Effectiveness of Music
Therapy on Pain Intensity among Hospitalized Post Operative Children Between
6-12 Years
Ms. Ria L.1*,
Mrs. Sumitra L.A.2, Mr. Gavi S.3
1Lecturer, Tripura Sundari College of Nursing, Tripura.
2Professor, K.L.E. University’s Institute of Nursing Sciences,
Belagavi, Karnataka.
3Asst. Professor. K.L.E. University’s Institute of Nursing
Sciences, Belagavi, Karnataka.
*Corresponding
Author’s Email: ria190144@gmail.com
ABSTRACT: An operation is one of the most traumatic
event children face and many of the children experience post-surgical pain
lasting for weeks or months. A combination of pharmacological and
non-pharmacological method of pain control yields the most effective relief for
the patient. Nurses have many approaches to treat pain by a variety of
non-pharmacological methods such as distraction, relaxation, meditation,
massage and auditory stimulation in combination with the traditional methods of
analgesics and of which music is one of the important among these. Music has
been recommended as an adjuvant to medication given to relief pain. Music
therapy provides distraction and disassociation by focusing on the
characteristics of the music selection. Music can block certain pain pathways
and diminish the amount of perceived pain. A quasi-experimental study was
conducted in Dr. Prabhakar Kore Hospital
and MRC, Belagavi among 30 post-operative children between 6-12 years
undergoing abdominal surgeries to evaluate the effectiveness of music therapy
on post-operative pain intensity and to associate the pretest scores of pain
intensity of children with selected socio-demographic variables. The subjects
were assigned to experimental and control groups by using convenience sampling
with an evaluative approach. In experimental group, music therapy (instrumental
music) was administered through head phone for 20 minutes of two sessions, at
an interval of one hour between each session. Data was collected by using
Oucher numerical pain scale. Data obtained were tabulated and analyzed in terms
of objectives of the study using descriptive and inferential statistics. The
mean post test pain scores for the experimental group after 1stsession
was 44 and that of 2nd session was 39.3 while the mean 1st
and 2ndpost test pain scores of the control group was 56.7.The study
findings showed that there was statistically significant difference in the post
interventional pain scores between experimental and control groups at P<0.05
level of significance but there was no association found between the pre test
pain scores with selected socio-demographic variables.
KEY WORDS: Music therapy, pain intensity, post-operative children, abdominal
surgeries, Oucher numerical pain scale.
INTRODUCTION:
“Pain is whatever the experiencing person
says it is, existing whenever the person says it does.’’
Mccaffery and Pasero
Pain is a complex multidimensional experience. For many people, it
is a major problem that causes suffering and reduces quality of life. A
thorough understanding of the physiologic and psychologic dimensions of pain is
important for effective assessment and management of patients with pain.1 An operation is one of the most
traumatic event children face, and many of the children experience post-surgical
pain lasting for weeks or months.2To manage post-operative pain
safely and effectively in children, focus should be given on reorganization of
pain in children, minimization of moderate and severe pain safely in all
children, to preserve pain where it is predictable, to bring pain rapidly under
control and to continue pain control after discharge from the hospital.3
A combination of pharmacological and non-pharmacological method of
pain control yields the most effective relief for the patient. Nurses have many
approaches to treat pain by a variety of non-pharmacological methods such as
distraction, relaxation, meditation, massage and auditory stimulation in
combination with the traditional methods of analgesics and of which music is
one of the important among these.4Music has been recommended as an
adjuvant to medication given to relief pain.5 Music therapy can help
to relieve pain and reduce stress and anxiety for the patient thereby
decreasing sympathetic nervous system output and dampening the overall
excitability of the central nervous system. The relaxation response results to
improve breathing, lower blood pressure and heart rate, reduce muscle tension,
increase attention span, improve memory, mental acuity and social interaction
and increase orientation to reality.6
Additional advantages of using music therapy in pain relief are
that it is not harmful to patients; has minimal risks, and its costs are low,
which means that music therapy has great potential to reduce suffering. As a
specific nursing intervention, music was found to be advantageous, particularly
owing to its lack of adverse reactions and as a non-invasive therapy, it is
relatively inexpensive, and ease to administer.7
NEED FOR THE
STUDY:
“He took his pain and turned it into something beautiful. Into
something that people connect to. And that's what good music does. It speaks to
you. It changes you.”
