ABSTRACT
A combination of harmonic, melodic and rhythmical sounds make up music, which has now been used for centuries for a variety of medicinal purposes. The therapeutic intervention of using music to ease the pain in patients in various conditions has been used for a long time and has been shown to be effective in relieving pain. As an element of pain control, music has stirred an interest amongst various researchers to file exactly its effect in various health conditions in which patients may be experiencing. While doing this, it is necessary to appreciate the fact that pain felt by an adult is not the same as the pain felt by young children. This is because of the fact that it is not easy to identify the exact part of the body that is ailing in a child. It is also worth mentioning that the mechanism of action of music in health therapy is not easily understood thus creating some controversies and theories which are yet to be contested.
This study proposal will provide a succinct understanding on the effects of music therapy on infants who are undergoing a painful procedure. The procedure in question is heel stick where capillary blood is withdrawn from an infant. The pain thereof felt by the infant has to be therapeutically cured to ensure that there is no much discomfort. The hypothesis for this study is: after music and therapy intervention, pain level will be lower in the experimental group who had music therapy compared to the control group without music therapy. To ensure success, the subjects under study were full term newborn infants between the ages of two to five. Additionally, they should be healthy with no other malformations or heath discomfort. This is to be carried out in Emory University Hospital Midtown and a maximum of 20 subjects for the pilot study.
STATEMENT OF THE PROBLEM
Heel stick is an essential procedure in the medical field when infants are to be diagnosed of any disease in blood. This creates pain when the procedure is being carried and calls for the intervention of music when it is being carried out. This intervention is notable because it will help future procedures to carry out with minimal pain of the infants. In order to ensure that future medical practices are observed, the intervention of music therapy in the infants will have to be carried out. This will be pivotal to the nursing in ensuring that infant do not cry much when the heel stick procedure is being carried out. This serves to create an ambient environment in hospitals where less crying from children will be expected.
LITERATURE REVIEW
Music has been for a long time as a therapeutic parameter when painful procedures are being carried out. In their study by Kwon, Kim and Min Park published in the Journal of Korean academy of Nursing, it sought to determine the effects of music therapy on pain discomfort, and depression on for patient with leg fractures (Kwon et al 2006). The study carried by those researchers is relevant to this proposal because the dependent variable, pain, has been taken into consideration. While considering the pain in the muscoskeletal muscles because of trauma, the scientists concluded that depression may occur and become extended in a victim suffering from muscoskeletal is not attended to in speed. From the research, the authors keep us updated on other classical methods that have been frequently used to ease pain incase one has trauma. The methods include cold therapy, skin stimulation, massage, relaxation and distraction. Some of the methods however, like cold therapy and distraction cannot be used in infants. This is one of the driving forces for his proposal. Distraction therapy for instance involves the use of rhythmic breathing, guided meditation and music. Out of the three methods, music therapy is appropriate for infants because there are is no way that someone can guide an infant to meditate.
After carrying out their research on various subjects falling under different age groups, they found out that the pain that ones feels because of trauma or other factors is psychologically control. This also calls for a psychological solution. The conclusion made from the carried out by Kwon et al showed that pain levels for participants who received music therapy were lower than of those who had under no pain therapy. This shows how vital music can be used for music therapy for infants with the heel stick procedure is being carried out (Kwon et al 2006).
Another research by Terry Richards et al sought to find out the clinical benefit of using music therapy in any hospital setting. They point out that music therapy, as a pain relieving parameter has been use as far as 1950s. Some of the most esteemed hospitals who have been seen to utilize music therapy for bedside treatment include West Virginia University hospitals among others. It also from Terry and Colleagues that they can obtain the best model of administering music therapy to patient under some sort of pain. This can also be used in infants because it is somewhat classical. In the first step, an assessment is done in order to ascertain and validate the need for music therapy for patients in question. The second step as identified from the research is for the problem intervention is likened with the outcomes. This is followed by synthesis to obtain evidence, design to practice change, and implementation to obtain a practical change. The final step is where the intervention is integrated and maintained in order to retain it as meaningful medical practices (Richards et al 2007).
As identify initially, the Terry et al were able to make a conclusion that the perception of pain is highly determined by the person’s physiological, psychological and cultural experiences. Credible results indicate that music therapy is more effective in the lowering of pain that the absence of any intervention. The pain so examined may be because of laceration repair, coronary artery bypass among other pain sources. Despite the fact that the efficacy of music therapy cannot be ascertained, it is indispensable to appreciate the fact that it can be used to alleviate anxiety, uneasiness, and pain. However, from the researchers, we are able to learn that music therapy has an enormous potential of being used in today’s medical environment in the reduction of anxiety and alleviation of pain. This includes it being used in most medical and surgical experiences that result in postoperative pain (Richards et al 2007). This does not exclude the heel stick that is mostly done to infants in order for someone to obtain capillary blood. The improvements in pharmacological treatments in managing pain, all medical practitioners should therefore re-thinks and apply music therapy amongst their patients.
