P, .005)

HR decreased (0.005)

RR decreased (P, .0005)

Control group

SBP decreased (P, .05)

DBP (NS)

HR (NS)

RR (NS)

Winter et al11 RCT to determine if music reduced

anxiety pre-op

62 SDS GYN pts STAI, BP, HR Music group

Anxiety decreased (P, .05)

BP (NS)

HR (NS)

Control group—NS

Hayes et al12 RCT to determine if music reduced

preprocedure anxiety for GI

procedures

198 pts undergoing EGD and

colonoscopy

STAI Music group

Anxiety decreased (F5 7.5

and P5 .007)

Lukas13 Trial to determine if pts would

perceive listening to music

throughout perioperative

experience as a positive addition

to medication to control pain

and anxiety

31 outpatients undergoing

orthopaedic surgery

Investigator survey 97% positive experience

Pts, patients; VAS, visual analog scale; NS, not significant; RCT, randomized controlled trial; NRS, numeric rating scale; BP, blood pressure; HR, heart rate; SpO2,

oxygen saturation; SBP, systolic blood pressure; DBP, diastolic blood pressure; VS, vital signs; RR, respiratory rate; STAI, State Trait Anxiety Inventory; TURP, transure-

thral resection of prostate; SDS, same-day surgery; GYN, gynecologic; GI, gastrointestinal; EGD, esophagogastroduodenoscopy.

PERIO

PERATIVE

MUSIC

149

150 JOHNSON, RAYMOND, AND GOSS

Lukas13 surveyed 31 patients’ perceived overall

experiences. This was the only study that allowed

patients to listen to music throughout the whole

perioperative experience. It was not a randomized

control test; however, 97% of the patients did ex-press a positive experience.

The review of the literature strongly suggests that

the use of music therapy has a direct effect on the

reduction of stress and anxiety. In addition, a posi-

tive relationship in patients’ satisfaction with their

surgical experience after listening to music was

suggested. The studies reviewed, however, werenot clear if results were because of the music or

the blocking of noise.

Purpose

The purpose of this study was to determine theeffect of music versus use of noise-blocking head-

phones on anxiety levels in women undergoing

SDS for gynecologic procedures. This intervention

could in turn improve the overall patient experi-

ence. It was hypothesized that both music and

headphone-only groups would have a decrease in

anxiety, with the greatest decrease in the music

group. Additional information on pain medicationwhile in PACU was also collected.

Methods

Study Design and Setting

An experimental three-group design was used with

pre- and postmeasurement of anxiety. The Institu-

tional Review Board approved the study, and data

collection was conducted over a 3-month periodin 2009. All data were collected at a single-

institution, a 550-bed tertiary care, community hos-

pital with two surgical areas. An average of 90 cases

per day is seen in themainORand recovered in a 24-

bed PACU. The PACU serves both inpatient and out-

patient surgical cases. The second operating area is

The Women’s Center, specifically for gynecological

surgery. The Center averages 18 procedures per daywith patients recovered in an 11-bed PACU. Most of

the surgeries are outpatient and include both inva-

sive and noninvasive procedures.

The study was conducted in The Women’s Center

for several reasons: (1) control of participant de-

mographics; (2) tighter study control; (3) studies

have shown that women are more likely to experi-

ence preoperative anxiety than men.1

Instruments

Most studies reviewed used the State Scale of the

STAI. Frequently, only the State Anxiety Score is

used, as it measures anxiety related to the current

situation. However, because the STAI includes 20

questions, it was not used for this study.

An alternative tool, the Rapid Assessment Anxiety

tool, has been used in a previous study of patient’spreoperative anxiety.1 Developed and validated by

Benotsch et al,14 this single-item numeric rating

scale provides a quick assessment of anxiety that

would be valid and time friendly in the presence

of our fast-paced OR schedules. The tool also pro-

vided the ability to detect change as it rated re-

sponses from 0 (no anxiety) to 10 (most anxiety

possible). Furthermore, it was easy for patientsto understand as it mirrored the usual pain mea-

surement format. The initial work on this tool

demonstrated that it correlated highly with STAI

State Score demonstrating validity (r5 0.77) in

a sample of 197 patients evaluated preoperatively.