-Hannah Harrington, Saving June:
When coming into hospital, children and
their families are often worried that they may be in pain and are anxious to
know what will be done to prevent and relieve any discomfort. Although pain is a predictable part of the
postoperative experience; inadequate management of pain is common and can have
profound implications. Unrelieved postoperative pain may result in clinical and
psychological changes that increase morbidity, mortality, and costs and
decrease the quality of life. Despite recognition of the importance of
effective control, up to 70% of children still complain of moderate to severe
pain post operatively. Pain relief is an important part of child’s care after
an operation or procedure and it is our aim to plan for and minimize pain as
far as possible. Research has shown that children whose pain is well controlled
recover more quickly and have fewer
lasting effects.8
Music therapy provides distraction and disassociation by focusing
on the characteristics of the music selection. The auditory pathway interacts
with the endogenous opiate system at several foci within the brain including
the hypothalamus and the limbic system. These are known to project to
periaqueductal gray (PAG), providing a mechanism to contribute to pain
reduction and /or relief through cerebral activity and spinal cord response.
The client should be allowed to choose the type of music when music therapy is
used to relief pain and music should be given for at least 15mins.9A
statistical pooling shows that patients who listened to music had a 70% greater
probability of having at least 50% of pain relief than patients who did not
listen to music.10
So, helping pediatric patients cope with the painful procedures is
a critical element in providing comprehensive medical care. Although
pharmacologic agents such as analgesics, sedatives are used, they do not
address all the elements of a painful experience and can have undesirable side
effects. Because of this, there has been a concerted effort to find
non-pharmacologic therapies that can be used to reduce reliance on
pharmacologic agents. The use of music to help children and adolescents cope
with pain has been the subject of considerable research.11
Music is a form of communication, and has been described as a
universal language, and so it can provide an escape from negative stimuli such
as pain and anxiety to something pleasant and encouraging. A patient’s mind can
escape into his or her own familiar and soothing world. Music can block certain
pain pathways and diminish the amount of perceived pain.12
The researcher in her clinical nursing practice observed that
nurses are constantly challenged with the management of post-operative pain in
children. As nurses are the only person who provide round the clock care of the
post-operative children, it is vital for the nurse to find other means for
reducing pain in children like music therapy besides routine analgesic so that
the children’s comfort and well-being can be improved; on the other hand they
are being prevented from the adverse side effects of the routine analgesics.
Therefore, this study further inspired to investigate this predicament and
generate facts that will equip nurses with the necessary knowledge; to make
better evidence- based decisions regarding the use of music therapy for
reducing post-operative pain in children.
STATEMENT
OF THE PROBLEM:
“A Study to evaluate the effectiveness of music therapy on pain
intensity among hospitalized post-operative children between 6-12 years
admitted in the pediatric surgical ward of selected hospital, Belagavi.”
OBJECTIVES
OF THE STUDY:
1. To evaluate the intensity of pain among
post-operative children between 6-12 years in both experimental and control
group before music therapy using Oucher numerical pain scale.
2. To evaluate the intensity of pain among
post-operative children between 6-12 years in experimental group as compared to
control group after music therapy using Oucher numerical pain scale.
3. To find out the association between
pretest scores of pain intensity in both experimental and control groups with
selected socio-demographic variables.
OPERATIONAL
DEFINITIONS:
Evaluate:
It refers to the
statistical analysis of pain intensity perceived by post-operative children.
Effectiveness:
It refers to the
extent or level of pain among post-operative children after music therapy as
evidenced by difference in pre -test and post test scores on Oucher numerical
pain scale.
Music Therapy:
It refers to
providing instrumental music to post-operative children to induce desired
changes in the level of post-operative pain
Pain Intensity:
It refers to the
extent or level of unpleasant sensory and emotional disturbances reported by
the post-operative children, which will be assessed by using Oucher numerical
pain scale.
Postoperative Children:
Children between
6-12 years of age admitted in the pediatric surgery ward and who have undergone
abdominal surgeries (colostomy, appendectomy, spleenectomy and laparotomy).
Pediatric Surgical Ward:
It refers to a
part of KLE’s Dr. Prabhakar Kore hospital and MRC where children between 6-12
undergoing abdominal surgeries are admitted.
HYPOTHESES:
H1. There will be statistically significant
difference in the post interventional pain scores between experimental and
control groups at 0.05 level of significance.
H2. There will be statistically significant
association between the pretest pain scores with their selected
socio-demographic variables both in experimental and control groups at 0.05
level of significance.
ASSUMPTIONS:
1. Post-operative children may have severe
pain after surgeries.
2. Music therapy will have effect on
post-operative pain intensity.
3. The socio-demographic variables of the
children will have influence on post-operative pain intensity.