The effect of music therapy as a tool to reduce pain has also been studied on children under pediatric cardiac intensive unit following a heart surgery. To achieve this, Hatem, Lira, and Mattos carried out a randomized clinical trial with placebo while assessing 84 children of different age brackets. To validate their research, the researchers knew in mind that music has been used for many centuries to relieve pain in various patients. Though the mechanism of action is still controversial, there are general believes that it acts either on the autonomic function, stimulates the pituitary gland or facilitates the release of endorphin which plays a part in relieving pain amongst various individuals (Hatem et al 2006). According to them, pain reduction by music may also occur due to the reduced release of catecholamine’s, which plays a part in reducing the heart rate. While keeping this in mind, it is worth noting that the distribution of pain is because of faster distribution of blood.
The researchers also bring forth the need to avoid bias while one is carrying out a research. They were able to do this by ensure that there was no significant difference in the sexes of the subjects. Additionally, they also made sure there is no other factor that influences the parameter under study. Severity of pain was also classified and this justifies the need of classifying various tools in the Neonatal infant pain scale. This is because the process of identifying pain in infants is not an easy task. This will require whoever is to carry out such a research to be extra careful and observant. The psychological effect of music therapy on pain cannot be underestimated just are pointed by Hatem TP et al. it is also essential to mention that various elements of music play a significant role in relieving depending on whether the music is tempo, rhythm, or classical (Hatem et al 2006). This provides relevant information to this proposal for the study is going to be carried out.
To show the severity of pain among infants and the need to eradicate it, various other methods have been employed. Taddio et al carried out a study that sought to find out the effect of sucrose analgesia in newborns undergoing painful medical procedures. Just like heel stick, infants undergo a score of painful procedures and this call for a variety of a number of interventions to ease the pain. Some of the instances include intramuscular injection of vitamin K and venipuncture among others. In their study, they sought to find out the efficacy of using sucrose to ease the pain. This study is relevant in a number of ways (Taddio et al 2008).
First, a well-structured study des9ignn must be observed. Additionally, carrying out requires observation of some ethical standards in order to ensure that the right information is obtained. Winning the confidence and participation of the subjects is a fundamental aspect for the success of the research. Some of the factors to put into consideration include the use of uniform intervention to all subjects, concealment of allocation and identity, randomness in the identification of subjects, and safety outcomes. It also requires one to carry a further analysis on the results obtained. This however, will not be carried at this proposal stage. This article also puts across some of the limitations encountered while one is using the Premature Infant Pain Profile. This has necessitated the need to use the Neonatal infant pain scale. This is a more detailed pain measuring parameter and is more efficient.
Another study by Joung, Chul, and Cho sought to find out on the effect of sucrose on infants undergoing a particular pain procedure. In this article titled “The effect of sucrose on infants during a painful procedure”, the researchers found out that the procedure of relieving pains is physiological and behavioral. This has facilitated the need to approach pain-relieving procedure using music therapy. Fromm the research, we find out that physiological changes do not affect the physiological changes of the subject in question. However, behavioral changes can be observed depending on the pain that one feels. This necessitates the need to NIPS for neonates in order to obtain accurate results. Additionally, we are able to appreciate the need to manage pain in infants because of a number of reasons as mentioned in the article. These include the fact that pain can occur because of decreased oxygen, hemodynamic instability, or increased intracranial pressure. This leads to the use of various parameters and discovery of some to lessen its effects (Joung and Cho 2010).
THEORETICAL FRAMEWORK
A theoretical framework is necessary for the success of this proposal. The model to be used is the one that can act as a prove that there are substantial changes when pain therapy is administered to patients undergoing Heel stick procedure. The first step in this model is the assessment of the area in which the research is going to be carried out. The problem is then identified, which in this case is pain. Systems of standardization will have to be put in place in order to minimize any discrepancies. This why the NIPS has been used in this proposal.
The third step in this model involves the synthesis of best evidence that necessitates the administration of the said therapy. Its feasibility will also have to be analyzed. The resources needed will have to be identified in the fourth step. This goes further to plan the implementation process of the proposal. The fifth step in this model involves the implementation and evaluation of the expected research. This is where a pilot study is being carried out to evaluate the overall process and outcomes. When the whole exercise has been cried out, integration and maintenance of the parameter that was being analyzed is done. This goes ahead to recommend the expected changes, and from then on, full integration and implementation is done. This model is the one proposed by Myra Levine in 1973. Conservation Model is based on the principles of energy conservation, integrity in terms of structure, personal and social rectitude.