Postoperatively, the same subjects also completed

both anxiety tools with a slight decrease in

strength of relationship (r5 0.69). The numericrating tool also demonstrated sensitivity to change

that mirrored the responsiveness of the STAI

20-item scale.

Inclusion/Exclusion Criteria

All women undergoing gynecologic surgery at TheWomen’s Center were included in the study if they

were older than 18 years, undergoing an outpa-

tient procedure, and provided written consent to

participate. Women were excluded if they had

hearing problems that would preclude their ability

to listen tomusic. A sample size of 120womenwas

determined using G Power program. Based on an

alpha of 0.05, power of 0.80, and effect size of0.25, a total sample of 120 subjects would be

needed for the planned analysis. A repeated mea-

sure analysis of variance with three groups and

two time points was planned to answer the re-

search question and used as the basis for the

power analysis.

Table 2. Comparison of Groups on Demographics and Select Variables of Interest

Demographics Control (n5 41) Headphones (n5 35) Music (n5 43)

Age 38.44 36.83 40.91

Number of medications 2.2 2.11 2.34

Number of previous surgeries 2.41 2.97 2.27

Minutes/day listening to music 194.7 180 212.2

Minutes in operating room 60.7 56.6 60.5

Minutes in PACU until Aldrete 2 17.4 15 21.5

Invasive procedure (%) 48.8 37.1 61.4

Pre-op routine anxiolytics (%) 4.9 5.7 6.8

PACU, postanesthesia care unit.

There were no significant differences among the groups on any of the above variables.

Change in Anxiety

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Pre-op Anxiety Post -op Anxiety

Level o

f R

ep

orted

A

nxiety (0-10)

Control (n=41)

Music (n=43)

Headphones only(n=35)

Figure 1. Changes in anxiety from pre-op to post-

op for each group. All subjects included. This figure is

available in color online at www.jopan.org.

PERIOPERATIVE MUSIC 151

Procedure for Data Collection

The procedure for this study was to initiate the

intervention preoperatively, continue into the

OR, and remain on in PACU until the patient was

awake at a level of consciousness (LOC) of 2 on

the Aldrete score.

The 120 women were approached for consent be-

fore their preoperative medication. After consent,

they were randomized to usual care, music with

headphones, or headphones only. Preoperative

anxiety was obtained using the Rapid Assessment

Anxiety tool, which rates anxiety on a scale of 0 to

10. Patients who received headsets only did not

have an MP3 player attached. The usual care groupreceived routine care given to all SDS patients.

Those in the music group selected one of three

types of music. Research suggests that the most

positive effects of music are found when the pa-

tient can choose the genre. Each of the five MP3

players was loaded with soft country, classical/

New Age, and inspirational music. Our team care-fully reviewed all music for its appropriateness to

the setting. Any music that had extreme crescen-

dos was eliminated. Headsets were chosen that

had padded ear covers. The MP3 player could be

set and locked keeping the volume at a constant

level.

Both music and headsets only were started in SDSbefore preoperative medications. Both interven-

tions were continued throughout surgery and

removed when Aldrete LOC equals 2. Post-op anx-

iety was then rated. One subject in the music

group refused to complete the postanxiety score

and was dropped from the analyses resulting in a

final total sample of 119 subjects. Additional com-ments from subjects were collected along with

a brief chart review of demographic information

and pain medication used in the PACU. The entire

headsets andMP3 playerswere sanitizedwith Sani-

Cloth PLUS (Professional Disposables Interna-

tional, Inc., Two Nice-Pak Park Orangeburg, NY)

germicidal disposable cloths before and after use.

Results

The 119 women completing the study had a mean

age of 38.8 (standard deviation5 2.2) years. There

were no significant differences in age or otherdemographic characteristics by group (P..05).

Table 2 provides general demographic information

for each of the three groups along with preopera-

tive medication use and type of procedure per-

formed.