DELIMITATION:
This study was delimited to the post-operative children between 6-12
years who had undergone abdominal surgeries (colostomy, appendectomy,
spleenectomy, laparotomy) and admitted in the pediatric surgical ward of KLE’s
Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka.
CONCEPTUAL
FRAMEWORK:
“WIEDENBACH’’A Helping Art of clinical Nursing (1964)
conceptual framework in modified form is used to evaluate the effect of music therapy on pain intensity of
post-operative children.
Fig
1.Modified form of “WIEDENBACH’’A Helping Art of clinical Nursing (1964)
RESEARCH METHODOLOGY:
Research Approach:
An evaluative research approach was
adopted in this study.
Research Design:
Quasi experimental –pretest post test
control group research design was adopted to carry out the present study.
Research
Setting:
Pediatric
surgical ward of KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka.
Variables under study:
In the present study, the independent variable was music therapy
and pain intensity was the dependent variable.
The extraneous variable was routine analgesic.
Population:
In the present study, population comprised of the post-operative
children between 6-12 years admitted in pediatric surgical ward after abdominal
surgeries.
Sample and Sample Size:
The sample for the present study consisted of 30 post-operative
children between 6-12 years with abdominal surgeries admitted in the pediatric
surgical ward of KLE Dr. Prabhakar Kore hospital and MRC, Belagavi.
Sampling Technique:
The sampling technique used for the study
was non -probability convenience sampling technique.
Description of Tool:
The data collection instruments used in the present study were:
a. 15 questions seeking socio -demographic
Proforma.
b. Standardized Oucher numerical pain scale 
0 10 20 30 40 50 60 70 80 90 100
It requires the child to rate pain on a line scale of 0-100 with 0
representing no hurt, 1-29=little hurt, 30-69 =middle hurt, 70-99=big hurt,
100=the biggest hurt you could ever have. Score is the actual number stated by
the child.
The pilot study was conducted in the pediatric surgical ward of
KIMS, Hubli from 27-9-13 to 2-10-13 on 6 post-operative children with abdominal
surgeries i.e. 3 experimental and 3 control by using convenience sampling. In
experimental group, music therapy (instrumental music) was administered through
head phone for 20 minutes of two sessions, at an interval of one hour between
each session. The findings of the pilot study revealed that there was a mean
reduction in the pain intensity after administering music therapy in the experimental
group as compared to the control group.
RESULTS:
The data obtained was analyzed in terms of the objectives of the
study using descriptive and inferential statistics. Experts in the field of
nursing and statistics directed the development of data analysis plan which was
as follows:
a. Organizing data on a master sheet.
b. Tabulation of the data in terms of
frequencies, percentage, to describe the data.
c.
Inferential
statistics used were paired t- test, unpaired t - test and chi square
Major Findings of the study were:
1. Findings related to
socio-demographic data of the subjects.
In the present study, majority of the
subjects, 10 (66.7%) belonged to the age group 10-12 years in experimental
group and 6 (40%) to the age group 6-7 years in control group; 4 (26.7%) of the
subjects belonged to the age group 8-9 years in experimental groups and 8
(33.3%) belonged to the age group 10-12 years in control groups; 1 (6.7%) of
subjects belonged to the age group 6-7 years in experimental group and 4 (26.7
%) belonged to the age group 8-9 years in control groups. With regard to sex of the child, majority of the subjects were
males, 11 (73.3%) in both the groups; 4 (26.7%) were females in both
experimental and control groups. 14
(93.3%) of the subjects were Hindus in both experimental and control groups
while 1 (6.7%) were Muslims in both the groups and none of the subjects were
Christian. About 8 (53.3%) of
subjects in experimental group and 12 (80%) in control group belonged to joint
family; 7 (46.7%) of subjects in experimental group and 3 (20%) of the subjects
in control group belonged to nuclear family and none of the subjects were from
extended family. About 8 (53.3%) of
subjects in experimental group and 9 (60%) in control group were the 1st
child; 5 (33.3%) of subjects in experimental group and 4 (26.7%) in control
group were last child; 2 (13.3% )of subjects were middle child in both
experimental and control groups. In
relation to the educational status of child, majority of the subjects,9 (60%)
were in 5th std. and above in experimental group while 6 (40%) were
in 3rd -4th std. in control group; 5 (33.3%) of subjects
were in 1st - 2nd std. in both experimental and control
group; 1 (6.7%) of subjects were in 3th -4thstd in experimental
group while 4 (26.7%) were in 5th std. and above in control group. Majority of the subjects, 12 (80%) in
experimental group and 8 (53.3%) in control group had chronic illness; 3 (20%)
of subjects in experimental group and 7 (46.7%) in control group had acute
illness.
