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Music: A Nursing Intervention

Article  in  European Journal of Cardiovascular Nursing · June 2011

DOI: 10.1016/j.ejcnurse.2010.06.004 · Source: PubMed

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Ulrica Nilsson
Karolinska Institutet
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 European Journal of Cardiovascular Nursing 10 (2011) 73 – 74
Editorial
Music: A nursing intervention
Keywords: Music; Nursing
People with coronary heart disease (CHD) often suffer
from severe distress. This stress is likely to stimulate the
sympathetic system resulting in increased heart rate,
respiratory rate, blood pressure, myocardial oxygen demand
and anxiety levels. Such adverse effects put the cardiac
patient at greater risk for complications, including sudden
cardiac death. Therefore, it is of crucial importance that in
the care of patients with CHD offer stress-reducing
interventions. One feature of such an intervention can be
music, an intervention that can help patients focus their
awareness on the music, to promote relaxation [1]. Music
intervention is a nursing intervention to facilitate healing
through pre-recorded music, defined as “a supportive source
of environmental sound that stimulates and maintains
relaxation and reduces or controls distress by a self-
management technique” [2]. The use of listening to pre-
recorded music has also been defined as “Music medicine” in
contradiction to “Music therapy” that includes an in-person
music therapy treatment by a music therapist [3]. Music that
has this relaxing and stress-reducing effect includes a slow
and flowing tempo around 60–80 beats per minute, a
maximum level of 60 dB and with duration of 20–60 min
[2]. Yet, no clear picture has emerged regarding which genre
is superior, or if research selected versus patient-selected
music is most beneficial [1–3]. The mechanism behind the
effect of relaxing music is not clearly understood. It has been
reported that the relaxing effect of music is related to an
increased release of plasma oxytocin [4], and a reduction in
plasma cytokine and catecholamine levels [5]. These
responses to music convey emotions through autonomic
arousal, likely in a bidirectional way [6]. A strong positive
correlation exists between the pleasurable aspects of music
listening and emotional arousal [7].
Florence Nightingale proposed that it was the responsi-
bility of nursing to control the patient's environment in order
for healing to take place. She recognized the power of music
as a part of the healing process. She recommended wind
instrumental pieces with continuous sound or air as generally
having a beneficial effect on the sick. She also observed that
instruments, which do not produce continuous sounds,
1474-5151/$ - see front matter © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.ejcnurse.2010.06.004
www.elsevier.com/locate/ejcnurse
would have the opposite effect [2]. A recent Cochrane
review [8] indicates that music listening can have a
beneficial effect for people suffering from CHD though
music listening reduce anxiety in myocardial infarction
patients upon hospitalisation as well as reduce systolic and
diastolic blood pressure and heart rate. The review therefore
recommends that music listening be offered as a stress
management intervention to MI patients upon hospitalisa-
tion. This blood pressure reduction effect of music has also
been reported in a recent study in older adults [9].
There is no clear evidence showing that soothing music
has a positive effect on patients during coronary angio-
graphic procedures [1,8]. This may be due to the fact that
anxiety is measured after completion of the procedure rather
than during. Physiological data indicates, however, that
patients may experience less anxiety during the procedure
when listening to music [8]. Both patients and staff alike
look favorably on music listening and the delivery of it
during the procedures do not disturb the examination [1].
Since physiological responses are continuously monitored
during procedures with CHD patients, and music interven-
tions can be easily halted in case the patient does not
experience beneficial effects, it is recommended that music
listening is offered as an anxiety management intervention
prior to and during procedures [1,8].
Studies reporting gender differences in response to
different music stimuli are rare. Only one study on gender
differences in response to music interventions in clinical
settings has been found reporting no differences between
gender [1]. Gender differences in response to music
interventions need further study. Particularly though
women with CAD suffer from more anxiety [1,10] as well
as more disturbed sleep [10].
Besides gender differences, more information is needed
about optimal length, the timing and the effect of multiple
sessions of the music intervention. Can music increase sleep
quality also for MI patients, especially women, as it has been
reported in older adults [11]. For patients during coronary
angiographic procedures, what is the most effective time to
start the music intervention? Should the music intervention
74
continue after completion of the procedure, and if so, for how
long?
In conclusion, providing music is an inexpensive
technique, which does not require the use of extra manpower
and resources. Music intervention can maximize the effort of
promoting comfort and relaxation, as well as reduce or
control distress. For that reason, music is a nursing
intervention that has an obvious role in cardiac care.
References
[1] Nilsson U, Lindell L, Eriksson A, Kellerth T. The effect of music
intervention in relation to gender during coronary angiographic
procedures: a randomized clinical trial. Eur J Cardiovasc Nurs
2009;8(3):200–6.
[2] Nilsson U. The Anxiety- and pain-reducing effects of music
interventions: a systematic review. AORN J 2008;87(4):780, 2, 5–
94, 97–807.
[3] Dileo C, Bradt J. Medical music therapy: a meta-analysis & agenda for
future research. Cherry Hill, NJ: Jeffrey Books; 2005.
[4] Nilsson U. Soothing music can increase oxytocin levels during bed rest
after open-heart surgery; a randomized control trial. J Clin Nurs
2009;18:2153–61.
[5] Okada K, Kurita A, Takase B, Otsuka T, Kodani E, Kusama Y, et al.
Effects of music therapy on autonomic nervous system activity,
incidence of heart failure events, and plasma cytokine and catechol-
amine levels in elderly patients with cerebrovascular disease and
dementia. Int Heart J 2009;50(1):95–110.
View publication stats
Editorial
[6] Bernardi L, Porta C, Casucci G, Balsamo R, Bernardi NF, Fogari R,
et al. Dynamic interactions between musical, cardiovascular, and
cerebral rhythms in humans. Circulation 2009;119(25):3171–80.
[7] Salimpoor VN, Benovoy M, Longo G, Cooperstock JR, Zatorre RJ.
The rewarding aspects of music listening are related to degree of
emotional arousal. PLoS ONE 2009;4(10):e7487.
[8] Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart
disease patients. Cochrane Database Syst Rev 2009(2) CD006577.
[9] Tang H-Y, Harms V, Speck SM, Vezeau T, Jesurum JT. Effects of
audio relaxation programs for blood pressure reduction in older adults.
Eur J Cardiovasc Nurs 2009;8(5):329–36.
[10] Johansson I, Karlsson BW, Grankvist G, Brink E. Disturbed sleep,
fatigue, anxiety and depression in myocardial infarction patients. Eur J
Cardiovasc Nurs 2010;9(3):175–80.
[11] Lai HL, Good M. Music improves sleep quality in older adults. J Adv
Nurs 2005;49:234–44.
Further reading
[1] Weeks BP, Nilsson U. Music interventions in patients during
coronary angiographic procedures: A randomized controlled study
of the effect on patients' anxiety and well-being. Eur J Cardiovasc
Nurs 2011;10(2):88–93.
Ulrica Nilsson
Centre for Health Care Sciences,
P.O. Box 1324, SE-70113 Örebro, Sweden
E-mail address: ulrica.nilsson@orebroll.se.
15 June 2010