Nurse’s DNP Project Examines Preoperative Music Listening Interventions

When Kristen Vargo, DNP, RN, NE-BC, considered topics for her evidence-based practice project as part of earning her Doctorate in Nursing Practice, she quickly landed on the use of music listening interventions in the preoperative setting. Vargo, who is nurse manager of same-day surgery and the pediatric PACU at Cleveland Clinic’s main campus, has a strong musical background, performing in multiple choirs while in high school. “I knew the impact that music had in my life and what music could do in the nursing setting,” she says.

Authors of other studies demonstrated that listening to music could benefit patients in the preoperative period. However, during a literature review Vargo did not find studies about implementation processes for music listening interventions or factors of patients who would benefit the most from listening to music.

Working as a clinical nurse also raised questions for Vargo. “I noticed a gap in our preoperative care, especially in managing patients’ anxiety outside the use of pharmacological medication,” she says. “I believed that patients with high anxiety who were able to listen to music preoperatively might benefit through their perioperative experience.”

Study methods

Vargo explored factors that influenced a patient’s decision to listen to music preoperatively. The population involved were adults, primarily general surgery and colorectal surgery. “We asked every patient coming in on the day of surgery if they would like to listen to relaxing music,” she says. “They were offered over-the-ear headphones and an iPod Touch device and could choose between six relaxing music stations: classical, jazz, piano, guitar, new age and world music.”

A sample of 483 preoperative patients qualified for participation in the project, with 122 agreeing to listen to the music. Nurses on the unit collected data on the reasons why patients declined the music intervention. “For the most part, those patients had other methods of self-relaxation during preop, such as talking to family or reading a book,” says Vargo. “Some wanted to listen to their own music.”

For patients who opted for the music listening intervention, nursing staff collected data on the genre selected, the amount of time patients listened to the music, interruptions in the music intervention and a rating of the patient’s likelihood to opt for a music intervention preoperatively in the future. Data were analyzed using Fisher’s exact test, t-test, chi-square and Pearson’s correlation coefficient.

Findings and practice implications

When demographic data of patients who listened to music and those who declined the intervention were compared, there were no differences between groups.

The preoperative anxiety level of patients, including those who chose not to listen to music, was assessed using the Visual Analogue Scale of Anxiety (VAS-A). When Vargo compared VAS-A anxiety scores between the two groups, “the group that listened to music had higher anxiety scores preoperatively than the group that declined to listen,” she says.

In addition, Vargo utilized a Likert scale to assess patients’ likelihood to listen to music in the preoperative setting in the future, with 0 being “not likely at all” and 10 being “highly likely.” Of the 122 patients who opted for the music intervention, 90 selected 5 or above, with a mean rating of 8. “This analysis confirmed that music listening was an effective intervention in the preoperative setting for those that selected it,” she says.

Implications for clinical practice include that preoperative patients with a VAS-A score of 5 or higher should be offered music listening interventions to decrease anxiety. Clinical nurses on the same-day surgery unit at Cleveland Clinic’s main campus found it easy to offer music via five iPod Touch devices and the Spotify app, and they appreciated having options aside from administration of anxiolytic medication to relieve patient anxiety.