About 6 (40%) of surgery in the
experimental group and 7 (46.7%) in the control group were colostomy; 4 (26.7%)
of surgery were appendectomy and laparotomy in the experimental group while 4
(26.7%) was spleenectomy in control group; 1 (6.7%) of the surgery was
spleenectomy in the experimental group, 3 (20%) of the surgery in the control
group was laparotomy while the remaining 1 (6.7%) was appendectomy. In relation
to the number of post-operative days, about 6 (40%) of subjects in the
experimental group were in 2ndand 3rd day while 7 (46.7%)
were in 1stand 2nd day in control group.
With regards to the source of information
regarding pain management, 6 (40%) of subjects in experimental group and 7
(46.7%) in control group obtained the information from parents; 4 (26.7%) of
subjects had no information regarding pain management in both the groups; 3
(20%) of subjects gathered information from health personnel in both groups; 2
(13.3 %) of subjects in experimental group and 1 (6.7%) in control group gained
information from mass media.
Majority of the subjects, 9 (60%) had the
previous experience of hospitalization in experimental group and 11 (73.3%) had
no previous experience of hospitalization in control group; 6 (40%) of the
subjects in experimental group had no previous experience of hospitalization
while 4 (26.7%) in control group had the previous experience of
hospitalization. About 8 (53.3%) of subjects in experimental group and 14
(93.3%) in control group had no previous experience of surgery; 7 (46.7%) of
subjects in experimental group and 1 (6.7%) in control group had previous
experience of surgery.
In relation to previous experience of
hospitalization of the parents, 9 (60%) of the parents in experimental group
had the previous experience of hospitalization,11 (73.3%) in control group had
no previous experience of hospitalization; 6 (40%) of the parents in
experimental group had no previous experience of hospitalization while 4
(26.7%) had previous experience of hospitalization in control group. In
relation to the educational status of the mothers, 6 (40%) of mothers had high
school education in both the groups; 3 (20%) of the mothers in experimental
group had non-formal, primary school, higher secondary and above education
while 4 (26.7%) of mothers in control group had primary school education; 3
(20%) had higher secondary and above education and 2 (13.3 %) had non- formal
education. Majority of the fathers, 7 (46.7%) had high school education in the
experimental group while 6 (40%) had high school and higher secondary and above
education in the control group; 4 (26.7%) in the experimental group and 2
(13.3%) in the control group had primary school education; 1 (6.7%) of the
father had non -formal education in both the groups.
2.
Findings on distribution of pain scores based on Oucher numerical pain scale in
experimental and control groups.
Table 1: Mean pre test scores, mean post
test scores and standard deviation for the pain assessment of post-operative
children in experimental and control groups after 1st session of MT.
n =15+15=30
|
|
Experimental
Group
|
Control Group
|
|
Pre test scores
|
Post test scores
|
Pre test scores
|
Post test scores
|
|
Mean
|
66
|
44
|
56.7
|
56.7
|
|
SD
|
19.2
|
18
|
14.9
|
11.8
|
Table 2: Mean pre test scores, mean post test
scores and standard deviation for the pain assessment of post-operative
children in experimental and control groups after 2nd session of MT.
n = 15+15=30
|
|
Experimental
Group
|
Control Group
|
|
Pre test Scores
|
Post test scores
|
Pre test scores
|
Post test scores
|
|
Mean
|
66
|
39.3
|
56.7
|
56.7
|
|
SD
|
19.2
|
15.8
|
14.9
|
15.9
|
Based on the Oucher numerical pain scale, the mean pain intensity
in the experimental group before, immediately after 1st and 2nd
sessions of music therapy were 66, 44 and 39.3while the correspondent in the
control group was 56.7.
3. Findings related to
comparison of pain scores based on observation within the groups.
Table 3: Mean difference, standard deviation and
paired t-test values of pain scores of post-operative children in experimental
group after music therapy. n =15
|
Paired t-test
|
|
|
Mean difference
|
SD
|
Calculated
|
Tabulated
|
|
After 1st session of MT
|
22
|
5.6
|
15.7*
|
2.145
|
|
After 2nd session of MT
|
26.7
|
9.8
|
10.7*
|
2.145
|
*p<0.05
Table -3 Revealed that the calculated ‘t’ values (t=15.7 and
t=10.7) were greater than the tabulated ‘t’ value (t= 2.145).This revealed that
music therapy was effective in reducing pain in both the sessions.
