Healing Harmony: The Power of Music in PACU

Submitted by Cheyenne Bonja BSN, RN, CPAN, CNIII

Tags: music therapy PACU pain patients therapy

Healing Harmony: The Power of Music in PACU

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What if something as simple as music could help to reduce pain, calm anxiety, and improve recovery after surgery? Patients arrive to PACU often confused and disoriented, experience lots of sounds, bright lights, and unfamiliar faces. This transition can be overwhelming that can contribute to increased pain, anxiety, and discomfort. A simple non-pharmacological act such as soothing music playing can transform a PACU full of beeping into a calmer, more therapeutic environment. 

History of Music

Music can be found throughout human history with the earliest form of musical instrument- a bone flute- dating back to 42,000 years old. The Ancient Greeks in the 5th century BCE with philosophers Plato and Pythagoras have often quoted in support of music education and music therapy. Plato believed that specific musical modes could cure, calm, and bring peace to individuals. This continued throughout history and one of the earliest references to music therapy was in 1789 that was published in Columbian Magazine. Isa Maud Ilsen was a Canadian-born American nurse that was considered the pioneer of music therapy. She was the Director of Hospital Music with the American Red Cross during World War I and in 1926 created the National Association for Music in Hospitals. During the 20th century, a formal profession began, and many would play for veterans in hospitals who were suffering from PTSD and other physical injuries. Between the 1950s and 1990s, many organizations were established here in the United States and internationally.

Effects of Music

Music. Everyone loves to listen to music, dance to it, feel its vibrates throughout one's body. We all connect to music and draw from its harmonies, its rhythms and notes, and can bring about emotions and memories, and express feelings when words fail. Music not only involves our emotions but also has a physical effect on us. Music evokes sound waves that transform into electrical signals in the brain to activate cortical areas. This shifts the body into a parasympathic state when listening to calm, soothing music such as when people listen to waves, rainstorms, or nature sound when falling asleep. It has shown to play a role in physiological effects such as decreased heart rate, decreased systolic and diastolic blood pressures, decrease respiratory effort, and decrease fear and anxiety. Music changes neurotransmitters in the brain such as dopamine and when activated cause a release linked to the pleasure receptors within the brain’s reward system. This pathway is connected to the auditory and frontal cortical areas to subcortical reward regions that release endorphins which are the body’s natural painkillers and bind to the brain's opioid receptors, reducing pain perception.

Music can lower stress hormones levels such as plasma cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) which are often increased due to surgical stress. By reducing these hormones, the body will be able to obtain a calmer state by decreasing muscle tension and decreasing vital signs. Music has the ability to alter the perception of pain by distracting the brain and activating pleasure pathways.

PACU

The Post Anesthesia Care Unit is where patients are transferred following general anesthesia to recover in Phase I. Patients wake up very different, some are extremely anxious and fearful others have no issues at all. Patients who are anxious and fearful can experience increased pain caused by muscle tension, rapid shallow breathing, increased blood pressure, headaches, and upset stomach that can increase nausea and vomiting. All these can increase can cause the patient to experience longer recovery times due to PACU nurses relying on Aldrete and pain scores, and minimal nausea to be discharged from Phase I. Nurses in the recovery room provide a total care nursing which involves management of all patient's needs. Many patients have underlying conditions such as anxiety, PTSD, and other mental health disorders that nurses must navigate. Waking up in an unfamiliar place with lots of noise and people talking all around can be frightening people. Along with providing patients with pharmacological pain medications and non-pharmacological interventions such as warm blankets and ice packs, and music therapy may be helpful using a multi-modal approach.

Nurses can create a calm, warm environment by providing patients with music therapy upon arrival to PACU after hands off and stability of the patient has been done. Music can help with the stressful noises of the recovery room, such as the beeping of monitors and conversation among staff although the music should be at an appropriate level where it does not interfere with the critical need for alarms. A quasiexperimental study was done at a Midwest hospital with 97 individuals that participated involving 2 groups. The first group (experiment) was patients who listened to music and quiet conversation among staff with the other experiences on a typical PACU day (control). About 65% of both groups report no pain. The experimental group with no pain increased to 74% at discharge, and the control group decreased to 58% at discharge. At the end of the study, the experimental group stated “that they experienced less noise caused by staff voices and monitors, higher availability of nurses, and positive experience of PACU stay.

An additional study on “One-hour intervention to improve quality in female patients' elective surgery after general anesthesia: A single-center randomized clinical study” involved 188 participates. The study incorporated soothing lighting and music from different genres concluded that patients who listened to music in PACU had reduced agitation, pain intensity, and reliance on analgesics as well as improved sleep quality. The study also concludes that music helps to decrease physiological factors that contribute to post-op nausea and vomiting. Lastly, the study found that the experimental group had decreased ACTH compared to those that did not listen to music, which effects cortisol levels otherwise known as the stress hormone.

Music therapy not only helps the patients reduce stress but also helps the nurses working in the unit. Nurses can often feel stressed taking care of Phase I patients especially when some require one or two nurses to stabilize a patient. It can help serve as a coping strategy for nurses and manage emotional stress. However, it is important to remember that the volume needs to be controlled to not interfere with essential alarms. A poll was taken among my fellow co-worker's nurse and concluded that when music was played during a PACU shift, they feel less stressed, boosts moral, and bring the unit together to make the day go by with less stress.

Conclusion

Music therapy has shown to reduce anxiety and pain, provide noise reduction, and an overall positive PACU stay. Research suggests that music therapy has great benefits to post-operative recovery on the physical pain that patients experience as well as emotional stress. It can be used in a multi-modal approach along with traditional pharmacological pain management. Implementing music therapy is a low-cost way to provide patients with comfort and increased satisfaction and can be easily incorporated into routine PACU.

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