To answer the research question, a repeated mea-

sure analysis of variance was performed using

Table 3. Comparison of All Subjects’ Anxiety Scores

All Subjects* Control (n5 41) Headphones (n5 35) Music (n5 43)

Preoperative 3.98 (2.3) 4.20 (2.7) 3.74 (2.4)

Postoperative 2.15 (2.5) 1.46 (1.8) 1.16 (2.2)

Change in anxiety 21.83 (2.5) 22.74 (2.6) 22.58 (2.5)

*F5 1.47 (degrees of freedom 1,2); P5 .244.

152 JOHNSON, RAYMOND, AND GOSS

PASW Statistics 17 (IBM Corp, Portsmouth, Hamp-

shire, UK). Figure 1 shows the change in anxiety

from pre-op to post-op for subjects by group. All

groups experienced a reduction in anxiety of

about 2 units, but there were no statistically sig-

nificant group differences (F5 1.47 [2,116];

P5 .224). Table 3 depicts the preoperative anxiety

and postoperative anxiety scores by group as wellas the change scores.

On closer examination, it was discovered that 12%

reported no anxiety pre-op and 51% had very low

levels of pre-op anxiety. Low anxiety (0-3) was

equally represented among the three groups. The

data were reanalyzed using only those with moder-

ate to high levels of pre-op anxiety ($4/10), andthese results are reported in Table 4. When exami-

ning those with moderate or high levels of pre-

operative anxiety, all groups experienced a drop

in anxiety from pre- to postoperative status, but

the control group had the smallest decrease

(F5 3.5; P5 .03; power5 0.63). Themusic group

experienced the lowest postoperative anxiety

scores, but the headphone group had a slightlygreater overall change score because this group

had a slightly higher preoperative anxiety score

(Figure 2). This significance in anxiety reduc-

tion was similar to those studies previously re-

viewed4-6,8-13 where P values ranged from .05

to .002.

Many subjects offered comments and opinions re-lated to the use of music or headphones. The only

negative comments were either from those who

Table 4. Comparison of Subjects With

Subjects With PreoperativeAnxiety $4* Control (n5 17

Preoperative 6.0 (1.5)

Postoperative 3.59 (3.1)

Change in anxiety 22.41 (3.6)

*F5 3.41 (degrees of freedom 1,2); P5 .04.

did not get music or related to the preferred type

of music available. The comments were similar to

those seen in the studies reviewed.4-6,8-13 See

Table 5 for examples of patient comments.

Although it was not a research question for this

study, post hoc we did examine the use of analge-

sics in the PACU. All narcotics were changed to theequianalgesic dosing for opioids equivalents using

the 2007 Pharmacist’s Letter conversion table.15

The control group had a higher mean dose of anal-

gesics (4.01 mg) than either the headphones-only

group (3.6 mg) or the music group (2.92 mg). Al-

though the use of analgesic was 28% less in the mu-

sic group than in the control, it was not statistically

significant.

Discussion

Anxiety decreased after surgery; however, half

had low pre-op anxiety, making it difficult to seethe effect of music. This was surprising to us; how-

ever, as noted in the earlier study on anxiety, 35%

of women report feeling calm preoperatively.

Fifty-one percent of our participants had anxiety

ratings of 0 to 3. The fact that this unit is a new,

small, and women-only facility that focuses on

family-centered care may have had a calming effect

on the patients.

The team also considered the possibility of

measuring patient satisfaction. Patient satisfaction

was at the time just starting to be measured by

Press Ganey for outpatient procedures. Although

Preoperative Anxiety Scores $4*

) Headphones (n5 15) Music (n5 19)

6.13 (1.6) 6.05 (1.0)

1.93 (1.9) 1.71 (2.8)

24.80 (2.0) 24.08 (2.8)

Change in Anxiety Level for Those with Moderate to

High Pre-op Anxiety

0

1

2

3

4

5

6

7

8

Pre-op Anxiety Post -op Anxiety

Level o

f R

ep

orted

A

nxiety (0-10)

Control (n=17)

Music (n=18)

Headphonesonly (n=15)

Figure 2. Change in anxiety score over time in

those with moderate or high pre-op anxiety (4-10/

10). This figure is available in color online at www

.jopan.org.