Table 4: Mean difference, standard deviation and
paired t-test values of pain scores of post-operative children in control
group. n =15
|
Paired t-test
|
|
|
Mean difference
|
SD
|
Calculated
|
Tabulated
|
|
After 1st session of MT
|
0
|
12.5
|
0
|
2.145
|
|
After 2nd session of MT
|
0
|
15.1
|
0
|
2.145
|
Table -4 Revealed that the calculated ‘t’ value (t= 0) was less
than the tabulated ‘t’ value (t=2.145).
This revealed that there was no effective reduction in pain.
4. Findings on comparison of
pain scores between both groups.
Table 5: Mean difference of pre-test scores and post test scores,
Standard error difference of experimental and control groups and testing of
significance by using unpaired t-test. n
=30
|
Mean difference
|
SED
|
Unpaired ‘t’
test
|
p value
|
|
|
|
|
Cal
|
Tab
|
|
|
Pretest
|
9.3
|
6.3
|
1.5
|
2.048
|
0.167
|
|
Post test after1st session of MT
|
12.7
|
5.6
|
2.268
|
2.048
|
0.030*
|
|
Post test after2nd
session of MT
|
17.4
|
5.8
|
3
|
2.048
|
0.004*
|
*p<0.05
An independent sample t-test showed significantly lower pain
scores in the music group immediately after both sessions of music therapy as
compared with the control group i.e. (t= 2.268, p=0.003 and t=3, p=0.002).So,
music therapy was proved to be effective on pain intensity of the hospitalized post-operative children
between 6-12 years.
Graph 1: Line graph showing mean difference of pre-test scores and
post test scores, standard error difference, unpaired ‘t’ tests and p value of
experimental and control groups.
5. Association between the
pre-interventional pain scores with selected socio-demographic variables.
The chi square test result showed that there was no significant
association between the pre interventional pain scores with selected socio-
demographic variables of the study subjects.
CONCLUSION:
The result of the study showed
that there was a statistically significant difference in the post
interventional pain scores between experimental and control group at 0.05 level
of significance. i.e. there was significant reduction in the pain intensity
among the post-operative children after the administration of music therapy.
So, music therapy was proved to be effective treatment for pain. Therefore,
this policy should be promoted as an Institutional policy and implemented as a
routine care for all post-operative children following surgery for the
effective management of pain
NURSING IMPLICATIONS:
The findings of this study have
implication for nursing services, nursing education, nursing administration and
nursing research.
1. Nursing Services:
This study highlights the nurses about the
importance of the management of post-operative pain in pediatric patients with
abdominal surgeries. Based on the findings of the study results, the nurses can
use music therapy as an effective management of post-operative pain in
pediatric patients following abdominal surgeries thereby reducing the use of
pharmacological interventions in the management of post-operative pain in them.
Also, it will improve the skills of pain assessment using Oucher numerical pain
scale.
2. Nursing Education:
Pain in the pediatric patients is of major concern especially
after surgery. The findings of this study will help the nurse educator to know
about the post-operative pain following abdominal surgeries and thus guide her
in imparting knowledge regarding assessment as well as treatment of pain. This
study will also help the nurse educator to motivate the student nurses to
include music therapy as an effective method of pain management.
3. Nursing Administration:
The findings of the study can be utilized
for the development of evidenced based protocols and policies regarding
post-operative pain assessment and its care. Also, the nurse administrator can
encourage the utilization of the study findings in daily clinical nursing
practices and also can plan for in-service education programs to make staff
nurses aware of the use of music therapy as an effective treatment for pain in
children
4. Nursing Research:
The findings of the study
contribute to the body of knowledge of nursing research. It provides guidelines
for the researcher to carry out other similar studies in different settings and
on a different population on a large scale for greater generalization of the
results. The evidenced based nursing will gain higher scope in nursing setting.
LIMITATIONS:
1. The study was delimited to pediatric
surgical ward of KLE Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka.
2. The study included only 30 post-operative
children between 6-12 years who had undergone abdominal surgeries
3. Control of the extraneous variables was
not possible in the clinical setting.
RECOMMENDATIONS:
1. A similar study can be carried out on
larger sample for a longer period of time for broader generalization of the
result.
2. A similar study can be conducted in
different setting.
3. A similar study can be done on patients
with other surgeries and during nursing procedures.
4. A similar study can be conducted using
randomized sampling technique.
5. A study can be done to compare the effect
of music with a placebo to evaluate the effect on intensity of pain.
6. A similar study can be conducted on
children of other age group using other pain scale assessment tool.
7. A study can be done on the staff nurses to
assess the knowledge and practice regarding pain management of post-operative
children
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