HYPOTHESIS
The hypothesis for this research proposal is: After music therapy intervention, pain level will be lower in the experimental group who had music therapy compared to the control group without music therapy.
REGULATORY AFFAIRS
Approvals for this proposal have to be obtained. One of the approvals is from IRB. The other approval is from the Emory university hospital midtown. The of the infants in which the study is going to be carried out will have to informed of the same and it is only when they have agreed to participate that the study can be carried out. Failure to obtain the consent will entail the infringement of privacy right and may result in the collection of compromised results.
RESEARCH DESIGN AND METHODS
The experimental design for this study will be qualitative and non-experimental. This is because of the fact that this is just but a pilot study just to determine the feasibility of the sample size.
POPULATION/SAMPLE
The subjects in question during the pilot study to be carried out will be 20. This will include both the experimental and control groups.
DATA COLLECTION AND MEASUREMENT
Data will be collected based on the identification of both independent and dependent variables. The independent variable in this case will be music of classical genre as sung Vivaldi or Beethoven. Measurement of the data will entail the use if Neonatal Infant Pain Scale (NIPS). This behavioral assessment tool takes into account parameters like facial expression of infant, crying, breathing patterns, and the state of arousal of arms and legs. The degree of pain by using facial expression could be either relaxed or grimaced. Crying on the other hand as a parameter of measuring pain includes its absence, a whimper or, a vigorous cry. Breathing patterns includes a relaxation or change in the pattern. Arms and legs on the other hand could be restrained, relaxed, flexed, or extended. Their observation will be used to indicate the extent of pain. The state of arousal could be sleep, awake or fussy and will also indicate varying degrees of pain felt by the infant. The expected score will be seven while the minimum zero. Any deviations particularly obtaining low scores will be indications that the infant is too ill or paralyzing agents have been used.
To maintain the integrity of the data being collected, all infants will be administered with 2ml of 24% sucrose solution prior to the music therapy. This is done because of the fact that it is a standard care for the management of pain in infants who are undergoing minor painful procedures. The experimental group will be given both music therapy and the sucrose solution. However, the control group will only be given a sucrose solution. Videotaping will have to carried out for further pain assessment using NIPS. Heart rate and oxygen saturation will however be recorded at the hospital. There will be minimal interaction between the patient and the parents.
DATA ANALYSIS/ STATISTICS TO BE USED
For the results obtained, a t-test will be carried with a confidence limit of 95% in testing the hypothesis. The t-value calculated, t-value from the table will be compared, and conclusions made.
FINDINGS: ANTICIPATED BASED ON HYPOTHESIS
As pointed out initially, it is expected that the results will be at par with the hypothesis. The anticipated results will be in favor of the hypothesis, which stated that: After music therapy intervention, pain level will be lower in the experimental group who had music therapy compared to the control group without music therapy.
DISCUSSION
Music has been used for a long time as a tool for intervention for relieving pain amongst individuals suffering from the same. This shows how valuable this study will be in providing a suitable alternative for the existing therapeutic interventions to relieve pain. Musk therapy acts by altering the behavior and physiology of an individual. This will therefore create and extra therapeutic tool to the medical field for the management of pain in both adults and infants.
REFERENCES
Anna Taddio, Vibhuti Shah, Rebecca Hancock, Ryan Derek Stephens, Eshetu Atenafu, Joseph
Beyene, Gideon Koren, Bonnie Stevens. Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ 2008;179(1):37-43
Cepeda, Soledad; Carr, Daniel B; Lau, Joseph; Alvarez, Hernando. Music for pain relief . Cochrane Database of Systematic Reviews. 2010;
Hatem, T, Lira, P. & Mattos, S. The Therapeutic Effects of Music in Children Following Cardiac Surgery. Jornal de Pediatria, 2006, vol.82(3), 186-192
Hodges AL; Wilson LL . Preterm infants' responses to music: an integrative literature review. Journal of Nursing Research, 2010; 10 (3). (8p)
Joung, K., and Cho, S. The Effect of Sucrose on Infants during a Painful Procedure. Korean J Pediatr 2010: 53(8):790-794
Kwon, S, Jungnam K, Park, K. Discomfort, and Depression for Patients with Leg Fractures. Journal of Korean Academy of Nursing (2006), vol. 36(4), 630-636
Mrázová M; Celec P. A Systematic Review of Randomized Controlled Trials Using Music Therapy for Children. Journal of Alternative & Complementary Medicine, 2010;16 (10):
Richards, T., Johnson, J., Sparks, A. & Emerson, H. The Effect of Music Therapy on Patients’ Perception and Manifestation of Pain, Anxiety, and Patient Satisfaction. MEDSURG
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