Table 5. Comments From Subjects

Usual care

� Would have preferred music (three)

� Brought own in past and found it beneficial to de-

crease anxiety

� ‘‘I was not really worried about the procedure; it was

just being in a hospital’’

� Music is a great idea (two)

Headsets only

� Would have liked to have music (six)

� Headphones were annoying (seven)

� Helped to decrease anxiety pre-op (two)

Music

� ‘‘I loved it. I would highly recommend it. It was

wonderful to wake up to music’’

� ‘‘I love the music before but quiet after’’ (two)

� ‘‘It was calming, a good distraction. Helped me relax

pre-op’’

� ‘‘I think it helped keep me calm’’

� ‘‘I liked it’’ (eight)

� Would have liked music earlier when too many family

members were in the room

� ‘‘Best PACU experience ever had’’ Earlier experience

with postoperative nausea and vomiting none this

time

� ‘‘I would recommend this to anyone’’

� Would prefer music again if ever needed surgery

� Patient wanted it off in PACU because of waking up in

pain

� Would prefer jazz

� ‘‘The headphones were too big and kept falling off my

head—frustrating’’

� Reported anxiety level 7 in PACU because of pain and

urgency to urinate

PACU, postanesthesia care unit.

PERIOPERATIVE MUSIC 153

our goal was to ultimately improve the overall ex-

perience of the patient, we did not feel patients

should receive another questionnaire to fill out at

that time. We felt a reduction in anxiety was

a needed outcome and measurable.

Pain reductionwas considered initially as a purpose

of the study. However, to truly explore the effects of

music on pain, everything else would need to be

controlled. The surgeon, the amount of marcaine

used in the incisions, the type of surgery being pre-

formed, and the use of Toradol or other analgesics

preoperatively would all need to be controlled.This did not appear to be feasible at our institution

at that time. In addition, the literature appeared to

have stronger support for anxiety reduction rather

than pain reduction (Table 1). The procedure of

starting the music in SDS and continuing it on into

the PACU is ideal. In our facility, we have continued

to offer music to preoperative patients in our

Women’s Center. A sign in the pre-op room tellspatients they may ask for MP3 players. In addition,

we have SDS nurses who have seen the benefits of

the music and are initiating it. Keeping track of

the players is a challenge, and each unit adopting

this intervention should have a procedure in place

to track the patients and equipment. We are noting

on the chart the patient has one of the players. SDS

nurses are giving a patient sticker to PACUnurses sothat the PACU nurse can bewatching for the player.

After each use, the PACU staff sanitizes and re-

charges the players.

At this time, we are implementing this procedure

in our main perioperative area. Patients attending

pre-op classes are also given the opportunity to

bring in their own players. We have recently pur-chased enough players to place in each nurse

server in PACU. This way the players can be used

even if they have not received it before PACU.

Guided imagery for successful surgery has also

been added to our players since this study, at the

request of a patient.

Limitations

All subjects were given music before pre-op medi-

cation; however, some had the opportunity to

154 JOHNSON, RAYMOND, AND GOSS

listen longer than others preoperatively. We did

not collect data on this pre-op time. Subjects

gave their consent to participate in the study. If

a patient did not feel they would benefit from

the study, they chose not to participate. This nar-rows the study group to only those who would

like music. It may not reflect the population at

large.

Conclusion

Music is a relatively inexpensive intervention, easy

to administer, noninvasive, and found to be a satis-

fier for most people. In addition, it offers patients

a coping strategy giving them a sense of control

over an unfamiliar environment and creating a pos-

itive patient outcome. Music can function as a dis-

tracter from the ambient noise of monitors, other

patients, staff, and equipment that routinely oc-

curs in the perioperative areas. The intentional

use of music can be instrumental in transforming

the environment of the surgical patient intoa soothing and restful atmosphere to decrease

anxiety and promote healing.

Acknowledgments

The authors acknowledge Linda S. Baas, PhD, RN, ACNP, Direc-

tor of Nursing Research, The Christ Hospital, for her assistance

with the design of the study and the statistical analysis of the re-

sults; Joyce Burke, RN, BES, CPAN, PACU, Clinical Manager, for

her support throughout the study; and PACU nurses Lisa Haub-

ner, RN, BSN, Diane Stapp, RN, and Kimberly Latham, RN, BSN,

CCRN, for their assistance with the study.

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